Antidepressants & Mood Stabilizers Flashcards
What are the 5 R’s for Antidepressant Efficacy?
Response - Greater than or equal to 50% reduction in symptoms
Remission - Symptom free (healthy state)
Recovery - 2-6 months of ongoing remission (not cured)
Relapse - return of symptoms after remission before recovery
Recurrence - return of symptoms after recovery
What is a partial response in antidepressant therapy?
When you are between 25%-50% reduction of symptoms
How long does it take antidepressants to take effect?
3-8 weeks
What is the goal of antidepressant therapy?
Remission/Recovery
Are antidepressant associated with withdrawal symptoms?
Yes - slow titration down so this does not happen.
What is the FINISH mnemonic stand for? These are symptoms of treatment with antidepressants
Flu-like symptoms Insomnia Nausea Imbalance Sensory disturbances Hyperarousal
What drug is an antidepressant that can also be given for nicotine withdrawal?
Bupropion
What drug can be given for Enuresis (involuntary urination)? What class?
Imipramine (TCA)
Drug for diabetic neuropathy, fibromyalgia, and chronic pain? What class?
Duloxetine (SNRI)
What can be given for stress incontinence?
Duloxetine (SNRI)
What is the SSRI that is only given for OCD?
Fluvoxamine
Which SSRIs have a little extra function or “little extra kick” as Segars would say?
Vilazodone and Vortioxetine, note that Segars said if we have them on a regular SSRI and they are not quite satisfied can try one of these for a little extra.
What are some side effects for SSRIs?
Sexual dysfunction, weight gain, and acute withdrawal symptoms (concern with all categories)
What are rare but serious side effects of SSRIs?
QT prolongation
Hyponatremia (SIADH-like)
Serious Side effects include Serotonin syndrome
- sweating, hyperreflexia, akathisia/myoclonus, shivering/tremors
What was the most serious side effect of SSRIs? Segars said this would be one the test
Suicidality - explanation was that the patient is so depressed they cant kill themselves but as they take these meds it gives them just enough energy to actually take their life
Which drug from the SSRI class has the most drug-drug interactions?
Fluoxetine
Which Drug has the least drug-drug interactions?
vortioxetine and escitalopram
TCAs block what other receptors?
HAM - histamine (H1), alpha 1 (adrenergic), and muscarinic (cholinergic)
What are the side effects of TCAs that block the alpha adrenergic receptors?
tachycardia, orthostatic hypotension, dysrhythmias
What are the side effects of TCAs that block the muscarinic?
dry mouth, urinary retention/constipation, blurred vision
What are the effects of TCAs that block the histamine receptor?
sedation/fatigue, dizziness/seizures
What do we need to remember for the TCAs?
3 - Cs
Coma, Cardiotoxicity, Convulsions
Which drug is a SARA and responsible for blocking presynaptic Alpha2 receptors on NE & 5HT as well as blocks post synaptic 5-HT2/3 receptors?
Mirtazapine
What are the two SARA drugs that block post synaptic alpha1 and 5HT2 receptors?
Trazodone and Nefazodone
Which SARA is highly associated with weight gain?
Mirtazapine
Which SARA has the strongest chance for orthostatic hypotension?
Trazadone
Which SARA has the strongest chance for CNS sedation?
Trazadone/Mirtazapine
What is the major side effect that we need to know for the NDRI bupropion?
Seizures
What are the MAOIs?
Selegeline
phenelzine
Isocarboxazid
Tranylcypromine
You want to give a patient a selective MAO-B inhibitor to help with parkinsons disease. What medication did you give the patient?
Selegeline
What is unique about the medication selegeline?
It is given via a patch
What is the major concern of MAOIs and what causes it?
Hypertensive crisis - caused by blocking MAO-A in the GI necessary for tyramine metabolism
What are the signs of hypertensive crisis with MAOIs?
headache, sweating, anxiety, tachycardia, chest pain, SOB, confusion, etc… these people need help quick.
What are example of foods with tyramine?
just think anything fermented or aged
What is the only drug that we know of that is used to treat post partum depression?
Brexanolone
What drug is given as a nasal spray and block the NMDA receptor?
Esketamine - remember all ketamines inhibit the NMDA receptor.
What is a side effect of giving lithium? (endocrine)
Hypothyroidism (thyroid goiter) and nephrogenic diabetes insipidus.
What are the drug interactions we should be concerned about with lithium?
Diuretics, ACEI, NSAIDS
Does lithium have a wide or narrow therapeutic index?
Narrow
What is an off label use of lithium?
Reduced risk of suicide
Which of the mood stabilizers is a major inducer of CYP450?
Carbamazepine
