Antidepressants + Lithium

Question 1

Monoamine Hypothesis

Answer 1

Depression is result of decreased levels of monoamine neurotransmitters (NE, SE, DE

Question 2

SSRI, SNRI, TCA, MAOI mechanisms of action

Answer 2

SSRI, SNRI, TCA: block reuptake to increase presence of neurotransmitters
MAOIs: block breakdown of neurotransmitters

Question 3

Explain why antidepressants take weeks to kick in and have increased depression risk in interim

Answer 3

• SSRI/SNRI prevent reuptake, increasing relative levels of neurotransmitters. Bound by autoreceptors for negative feedback and DECREASED short term neurotransmitter production
• Over time, continued high levels of neurotransmitters from reuptake inhibition but autoreceptors signal less over time, so less inhibition of production

Question 4

SSRIs (6)

Answer 4

FLu to PARis to ESCape SERvice, FLU to CITy
Fluoxetine (prozac)
Paroxetine (paxil)
Escitalopram (lexipro)
Sertraline (zoloft)
Citalopram
Fluvoxamine

Question 5

SSRI mechanism, side effects

Answer 5

• selective for SE reuptake
• Effect For Panic, Compulsions, Sadness (depression, anxiety/PTSD, OCD)
• Side effects: nausea, headache, anxiety, agitation, insomnia, sexual dysfunction, seizures, Serotonin Syndrome

Question 6

SNRIs (2)

Answer 6

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

Question 7

SNRI mechanism + side effects

Answer 7

Targets SE and NE

-same side effects as SSRI + SHAT (sedation, hypertension, anticholinergic, tachycardia)

Question 8

TCAs (5)

Answer 8

-ipramines and -triptylines (Not ACID)
Imipramine
Amitriptyline
Clomipramine
Desipramine
Nortriptyline

Question 9

TCA mechanism and side effects

Answer 9

prevents MAO reuptake by targeting NE and SE transporters, + hits å-1 receptors
Side effects: same as SSRIs + MOWSS- å-block (Orthostatic hypertension), Muscarinic block, Sedation, Weight gain, Seizures + arrhythmias with OD

Question 10

MAOIs (2), use

Answer 10

Phenelzine
Tranylcypromine

used for unresponsive MDD

Question 11

MAOI side effects

Answer 11

-Targets MAO, preventing neurotransmitter degradation. many receptor side effects.
Side effects: CHOSH- hypertensive reactions, hyperthermia, CNS stimulation, Serotonin Syndrome with SSRI, orthostatic hypotension

Question 12

5HT2 Antagonists (SE antagonists) (2)

Answer 12

Nefazodone

Trazodone

Question 13

5HT2 mechanism and side effects

Answer 13

nefazodone has hepatotoxicity risk. Side effects: sedation, å-block (orthostatic hypotension)
-no SSRI effects

Question 14

Heterocyclic Antidepressants (2), special uses

Answer 14

Bupropion (smoking cessation)

Mirtazapine (sedation)

Question 15

Heterocyclic Antidepressants mechanisms + side effects

Answer 15

Bupropion: unclear mechanism, lowers seizure threshold
Mirtazapine: 5HT2 and autoreceptor antagonist, causing increased SE/NE. Side effect sedation
-no SSRI effects

Question 16

Serotonin Syndrome symptoms

Answer 16

SHIVERS
S- shivering
H- Hyperreflexia + myoclonus
I- Increased temperature (hyperthermia)
V- Vital signs (tachycardia, blood pressure)
E- Encephalopathy (altered mental status
R- Restlessness/agitation
S- Sweating (diaphoresis)

Question 17

Drugs Inducing Serotonin Syndrome

Answer 17

Sinners Sell Drugs That Make Me Trip On The Tram Line
S - St Johns Wort
S - SSRIs 
D - Dextromethorphan
T -TCAs
M - MAOIs
M - MEperidine
T - TRIPtans
O- Olanzapine
T
T
L - LINEzolid

Question 18

Lithium

Answer 18

Used for bipolar
Side effects: tremor, reversible thyroid,polydypsia, polyuria, inhibit K+ entry to mycocytes (extracellular hyperkalemia)
-contraindicated in dehydrated, CVD, renal impairment