Depression Core Drugs Flashcards
What is the primary mechanism of action for sertraline?
Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness
What is the drug target for sertraline?
Serotonin transporter
What are the main side effects of sertraline?
- GI effects (nausea, diarrhoea)
- Sexual dysfunction
- Anxiety
- Insomnia
What does sertraline partially inhibit?
- Mild inhibition of dopamine transporter
2. Partial inhibition of CYP2D6 at high doses (150 mg)
How commonly were these drugs prescribed in 2020 in West London?
- Sertraline: 16th
- Citalopram: 27th
- Fluoxetine: 68th
- Venlafaxine: 83rd
- Mirtazapine: 30th
How do you decrease sertraline?
Must be gradually decreased on discontinuation
What is the primary mechanism of action for citalopram?
Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness
What is the drug target of citalopram?
Serotonin transporter
What are the main side effects of citalopram?
- GI effects (nausea, diarrhoea)
- Sexual dysfunction
- Anxiety
- Insomnia
What does citalopram antagonise?
Mild antagonism of muscarinic and histamine (H1) receptors
What is citalopram metabolized by?
CYP2C19
How do you decrease citalopram?
Must be gradually decreased on discontinuation
What is the primary mechanism of action for fluoxetine?
- Inhibition of serotonin reuptake results in an accumulation of serotonin
- Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.
What is the drug target for fluoxetine?
Serotonin transporter
What are the main side effects of fluoxetine?
- GI effects (nausea, diarrhoea)
- sexual dysfunction
- anxiety
- insomnia
What is fluoxetine an antagonist of?
Mild antagonism of 5HT2A and 5HT2C receptors
What does fluoxetine inhibit?
- Complete inhibition of CYP2D6
2. Significant inhibition of CYP2C19 (caution with warfarin)
What is the primary mechanism of action for venlafaxine?
- Venlafaxine is a more potent inhibitor of serotonin reuptake than norepinephrine reuptake
- Noradrenaline in the central nervous system is implicated in the regulation of emotions and cognition.
What is the drug target of venlafaxine?
- Serotonin transporter
- Noradrenaline transporter
What is the main side effects of venlafaxine
- GI effects (nausea, diarrhoea)
- sexual dysfunction
- anxiety
- insomnia
- hypertension (at higher doses)
How you decrease venlafaxine?
Must be gradually decreased on discontinuation
What is the primary mechanism of action for mirtazapine?
- Antagonises central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine.
- Antagonises central 5HT2 receptors, which leaves 5HT1 receptors unopposed causing anti-depressant effects.
What the drug target of mirtazapine?
- Alpha-2 receptor
- 5-HT2 receptor
What is the main side effect if mirtazapine?
- Weight gain
2. sedation
