Antidepressants and Mood Stabilizers Flashcards
What are some treatment options for depressive disorders?
- Pharmacotherapy
- Biopsychosocial therapies
- Electroconvulsive therapy
- Deep Brain Stimulation
- Transcranial Magnetic Stimulation
- Light therapy
What are some other indications for antidepressants?
- Anxiety
- PTSD
- Panic disorder
- OCD
- SAD
- Premenstrual dysphoric disorder
- Disruptive mood dysregulation disorder
- Nicotine withdrawal
- Enuresis
- Diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain
- Stress incontinence
What are the 5 R’s of antidepressant efficacy?
- Response
- Remission
- Relapse
- Recovery
- Recurrence
What is response in antidepressant efficacy?
- > 50% reduction in symptoms form baseline
- Not well, just better
What is remission in antidepressant efficacy?
- Symptom free (very low to no symptoms)
- Not only better, but well; a healthy state of functioning
What is recovery in antidepressant efficacy?
- 6-12 months of ongoing remission
- Not cured
What is relapse in antidepressant efficacy?
- Return of symptoms after Remission but before recovery
What is recurrence in antidepressant efficacy?
- Return of symptoms after recovery
When is the usual time frame for antidepressive agents to demonstrate their clinical benefits?
- 3-8+ weeks
When do most patients see up to 50% of reduction in symptoms?
- Within the first 3-4 weeks
When should you consider switching to another antidepressant in a patient?
- If the patient does not respond after an 8 week trial
What should you do if a partial response is observed?
- Add another drug (like antipsychotics)
What are all antidepressants well know for?
- Cause or be associated with a withdrawal syndrome
- This means that we need to slowly titrate off of medicaton
What is the acronym for the symptoms of the withdrawal syndrome of antidepressants?
- FINISH
What does FINISH stand for?
- Flu-like symptoms
- Insomnia
- Nausea
- Imbalance
- Sensory disturbances
- Hyperarousal
What are the general antidepressants MOA?
- Primarily, agents block 5-HT and/or NE reuptake by presynaptic transporters (SERT, NET, or both)
- Secondary mechanisms of a few agents block or stimulate pre and/or postsynaptic receptors
What are SSRI’s?
- Selectively Inhibit the presynaptic reuptake of serotonin (via SERT)
- Results in enhanced, prolonged serotonergic neurotransmission to postsynaptic receptors
What is seen in SSRI’s when compared to TCA’s?
- Much less impact on histamin, muscarinic, and adrenergic receptors
What are some primary side effects of SSRI’s?
- CNS (sedation or insomnia/agitation/nervousness)
- Sexual dysfunction (change in libido/impotence)
- Weight gain (adults)/Weight loss (mild; adolescents)
- Acute withdrawal reactions (concern with all categories)
What are some rare side effects of SSRI’s?
- QT prolongation
- Hyponatremia
- Serotonin syndrome (sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors)
- Suicidality
What is the risk of drug interactions with SSRI’s?
Variable risk of drug-drug interactions resulting (CYP450):
- Most is fluoxetine
- Least is vortioxetine and escitalopram
- Low/mild include citalopram, sertraline, and vilazodone
What are some drugs that are SSRI’s?
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
- Vilazodone
- Vortioxetine
What are SNRI’s?
- Selectively inhibit the presynaptic reuptake of serotonin and norepinephrine (via NET)
What is the MOA of tertiary amine TCAs?
- Inhibit both NE/5-HT relatively equally
- Except clomipramine/amitriptyline which impact 5-HT>NE
What is the MOA of secondary amine TCAs?
- Inhibit NE>5-HT