Antidepressants & ECT II Flashcards
Fluoxetine (Prozac)
SSRI; half life 2-3 days
No serotonin discontinuation symptoms
Sertraline (Zoloft)
SSRI; half life of 24 hrs, risk of discontinuation symptoms
Weak dopaminergic activity, useful after brain injury
Paroxetine (Paxil)
SSRI; half life of 24 hrs, somewhat sedating, useful in anxiety disorders
- Significant 2D6 inhibition
- Anticholinergic side effects
Citalopram (Celexa)
SSRI; half life of 24 hrs
Fewer drug interactions, useful if someone is on numerous meds
What is the enantiomer of Citalopram (Celexa)?
Escitalopram (Lexapro)
Fluvoxamine (Luvox)
SSRI
Approved for treatment of OCD, but used by some to treat depression
fever, delirium, hypertension, hypotension, neuromuscular excitability occurring after taking a certain class of drugs
Serotonin Syndrome
Buproprion (Wellbutrin)
- Dopamine and NE reuptake inhibition (most likely)
- Few side FX
- Electrolyte imbalance –> increased seizure risk
- Used in smoking cessation
- May be useful for ADHD
What is Buproprion (Wellbutrin) contraindicated in?
Patients with history of seizures, patients with eating disorders or other metabolic disturbances
What drug can be effective in decreases sexual side FX when given with an SSRI?
Buproprion (Wellbutrin)
Venlaxafine (Effexor)
SNRI (serotonin-NE reuptake inhibition)
- Side FX similar to SSRIs
- Dose related increase in BP
- Useful in patients on numerous meds (very few drug interactions)
- Treatment of generalized anxiety disorder
Desvenlafaxine (Pristiq)
- SNRI
- Relatively greater NE reuptake inhibition than venlaxafine, but more serotonergic than noradrenergic
- Plasma levels more consistent than venlaxafine
- More potent effect on NE may be helpful in pain conditions like fibromyalgia
Duloxetine (Cymbalta)
- SNRI
- Less likely than Effexor to cause dose-related HTN
- Also indicated for depression and diabetic neuropathic pain
Mirtazapine (Remeron)
- alpha-2 Antagonist at central presynaptic adrenergic autoreceptors
- very sedating
- Antihistaminic properties dramatically increase appetite and weight gain
- Useful for people w/ loss of appetite and poor sleep
Trazodone
- Most common use is for insomnia in low doses
- Major concern is priapism, and failure to treat in time can lead to permanent erectile dysfunction
TCA Side Fx
- Anticholinergic - dry mouth, urinary retention, constipation, blurred vision
- Alpha adrenergic blockade - orthostatic hypotension
- Antihistamine - sedation, increased appetite, weight gain
TCAs cause prolongaiton of what cardiac EKG interval?
QT
T or F. TCAs are not lethal in overdose.
F - very lethal
MAOI’s (monoamine oxidase inhibitors)
- Inhibits enzyme that metabolizes NE, serotonin, dopamine, tyramine, resulting in increase in neurotransmitters in synapse
- Used for major depression, anxiety disorders, social phobia, treatment resistant depression
- Hypertensive crisis can occur as side effect when combined with certain drugs/foods
Selegiline (EMSAM)
MAOI-B previously used for Parkinson’s, but was used off label for depression
How long do you have to be off of an MAOI before a regular diet can be resumed or contraindicated meds started?
at least 2 weeks
What drug can cause congenital cardiac abnormalities in first trimester?
Paroxetine (Paxil)
When does postpartum depression occur?
Within four weeks of delivery
What is normal postpartum sadness timeframe?
7-10 days
What is drug of choice for postpartum depression? Why?
Sertraline b/c exposure through breast milk is lower than in utero
What does ECT induce?
Bilateral, generalized tonic-clonic seizure for 30-90 seconds, often involving deeper brain structures like thalamus and also affecting every major neurotransmitter system
What conditions is ECT used for?
- Major depressive disorder
- Manic episodes
- Schizophrenia
What type of schizophrenia can be helped by ECT? Which is not helped by ECT?
Schizophrenia characterized by catatonic or mood symptoms most likely show a response.
Chronic schizo does not.
T or F. ECT can help with somatization disorders, personality disorder, OCD
False
What medications are given to a patient prior to ECT?
Muscarinic anticholinergic agent for control of oral and respiratory secretions
General anesthetic, usually short acting barbiturate
Muscle relaxants to decrease bone fractures, succinylcholine
What receptors are down regulated in ECT?
Post synaptic beta adrenergic receptors
Common side FX of ECT
- headache, confusion, delirium, muscle soreness, some memory impairment
What can be used as therapy for SAD (seasonal affective disorder) which occurs in winter months or in cloudy climates?
Light therapy
What newly approved treatment for depression generates a magnetic field that induces an electrical current in undrlying areas of brain?
Transcranial magnetic stimulation
What highly experimental treatment is a battery powered pulse generator implanted in chest with leads tunneled under scalp and guided into brain near the cingulate cortex?
Deep brain stimulation
