CNS - antidepressants

Question 1

Amitriptyiline
Clomipramine
Imipramine

1. Mechanism?
2. Uses? (3)
3. Adverse effects?

Answer 1

TCAs:

1. Blocks NE and 5-HT transporters
   (also alpha and M block)
2. Major depression (backup)
   chronic pain
   OCD - (Clomipramine)
3. sedation, weight gain
   overdose: arrythmias, seizures

CYP450 interactions

Question 2

Citalopram
Fluoxetine
Paroxetine
Sertraline

1. Mechanism?
2. Uses? (6)
3. Adverse effects?

Answer 2

SSRIs:

1. Blocks serotonin reuptake

2. Major depression
    Anxiety disorders
    OCD
    PMDD (pre - menstrual dysphoric disorder)
    PTSD
    bulimia

3. Sexual dysfunction

CYP inhibitors!

Question 3

Venlafaxine
Desvenlafaxine
Duloxetine

1. Mechanism?
2. Uses? (4)
3. Adverse effects?

Answer 3

SNRIs:

1. Blocks NE and serotonin reuptake
2. Major depression
   Chronic pain
   fibromyalgia
   menopausal symptoms
3. Anticholinergic
   Sedation
   Hypertension (Venlafaxine)

Question 4

Nefazodone
Trazodone

1. Mechanism?
2. Uses? (2)
3. Adverse effects?

Answer 4

1. 5-HT2 antagonists
2. Major depression
   Hypnosis (Trazodone)
3. Sedation
   alpha/H1 blockage (modest)

CYP inhibition (Nefazodone)

Question 5

Amoxapine
Bupropion
Maprotiline
Mirtazepine

1. Mechanism?
2. Uses? (3)
3. Adverse effects?

Answer 5

1. Mirtazepin blocks alpha2
   Mechanism of others uncertain
2. Major depression
   Smoking cessation (Bupropion)
   Sedation (Mirtazepine)
3. sedation and weight gain (Mirtazepine)
   Lower seizure threshold (amoxapine, bupropion)

CYP inhibition (bupropion)

Question 6

Isocarboxazid
Phenelezine
Selegine

1. Mechanism?
2. Use? (1)
3. Adverse effects?

Answer 6

1. Inhibits MAO A and B (Selegine - B)
2. Major depression unresponsive to other drugs
3. Hypertension (Tyramine/symptatethics)
   Serotonin Syndrome (with SSRIs)
   Hypotension
   Insomnia