Depression and BPD Flashcards
causes predisposing to depression
blood relatives with depression
trauma/stress/death in family/financial trouble
major life changes
medical problems
certain medications
alc/drug use
depression hypotheses: monoamine
decreased brain levels of NE, serotonin, dopamine
depression hypotheses: postsynaptic changes in receptor sensitivity
desensitization/downregulation of NE/5HT receptors
depression hypotheses: dysregulation
failure of homeostatic NT regulation
no absolute increase or decrease in NT activity
tricylics
amitriptyline
nortriptyline
older, now second line
monoamine oxidase inhibitor: list
moclobemide
older, now second line
SSRIs list
fluoxetine
sertraline
citalopram
escitalopram
SNRIs list
duloxetine
venlafaxine
desvenlafaxine
NDRI: NE and dopamine reuptake inhibitor
bupropion/wellbutrin
antidepressant MOA
prlong effects of amine NTs by inhibiting NT reuptake (new)
autoreceptor blockade
decreasing NT breakdown
side effects of TCAs
sedation
anticholinergic: confusion/delerium, dry mouth, constipation, urinary retention, tachycardia, confusion
OH
arrhythmias
MAO inhibitor side effects
CNS excitment: restlessness, agitation, sleep loss, irritability
increased BP
food drug interactions with tyramine containing foods
side effects of 2nd generation antidepressants
including SSRIs, etc
GI
sexual side effects
less sedation
OH
arrhythmia
anticholinergic
serotonin syndrome
overstimulation of serotonin receptors
serotonin syndrome s/s
mild: mydriasis, shivering, sweating, tachycardia
mod: altered mental status, autonomic, neuromuscular tremor/clonus
severe: delirium, HTN, hyperthermia, muscle rigidity, tachycardia
antidepressants mechanism for chronic pain
effect on CNS monoamine NTs, esp serotonin
brexanolone MOA
antidepressant by allosteric modulation of GABA A receptors to increase 5HT and NE transmission
brexanolone indications
post partum depression, IV infusion
side effects of brexanolone
headache, dizzines, somnolence
drugs for manic episodes in BPD
lithium *best for euphoric mania
divalproex
drugs for depressive episodes in BPD
lithium
lamotrigine
aripiprazole
quetiapine
risperidone
lithium MOA
neuroprotection
NT modulation
cellular inhibition of inositol phosphate 3
side effects of lithium
acute: nausea, diarrhea, lethargy, impaired cog fx, hand tremor
long term: hypothyroidism, cardiac, weight gain, leukocytosis, acne/psoriasis
PT considerations for antidepressants
lag time on beneficial effects
sedation, lethargy, muscle weakness
OH
increased BP w MAO inhibitors
exercise tolerance decreased
increased risk of suicide
