Depression Flashcards
Depression Drugs
SSRI SNRI Aminoketones (bupropion) Tetracyclics (mirtazapine) Triazolopyridines (trazodone & nefazodone) Tricyclic (TCAs) Monoamine Oxidase Inhibitors (MAOIs)
SSRI Contraindications
Use of a MAOI or use of a MAOI within 14 days.
Must have 2 week washout for most SSRIs, 5 week washout for fluoxetine
SSRI Uses
Major Depression Disorder (MDD) Obsessive Compulsive Disorder (OCD) Panic Disorder (PD) Generalized Anxiety Disorder (GAD) Social Anxiety Disorder (SAD) Eating disorders Premenstrual Dysphoric Disorder (PMDD)
Antidepressant DOC
SSRI’s
- citalopram (MDD Only)
- escitalopram
- paroxetine
- fluoxetine
- sertraline
- fluoxamine (OCD Only)
Only SSRI not indicated for MDD
fluoxamine
SSRI indicated only for OCD
fluoxamine
SSRI indicated only for MDD
citalopram
SSRI Pearls
-Counsel on GI dist (n/v/d) and
CNS side effects
(anxiety, headache, insomnia, sedation)
-Counsel about sexual dysfx
-Safer in overdose than TCAs
-Variable response to different SSRIs
-Start low and go slow
-Can impair platelet aggregation, fall risk
-Can cause SIADHDrug that does not have serotonin component
bupropion
Good adjunctive therapy for depression if anxiety is not present
bupropion
Options for depressed pt with sexual dysfxn
bupropion
trazodone
Pt w/depression has not been sleeping and has sexual dysfxn should be given
trazodone (most commonly used for sleep)
Antidepressants should not be used concurrently with
MAOIs, linezolid, methylene blue, other serotonin drugs
Drug that increases trazodone concentrations
fluoxetine (can be a good thing - requires lower dose of trazodone)
High vs low doses of trazadone
low - hypnotic
high - depression
SSRI that causes QTc prolongation
citalopram
escitalopram
great antidepressant for noncompliant pts
fluoxetine (Prozac)
-most activating SSRI
SSRI that causes diarrhea
sertraline (Zoloft)
PC for starting MAOI after SSRI or SNRI
Wait at least 2 wks (flush-out)
- 5 wks for fluoxetine
Bupropion indications
MDD
Smoking cessation
SAD (social anxiety disorder)
DSM-V criteria for depression
must have 5 and at least one of:
- depressed mood or
- loss of interest or pleasure
Bupropion contraindications
seizures
eating disorder
electrolyte imbalance
Bupropion metabolism
2D6
- tamoxifen
- ritonavir
SNRI common ADE’s
GI complaints
Sexual dysfxn
Bupropion has not been shown to be effective in
Anxiety disorders
Bupropion dosing frequency
XL - QD
SR - BID
IR - TID
Bupropion often prescribed in pts who experience:
sexual dysfxn with SSRIs
Why do you need to titrate dosing for bupropion?
Prevent risk of seizures
Antidepressant that has ADE of priapism
Trazodone
Trazodone contraindications
MAOIs, methylene blue, linezolid
MAOIs block
Tyramine degradation
Serotonin Syndrome Triad
Mental Status Change
Autonomic Hyperactivity
Neuromuscular Abnormalities
Antidepressants given with pt experiencing weight loss
Sertraline
Venlafaxine
Mirtazapine
MAOI ADE’s
orthostatic hypotension
wt. gain
sexual dysfxn
TCA contraindications
Pregnancy
QTc greater than 450 msec
MAOI w/in 14 days
Glaucoma
Antidepressant with no GI ADE’s and good for elderly pt with wt. loss
mirtazapine
