antidepressants: mood stabilizers Flashcards
three phases of treatment
acute (3 months), continuation (4-9 months), maintenance (years)
How long does it take for antidepressants to start working
4-16 weeks
What is an adequate amount of time for antidepressant trial
8-14 weeks
Which antidepressive therapy works the fastest
electroconvulsive therapy
How many patients treated with SSRIs achieve remission
one third
Function of mirtazapine
blocks 5-HT2A, 5-HT2C, 5-HT3, a-2-adrenergic receptors
Function of buproprion
increases whole-body NE, weakly blocks reuptake of DA
Function of trazadone and nefazodone
most potent action is blockade of post-synaptic 5-HT2. Block reuptake of 5-HT and NE
Function of tricyclics
block reuptake of 5-HT and NE, (and, to lesser extent, DA), as well as H1, muscarinic cholinergic receptors and a-1.
Function of MAOIs
irreversibly inhibit MAO-A and MAO-B, increasing levels of 5-HT and NE.
Function of vilazodone
a new antidepressant, is an SSRI + 5HT1A partial agonist
tricyclic antidepressants benefits and negatives
• Pluses: Time-tested, very effective, more effective in severe depression, can monitor blood levels. Newer TCAs (secondary amines such as desipramine and nortriptyline) have fewer side effects than older TCAs (tertiary amines, such as imipramine and amitryptyline) • Minuses: Hypotension, orthostasis, anticholinergic side effects, weight gain, sexual side effects, dangerous in overdose* (10 day supply can be lethal)
MAOIs benefits and negatives
• Pluses: Can be very effective in non-responsive patients, especially atypical depression, time-tested. • Minuses: Hypotension, orthostasis, dry mouth, constipation, urinary retention, sexual side effects, weight gain, hypertensive crisis–Tyramine reaction*
SSRIs benefits and negatives
- Pluses: Safe, effective, multiple indications: Generalized Anxiety Disorder, social anxiety, panic, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Premenstrual Dysphoric Disorder
- Minuses: Diarrhea, nausea, jitteriness/anxiety, sexual side effects, drug interactions: P450 inhibition
- Pluses: Safe, effective, multiple indications: Generalized Anxiety Disorder, social anxiety, panic, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Premenstrual Dysphoric Disorder
- Minuses: Diarrhea, nausea, jitteriness/anxiety, sexual side effects, drug interactions: P450 inhibition
SNRIs benefits and negatives
- Pluses: Some evidence more effective than SSRIs, safe, better tolerated than TCAs*, multiple indications
- Minuses: Sexual side effects, sweating, increased diastolic blood pressure, withdrawal syndrome (flu-like, “electric shocks”)*
- Pluses: Some evidence more effective than SSRIs, safe, better tolerated than TCAs*, multiple indications
- Minuses: Sexual side effects, sweating, increased diastolic blood pressure, withdrawal syndrome (flu-like, “electric shocks”)*
Buproprion benefits and negatives
- Pluses: No sexual side effects, weight neutral, activating*.
- Minuses: Increased anxiety, jitteriness, ineffective in panic disorder, insomnia, higher seizure risk* (contraindicated in eating disorder patients and those with seizure disorder*)
- Pluses: No sexual side effects, weight neutral, activating*.
- Minuses: Increased anxiety, jitteriness, ineffective in panic disorder, insomnia, higher seizure risk* (contraindicated in eating disorder patients and those with seizure disorder*)
Mirtazapine benefits and negatives
- Pluses: Helpful with insomnia*, rapid anti-anxiety effect, low incidence of sexual side effects
- Minuses: Daytime somnolence, weight gain*
Treatment of bipolar depression
difficult! there are only 2 FDA approved treatments: quetiapine and Olanzapine+fluoxetine (marketed as Symbyax).
Anti-manic agents
All atypical antipsychotics, lithium, divalproex and carbamazepine
Lithium pluses and minuses
- Pluses: Best studied, best proven drug, effective anti-manic, reasonable preventative agent, some antidepressant effect, anti-suicidal properties, neuro-regenerative effects, inexpensive.
- Minuses: Tremor, nausea, diarrhea, taste, thirst, cognitive dulling, narrow therapeutic window* (0.6-1.2 mEq/l), toxic/lethal in overdose, renal effects, decreased urine concentration, diabetes insipidus, hypothyroidism.
Divalproex Sodium pluses and minuses
• Pluses: Individualized treatment (based on weight), rapid loading* (20-30 mg/kg), safe and effective.• Minuses: Not proven as preventative agent*, weight gain, sedation, not effective in bipolar depression
Atypical antipsychotics pluses and minuses
- Pluses: All are anti-manic*, reasonably safe & effective, different routes of administration (injection, dissolvable tabs), rapid dose titration
- Minuses: Weight gain, risk of metabolic effects/diabetes, risk of increased cholesterol/lipids, expensive, are they any better than typical antipsychotics?
are antidepressants effective in treatment of bipolar depression?
No large, randomized, adequately controlled and powered studies have shown that antidepressants are effective in the treatment of bipolar depression. There is some evidence that antidepressants can worsen the course of bipolar disorder.
Best agent for preventing future bipolar episodes
lithium
