Ch 32 Antidepressants Flashcards
The principal symptoms of major depression are __.
depressed mood and loss of pleasure or interest in one’s usual activities and pastimes
Patients with mild depression can be treated equally well
with ___.
Patients with severe depression respond better to a ___.
antidepressant drugs or psychotherapy
combination of drugs plus psychotherapy than to either intervention alone
Patients with depression often think about or attempt suicide. During treatment with antidepressants, especially initially, the risk of suicide may__. To reduce the risk of suicide, patients should be followed closely by family members, caregivers, and the prescriber. Suicide risk is greatest in ___.
increase
children and young adults
All antidepressants appear equally effective. Differences
relate primarily to __(3)__.
side effects, drug interactions, and cost
Therapeutic responses to antidepressants develop slowly. Initial responses develop in ___. Maximal
responses may not be seen until __.
1 to 3 weeks
12 weeks
Antidepressant therapy should continue for __
after symptoms resolve.
4 to 9 months
___ block reuptake of serotonin, and thereby intensify
transmission at serotonergic synapses. Over time, this
induces adaptive cellular responses that are ultimately
responsible for relieving depression.
SSRIs
SSRIs have two major advantages over TCAs:
they causefewer side effects and are safer when taken in overdose
Most SSRIs have stimulant properties, and hence can cause __. This contrasts with TCAs, which cause sedation.
insomnia and agitation
Like most other antidepressants, SSRIs can cause __.
weight gain
___ is more common with SSRIs than with most other antidepressants.
Sexual dysfunction (e.g., impotence, anorgasmia)
SSRIs can cause ___, especially when
combined with MAOIs.
Combined use of SSRIs and MAOIs is contraindicated,
and combined use with other serotonergic drugs should be done with extreme caution, if at all.
serotonin syndrome
Symptoms include agitation, confusion, hallucinations, hyperreflexia, tremor, and fever.
SNRIs block reuptake of __.
Effects are similar to those of the SSRIs.
serotonin and norepinephrine
The most common side effects of SNRIs include __.
nausea, insomnia, and hypertension.
SNRIs can also contribute to sexual dysfunction.
SNRIs, like SSRIs, can cause __.
serotonin syndrome
___ block reuptake of NE and 5-HT and thereby intensify transmission at noradrenergic and serotonergic synapses. Over time, this induces adaptive cellular responses that are ultimately responsible for relieving depression.
TCAs
The most common adverse effects of TCAs are (3).
sedation, orthostatic hypotension, and anticholinergic effects (e.g., dry mouth, constipation).
The most serious adverse effect of TCAs is __.
cardiotoxicity, which can be lethal if an overdose is taken
TCAs can cause a ___ if combined with
an MAOI. Accordingly, the combination is generally
avoided.
hypertensive crisis
TCAs intensify responses to __ and diminish responses to __.
direct-acting sympathomimetics (e.g., epinephrine)
indirect-acting sympathomimetics (e.g., amphetamine)
__ increase neuronal stores of NE and 5-HT, and
thereby intensify transmission at noradrenergic and serotonergic synapses. Over time, this induces adaptive cellular responses that are ultimately responsible for relieving depression.
MAOIs
__ are as effective as SSRIs and TCAs, but are
potentially more hazardous.
MAOIs
MAOIs are first-choice drugs only for patients with __.
atypical depression
Like SSRIs and SNRIs (and unlike TCAs), MAOIs cause
direct __.
CNS stimulation
Like TCAs (and unlike SSRIs or SNRIs), MAOIs cause \_\_.
orthostatic hypotension
Patients taking MAOIs must not eat __ because hypertensive crisis can result. Hypertensive crisis can be treated with an __.
tyramine-rich foods
IV vasodilator (e.g., sodium nitroprusside, labetalol, phentolamine)
MAOIs must not be combined with __ because
hypertensive crisis can result.
indirect-acting sympathomimetics (e.g., amphetamine, cocaine)
MAOIs must not be combined with (3) because serotonin syndrome could result.
SSRIs, SNRIs, or other serotonergic drugs
__ relieves depression faster than antidepressant drugs, and often helps when antidepressants have failed.
ECT
ECT as practiced today is safer and less traumatic than in the past, owing to adjunctive use of (2).
(1) a short-acting IV anesthetic (e.g., propofol, etomidate) to produce unconsciousness and
(2) a short-acting muscle relaxant (succinylcholine) to prevent convulsions
