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Psychiatry > Drug Therapies - Anti-depressants > Flashcards

Drug Therapies - Anti-depressants Flashcards

1
Q

What conditions are Anti-depressants prescribed for?

A

Depression (incl BPD)
Organic mood disorders
Schizoaffective disorder
Anxiety disorders e.g. OCD, panic &social phobia
PTSD
Impulsivity with associated personality disorders

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2
Q

How long do anti-depressants take to work?

A

3-6wks.

The guidelines state a therapeutic trial should last atleast 2 months before you change drug

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3
Q

How long after a depressive episode should someone be on prophylactic anti-depressants?

A

Depends on how many episdoes they’ve had?
1st = 6 months/1 yr
2nd = 2yrs
3rd = ~lifelong

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4
Q

What are the categories of anti-depressants?

A

SSRIs - Selective Seratonin reuptake inhibitors
SNRIs - Serotonin &Noradrenaline reuptake inhibitors
TCAs - Tricyclic
MAOIs - Monoamine Oxidase inhibitors
Novel e,g, Mirtazepine & Buproprion

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5
Q

In what order would we generally use anti-depressants?

A

1) SSRI
2) 2nd SSRI or augment with a novel agent
3) SNRIs
4) TCAs or MAOIs

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6
Q

TCAs are very effective, why aren’t they more commonly used?

A

1st - Easy to OD
2nd - Heavy side effects:
- Antihistaminic e.g. sedation & weight gain
- Anticholinergic e.g. Dry mouth & constipation
- Antiadrenergic e.g. Orthostatic hypotension & sexual dysfunction

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7
Q

What are the types of TCAs?

A

Tertiary - Worse side effects e.g. Amitryptiline

Secondary - active metabolites of tertiary

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8
Q

How do MAOIs work?

A

Bind irreversible to Monoamine oxidase preventing deactivation of dopamine & serotonin

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9
Q

Why don’t we use MAOIs much?

A

Side effects:

  • Orthostatic HTN
  • Weight gain
  • Dry mouth
  • Sedation
  • Sleep disturbance
  • HTN crisis (cheese reaction, due to tyramine-rich foods )
  • Serotonin syndrome if taken with meds that increase serotonin
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10
Q

What are the major side effects of SSRIs?

A 
GI
Sexual dysfunction (main reason patients drop out)
Anxiety
Insomnia/fatigue 
Dizziness/Sedation
Activation syndrome  
Discontinuation syndrome
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11
Q

What’s Activation syndrome?

A

Increased serotonin from SSRIs –>:
Nausea, anxiety, panic & agitation

It only lasts 2-10 days so warn and reassure your patients

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12
Q

What is discontinuation syndrome?

A

Agitation, nausea, disquilibriujm & dysphoria when stopping an SSRI

Fluoxetine has a long half life so can be used to wean off SSRIs

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13
Q

What are the major SSRIs?

A 
Paroxetine
Sertraline!
Fluoxetine!
Citalopram!
Escitalopram`
Fluvoxamine
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14
Q

pros & cons of paroxetine?

A

Good for anxiety as it has quite a lot of sedation

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15
Q

+/- for Sertraline?

A

Has relatively few side effects

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16
Q

Pros of Prozac (Fluloxetine)>

A

Has a long half life so it’s good for compliance issues and preventing discontinuation syndrome

17
Q

What’s the big risk from from citalopram

A

Dose dependant QT prolongation

18
Q

How do SNRI’s work?

A

Affect both serotonin and noradrenaline reuptake, hence they work like TCAs without the big bad side effects

19
Q

List some SNRIs?

A

Venlafaxine

Duloxetine

20
Q

Pros &Cons of venlafaxine?

A

an SNRI:
Pros = good renal clearance & short half life –> little toxic buildup

Cons =

  • Dose dependant diastolic bp increase
  • QT prolongation
  • Sexual dysfunction
  • Bad discontinuation syndrome (due to short half life)
21
Q

Why use duloxetine over venlafaxing?

A

Less BP effect so useful in that context

22
Q

List the major 2 novel antidepressants?

A

Mirtazepine

Buproprion

23
Q

What are the risks with mirtazapine?

A

Increases serum cholesterol & Triglycerides
Weight gain & appetite increase
Sedating at low doses

24
Q

Pros and cons of Buproprion?

A
  • A good augmenter with few side effects. No weight gain, sexual dysfunction, sedation or cardiac problems
  • Is a second line agent for ADHD so consider if patient has ADHD.
  • But increases seizure risk
25
Q

What drugs can we use to treat Resistant Depression?

A

1) Combination antidepressants e.g. SSRI/SNRI with mirtazapine
2) Adjunctive lithium
3) Adjunctive Anti-psychotic
4) ECT

26
Q

What else are SNRI’s helpful with?

A

Neuropathic pain

27
Q

What is serotonin syndrome?

A

Symptoms: abdominal pain, diarrhea, sweats, tachycardia, HTN, myoclonus, irritability, delirium. Can lead to hyperpyrexia, cardiovascular shock and death.

28
Q

How to prevent serotonin syndrome?

A

To avoid need to wait 2 weeks before switching from an SSRI to an MAOI. The exception of fluoxetine where need to wait 5 weeks because of long half-life.

29
Q

How does Mirtazapine work?

A

It is Serotonin receptor antagonist (5HT2)

30
Q

How does Buproprion work?

A

 Mechanism of action likely reuptake inhibition of dopamine and norepinephrine

Psychiatry (22 decks)

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