Atypical Antidepressants Flashcards
bupropion
wellbutrin
mirtazapine
remeron
role of atypical antidepressants
- cannot tolerate SSRI
- SSRI not effective
- CAN be used as 1st line therapy
MOA of bupropion
structurally similar to amphetamine, some think it’s really a dopamine norepinephrine reuotake inhibitor
which neurotransmitter does buproprion have the greatest effect on?
dopamine
metabolism of buproprion
liver
indications for bupropion
- MDD, dysthymia, bipolar depression
- ADHD
- SAD
- low dose can help sexual dysfunciton with SSRIs
- smoking cessation
side effects of bupropion
insomnia, QT prolongation, GI effects, CNS stim, HA, constipation, dry mouth, tremor, at high doses can exacerbate psychosis
is there an increased seizure risk in higher doses of bupropion?
YES
will bupropion raise BP in a hypertensive patient?
maybe
Who shouldn’t get Wellbutrin?
Not optimal for pts with anxiety
Contraindicated in pts with seizure or active eating disorder and in those on a MAOI
should bupropion be taken before bed?
probably not, some report stimulant like effect (duh it’s chemically similar to a stimulant)
can bupropion be taken during pregnancy?
NOPE
can bupropion be combined with prozac?
YES, it is actually the MOST effective and well tolerated treatment of all types of depression, BUT can exacerbate panic disorder
can bupropion give a false positive urine amphetamine?
YES
MOA of mirtazapine
structurally similar to tricyclic and tetracyclic antidepressants. NOT a reuptake inhibitor, antagonizes adrenergic and serotonin receptors
does mirtazapine have an effect on histamine receptors?
YES, which explains why it is very sedating
indications for mirtazapine
Refractory depression and anxiety disorders, especially in pts who need to gain weight
side effects of mirtazapine
SEDATION, anticholinergic, QT prolongation, weight GAIN/increased appetite, sexual dysfunction
what happens if mirtazapine is taken with benzos or alcohol?
potentiates sedation
Trazodone
Desyrel
Use of trazodone
Refractory major depression, depression with anxiety and insomnia
side effects of trazodone
Nausea, dizziness, orthostatic hypotension, cardiac arrhythmia, sedation and priapism
High vs low dose or remeron
Low dose: maximum sedative effect
High dose: increases norepinephrine uptake and is less sedating
