Antidepressants and Mood Stabilizers-Craviso Flashcards
Currently available drugs are based on the (blank) hypothesis of depression
monoamine
All the antidepressants cause immediate effects on synaptic (blank) levels
monoamine
How long does it take for antidepressants to kick in? Why?
one or more weeks
-due to slow increase in expression of BDNF that promotes synaptogenesis
Which antidepressant class is superior?
there isnt one
At least (blank) percent of all depressed patient are refractory to multiple different antidepressants at adequate doses
20%
What are the four major classes of antidepressant drugs?
What is the first line drug?
- SSRI
- SNRI
- MAOis
- New drugs
SSRI and SNRIs are first line drugs
What do SSRIs work?
block 5-HT reuptake
What are serotonin-norepinephrine reuptake inhibitors?
- newer “selective” inhibitors - block NE and 5-HT reuptake
- older, less selective inhibitors-tricyclics (TCA) that exert antagonist effects on a variety of receptors
How do the newer antidepressants work?
- inhibit reuptake of dopamine
- agonist/antagonist activities at certain types of 5-HT and NE receptors
How do Monamine oxidase inhibitors work?
inhibit the metabolism of NE and 5-HT
What AA does serotonin come from?
What AA does NE come from?
tryptophan
tyrosine
What are the five famous SSRIs (first line drugs)?
- Fluoxetine (prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Escitalopram (Lexapro)
How are SSRIs metabolized?
in the liver
What are SSRIs potent inhibitors of?
several cytochrom P-450 enzymes (CYP2D6)
Fluoxetine and Paroxetine are (low/high potential) cytochrome P450 inhibitors?
High potential
Citalopram (celexa) and Escitalopram (lexapro) are (low/high potential) cytochrome P450 inhibitors?
low potential
What are the adverse side effects of SSRIs?
- Signif sexual dysfunction
- Gi disturbance
- Insomnia, restlessness
- anorexia and weight loss (early treatment)
- Weight gain (long term)
What SSRI can give you QT prolongation?
Citalopram
Use of (blank) during pregnancy linked to an increased risk for cardiovascular
paroxetine
How can you get 5-HT syndrome when giving SSRIs?
You give them with MAO inhibitors or other drugs that enhance 5-HT neurotransmission
WHy dont you want to give antidepressants to children, adolescents and young adults really?
because it can worsen their depression (suicide)
What is the only SSRI approved for use in children and adolescents?
Fluoxetine
What is an SSRI approved for use in adolescents?
escitalopram
What can you use SSRIs for other than treatment for depression?
- anxiety
- seasonal affective disorder
- bulimia nervosa
- migraine prophylactic
- PMS and PMDD, hot flashes