Depression - Ott and Watts Flashcards
Which SSRI can cause dose-dependent QTc prolongation?
Citalopram
Which SSRIs are 2D6 inhibitors?
Fluoxetine, Paroxetine
Which SSRI has a long half life (96-144 hours)?
Fluoxetine
Fluvoxamine is an inhibitor of which CYP enzymes?
1A2, 2C19
What birth defect can paroxetine cause?
Septal wall defect
Which SSRI may cause more GI upset than other antidepressants?
Sertraline
What adverse effect is associated with SSRIs, especially in the elderly?
Hyponatremia
Duloxetine has an FDA warning for what?
Hepatotoxicity
Amitriptyline is a ____________ amine
tertiary
TCAs have a narrow therapeutic index and can be fatal in overdose due to what adverse effects?
cardiac arrhythmias
seizures
For MAOIs, there must be a ____ week washout period before switching antidepressants
2
MAOIs should be used with caution due to risk of what adverse events?
Serotonin syndrome
Hypertensive crisis
When taking mirtazapine, sedation and increased appetite occur with doses ≤ ______ mg/day
15
T/F: you can use vilazodone and vortioxetine in combination with SSRIs.
FALSE
Antidepressant withdrawal syndrome is common with all antidepressants EXCEPT:
Fluoxetine
What are the four FDA-approved augmentation agents?
Aripiprazole
Brexpiprazole
Cariprazine
Quetiapine
MOA of vortioxetine
SSRI + 5HT1a agonist + 5HT3 antagonist
MOA of vilazodone
SSRI
some 5HT1a agonism
What was the first antidepressant? What class was it?
Imipramine - TCA
Biogenic amine hypothesis of depression
- Reserpine causes depression by depleteing NE and 5HT
- Agents that increase 5HT and NE are effective for treating depression
Neuroendocrine hypothesis of depression
Changes in hypothalamic-pituatary-adrenal (HPA) axis -
1. overactivity of HPA and elevated CRF found in almost all depressed patients
2. elevated CRF causes insomina, anxiety, etc.
3. Antidepressants reduce CRF levels
Neurotrophic hypothesis of depression
- brain-derived neurotrophic factor (BDNF) has antidepressant activity in animals
- depressed patients have reduced levels of BDNF
- Antidepressants increase BDNF levels
MAOIs mechanism of action
Monoamine oxidase degrades NE and serotonin - inhibitors therefore increase the amount of NE and 5HT packed in vesicles which is then released into synapse
Non-selective MAO inhibitors
Phenelzine (Nardil)
Tranylcypromine (Parnate)
MAO-B selective MAOIs
Selegiline (Ensam)
Safinamide (Xadago)
MAO-A selective MAOIs
Moclobemide (Manerix)
When taking an MAOI, you should avoid foods with what? What are examples of these foods?
Foods with tyramine:
aged cheeses, sour cream, beer, red wine, avocados, bananas
Major side effects of tertiary amines (TCAs)
Sedation
Weight gain
Autonomic side effects
Examples of tertiary amines
Imipramine (Tofranil)
Amitriptyline (Elavil)
Clomipramine (Anafranil)
Doxepin (Adapin)
In general, side effects of ALL TCAs are….
anticholinergic
CV
neurological
Weight gain
Serotonin syndrome symptoms
hyperthermia, muscle rigidity, myoclonus, restlessness, sweating, shivering, seizures
Serotonin syndrome treatment
- stop medication
- serotonin antagonists - cyproheptadine, methysergide
- benzos for myoclonus
What two drugs are 5HT2 antagonists and weak SERT inhibitors?
Trazodone (Desyrel)
Nefazadone (Serzone)
Rapidly acting antidepressants are ______ antagonists
NMDA
