Antidepressants Lecture PDF

Question 1

Response to significant loss may have criteria for major depression, but…

Answer 1

….only after a prolonged period beyond the normal response to significant loss judged clinically

Question 2

Pathophysiology of depression

Answer 2

Multi-factorial between genetic, social, and biochemical processes, but often focus is placed on neurotransmitter defect reflects symptoms of depression

Question 3

Monoamine hypothesis of depression

Answer 3

Clinical observations that have provided evidence that maintains depression is caused by functional insufficiency of monoamine transmitters in the brain (serotonin, norepi) based on 2 observations -that depression was induced by reserpine (a drug that depletes monoamines from the brain) and -drugs that treat depression intensify monoamine induced neurotransmission

Question 4

Electroconvulsive therapy indications (2)

Answer 4

-When speed is critical, when a patient has failed to respond to antidepressants

Question 5

Repetitive transcranial magnetic stimulation

Answer 5

Production of pulsed magnetic fields that can induce electrical currents in the brain and unlike electroconvulsive therapy does not require anesthesia or induction of seizures

Question 6

Light therapy

Answer 6

Bright light exposure that can be effective in managing SAD or nonseasonal depression

Question 7

Suicide risk with antidepressants

Answer 7

Patients taking antidepressants should be watched closely for suicide ideation, worsening mood, and behavioral changes particularly within the first one to two months of therapy or when dosage is changed (theorized to increase energy potentiating risk of acting on suicidal thoughts) most often seen in children thru young adults creating a blackbox warning for all antidepressants

Question 8

Time of response to antidepressants and maintenance treatment

Answer 8

Initial responses develop in 1-3 weeks, max response not seen until 12 weeks, must take at least 1 month before considered a treatment failure, low doses used initially to reduce side effects and gradually increased, if not effective, can increase dosage, switch another drug in same class, switch to drug in different class, combine 2, ad supplemental, can withdraw only via taper but long term maintenance therapy can reduce risk of recurrence for patients with recurrent depressive episodes

Question 9

Only SSRI approved by FDA for treatment of major depression in children

Answer 9

Fluoxetine (prozac)

Question 10

SSRI mech of action, ADRs (3)

Answer 10

• selective inhibition of serotonin reuptake

- excessive CNS excitation, sexual dysfunction, nausea

Question 11

Therapeutic uses for SSRI’s (4)

Answer 11

• Major depressive disorder
• Generalized anxiety disorder
• OCD
• PTSD

Question 12

Serotonin syndrome

Answer 12

Risk of often combining SSRI’s with MAOI or from overdosing or from utilizing St John’s wort, often starting 72 hours after starting drug resulting in altered mental status, agitation, confusion, hyperreflexia, tremor, and potentially death

Question 13

Bruxism

Answer 13

Clenching or grinding of teeth usually occuring during sleep that can lead to headache, jaw pain, or dental problems, a bad side effect of SSRI’s

Question 14

SSRI drug interactions

Answer 14

• MAOI can potentiate risk of serotonin syndrome requiring withdrawal at least 14 days before starting fluoxetine
• Warfarin can increase effect
• St. John’s wort can potentiate risk of serotonin syndrome
• small risk in pregnancy of neonatal absence syndrome (self resolving)

Question 15

SNRI’s function, drug metabolism,

Answer 15

• Alongside SSRI considered first line option for treatment of major depression
• metabolized in the liver and excreted in the urine

Question 16

Duloxetine (cymbalta) indications (2)

Answer 16

• Major depressive disorder in adults

- Depression in patients with prominent pain complaints (diabetic neuropathy or fibromyalgia)

Question 17

Duloxetine (cymbalta) ADR’s (3)

Answer 17

• Dry mouth
• somnolence
• hyperdiaphoresis

Question 18

Tricyclic antidepressants mech of action, therapeutic uses (3), ADR’s (4), drug interactions (3)

Answer 18

• Block reuptake of NE and serotonin alongside other mechanisms
• alternative for treatment of depression, enuresis (inability to control urination), pain management
• anticholinergic effects/sedation/orthostatic hypotension/overdosage
• Sympathomimetic drugs, anticholinergic drugs, MAOI’s

Question 19

Before moving a patient from an SSRI to a MAOI, need to have a ____

Answer 19

washout period

Question 20

MAOI inhibitors function, mech of action, drug interactions (5), ADR’s (3)

Answer 20

• 3rd line agents for patients not responding to SSRI’s or TCA’s for treatment of depression
• Prevents breakdown of NE and serotonin by MAO causing buildup in the brain
• tyramine (amino acid in food), TCA’s, SSRI’s, SNRI’s, sympathomimetics
• Postural hypotension, CNS stimulation, liver damage

Question 21

Selegiline (emsam) drug class, yhhhh

Answer 21

• Transdermal MAOI

- Approved for treatment of major depression

Question 22

Trazodone (desyrel) function

Answer 22

Moderate blockade of serotonin reuptake that is not effective when used alone but often as an adjunct to an SSRI in patients with insomnia

Question 23

Amoxapine function

Answer 23

-Similar to antipsychotic agent loxapine, has both antidepressant and neuroleptic properties but can block dopamine receptors inducing parkinson like side effects

Question 24

Buproprion (Wellbutrin) function

Answer 24

Antidepressant similar in structure to amphetamines that has stimulant properties and suppresses appetite, is generally well tolerated and devoid of ADR’s associated with TCA’s including weight gain and sexual dysfunction

Question 25

Adjunctive antipsychotics for major depression

Answer 25

Augmentation with second gen atypical antipsychotic is treatment option for major depressive disorder in those whose symptoms persist following antidepressant monotherapy, even available in combo such as symbyax (fluoxetine and olanzapine)