Atypical depression meds and only-anxiety meds

Question 1

Mirtazapine/Remeron (

Answer 1

Class: serotonin-norepinephrine receptor antagonist

Use: MDD, panic d/o, GAD, PTSD
- Good adjunct with Effexor
- Quick on anxiety
- Combats GI side effects of SSRI’s

Start 15 mg nights, max 45 mg nightly for MDD
-Tabs in 15, 30, 45

Side effects
- Taper to d/c
- Caution renal/hepatic-lower dose
- Does NOT affect CYP450
- Infrequent sexual side effects
- anticholinergic, orthostatic hypotension, dizziness, constipation

Question 2

Bupropion/Wellbutrin

Answer 2

Class: NDRI (norepinephrine-dopamine reuptake inhibitor)

Use: MDD, seasonal affective d/o, nicotine
addiction, bipolar depression, ADHD, sexual
dysfunction
● Improve cognitive slowing
● Less likely to induce hypomania

• Bupropion IR: 225–450 mg
  in 3 divided doses
  (maximum single dose 150
  mg)
• Bupropion SR:
  200–450 mg in 2 divided
  doses (maximum single
  dose 200 mg)
  -Tabs in 100, 150, 200
• Bupropion XL: 150–450 mg
  once daily
  (maximum single dose 450
  mg)
  -Tabs in 150, 300, 450
  XL preferred

Side effects:
- Adjust for hepatic- avoid with cirrhosis
● Taper to d/c
● NO seizure or eating d/o
● Caution with TBI, SUD, renal or hepatic
impairment, DM, HTN
● dry mouth, constipation, nausea, weight
loss, anorexia, myalgia, insomnia, HA,
dizziness, agitation, anxiety, tremor, abd pain,
sweating, tinnitus, HTN

Question 3

Vortioxetine XR/Trintellix

Answer 3

Use: MDD, GAD, geriatric depression, cognitive sx
● Good for elderly
● Low weight gain
● Good for prior med failures
● Pro- cognitive

Start 10 mg, max 20 mg
(5mg intolerance,
TAB: 5,10, 20

Side effects:
- GI upset
● Less sexual dysfunction,
● CYP450

Question 4

Vilazodone/Viibryd

Answer 4

Use: MDD, anxiety, OCD
● Good for anxiety and comorbid depression

• start 10 mg day x7 days, 20
  mg daily x7 days, max 40 mg
  TAB: 10, 20, 40, starter
  pack

Side effects:
- Give with food
- taper to d/c

Question 5

Doxepin/Sinequan

Answer 5

Class: TCA

Use: Psychoneurotic depression/anxiety,
depression/anxiety r/t alcohol, organic
disease, insomnia, MDD
● Immediate effect on insomnia
● Low dose= no weight gain

• 6 mg qhs, avoid meals w/in
  3 hr of administration
  TAB: 3, 6

Side effects:
- EKG with cardiac hx, > age 50
● Caution urinary retention, cardiac hx, hepatic
impairment, seizures, thyroid, diabetes,
parkinson’s
● Increases appetite, carb cravings, anticholinergic, sweating

Question 6

Amitriptyline/Elavil

Answer 6

Class: TCA

Use: Depression, neuropathic/chronic pain, fibro, HA, low back/neck pain, insomnia
● Tx resistant depression

• start 25-75 mg, max 300
  mg
• TAB:10, 25, 50, 75,100,150

Side effects:
-Baseline EKG, no recent MI
● Taper off
● Caution renal/hepatic
● blurred vision, anticholinergic, weight gain,
heartburn

Question 7

Clomipramine/Anafranil

Answer 7

Class: TCA

Use: OCD, depression, severe tx resistance, cataplexy, anxiety, insomnia,
neuropathic/chronic pain

• start 25 mg 200 mg nightly,
  250 mg (OCD- higher dose)
  CAP: 25, 50, 75

Side effects:
- Taper
● Higher dose increases seizure risk
● Baseline EKG
● Anticholinergic, weight gain

Question 8

Nortriptyline/Pamelor

Answer 8

Class: TCA

Use: MDD, anxiety, insomnia, neuropathic/chronic
pain, Tx resistant depression
● Dose at bedtime

start 25-50 mg nighly, max
150 mg (depression)
Cap 10, 25, 50, 75

Side effects
-Taper
● Caution hepatic/renal
● Baseline EKG

Question 9

Imipramine/Tofranil

Answer 9

Class: TCA

Use: Depression, enuresis, anxiety, insomnia,
neuropathic/chronic pain, tx resistant depression

• start 25-75 mg, max 300 mg (depression)
• 10-50 mg nightly (sleep
  terrors, sleepwalking)
• 25-75 mg nightly (nocturnal
  enuresis)
  TAB: 10, 25, 50
• Taper
  ● Adjust for hepatic
  ● No recent MI
  ● Baseline EKG
  Side effects
  -

Question 10

Trazodone

Answer 10

Class: Serotonin receptor
agonist/reuptake
inhibitor

Use: Depression, insomnia, anxiety
- SSRI adjunct for insomnia

start 25-50 mg, max 200 mg
TAB: 50, 100, 150, 300

Side effects
- May need higher dose for difficult cases
● taper dose gradually to d/c
● May cause hangover feeling at first
● Caution hepatic
● No recent MI
● priapism, orthostasis, dizziness, seizures, sedation

Question 11

Buspirone/Buspar

Answer 11

Use: anxiety

• start 7.5 mg bid, standard
  20-30 mg, max 60 mg
  TAB: 5, 7.5, 10,15, 30mg

Side effects
- Adjust renal & hepatic impairment
● dizziness, nervousness, headache, insomnia,
GI, constipation, restless

Question 12

Hydroxyzine/Atarax

Answer 12

Class: Antihistamine

Use: Anxiety, anxiety withdrawal relate to ETOH, nausea and vomiting, insomnia

Dose: 35-100mg
- Caps in 25, 50
- Ages 6 and up

Side effects
- Adjust renal
- Dry mouth