antidepressants: mood stabilizers

Question 1

three phases of treatment

Answer 1

acute (3 months), continuation (4-9 months), maintenance (years)

Question 2

How long does it take for antidepressants to start working

Answer 2

4-16 weeks

Question 3

What is an adequate amount of time for antidepressant trial

Answer 3

8-14 weeks

Question 4

Which antidepressive therapy works the fastest

Answer 4

electroconvulsive therapy

Question 5

How many patients treated with SSRIs achieve remission

Answer 5

one third

Question 6

Function of mirtazapine

Answer 6

blocks 5-HT2A, 5-HT2C, 5-HT3, a-2-adrenergic receptors

Question 7

Function of buproprion

Answer 7

increases whole-body NE, weakly blocks reuptake of DA

Question 8

Function of trazadone and nefazodone

Answer 8

most potent action is blockade of post-synaptic 5-HT2. Block reuptake of 5-HT and NE

Question 9

Function of tricyclics

Answer 9

block reuptake of 5-HT and NE, (and, to lesser extent, DA), as well as H1, muscarinic cholinergic receptors and a-1.

Question 10

Function of MAOIs

Answer 10

irreversibly inhibit MAO-A and MAO-B, increasing levels of 5-HT and NE.

Question 11

Function of vilazodone

Answer 11

a new antidepressant, is an SSRI + 5HT1A partial agonist

Question 12

tricyclic antidepressants benefits and negatives

Answer 12

• 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)

Question 13

MAOIs benefits and negatives

Answer 13

• 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*

Question 14

SSRIs benefits and negatives

Answer 14

• 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

Question 15

SNRIs benefits and negatives

Answer 15

• 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”)*

Question 16

Buproprion benefits and negatives

Answer 16

• 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*)

Question 17

Mirtazapine benefits and negatives

Answer 17

• Pluses: Helpful with insomnia*, rapid anti-anxiety effect, low incidence of sexual side effects
• Minuses: Daytime somnolence, weight gain*

Question 18

Treatment of bipolar depression

Answer 18

difficult! there are only 2 FDA approved treatments: quetiapine and Olanzapine+fluoxetine (marketed as Symbyax).

Question 19

Anti-manic agents

Answer 19

All atypical antipsychotics, lithium, divalproex and carbamazepine

Question 20

Lithium pluses and minuses

Answer 20

• 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.

Question 21

Divalproex Sodium pluses and minuses

Answer 21

• 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

Question 22

Atypical antipsychotics pluses and minuses

Answer 22

• 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?

Question 23

are antidepressants effective in treatment of bipolar depression?

Answer 23

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.

Question 24

Best agent for preventing future bipolar episodes

Answer 24

lithium