Drug Treatments

Question 1

SSRIs

Answer 1

• Prozac (fluoxetine)
• Paxil (paroxetine)
• Zoloft (sertraline)
• Celexa (citalopram)
• Lexapro (escitalopram)

Question 2

SNRIs

Answer 2

• Effexor (venalafaxine)
• Pristiq (desvenlafaxine)
• Cymbalta (duloxetine)

Question 3

Side Effects

Answer 3

• Emotional numbing
• Anorgasmia/sexual response
• Reduced “error detection” (anterior cingulate) governs over detection, drives consciousness, perfection and so on (give a damn level)
• weight gain
• Insomnia (sleep not as restful)
• Grinding of teeth (bruxism)
• Withdrawal syndrome
• Activation syndrome
• Gastrointestinal Distress
• Birth defects, heart defects, lung defects, add, risk of autism
• Tardive dysphoria= long antidepressant usage leads to more depression
• occasionally increased suicide risk

Question 4

Tricyclics

Answer 4

• Tofranil (imipramine)
• Elavil (amitriptyline)
• Similar response rate as SSRIs, but lethal overdose potential
• Until 20 yrs ago most popular antidepressant; now less widely used

Question 5

Atypical Antidepressants

Answer 5

• Wellbutrin (bupropion)
• Remeron (mirtazapine)
  Wellbutrin works on dopamine/reward circuits
• (spontaneous orgasm)
• only one that targets dopamine
• things more pleasurable
• potentially ups anxiety levels
• higher dosages can cause seizure and look like epilepsy
• below 300mg low dose
  Remora hits dopamine and serotonin circuits
• evidence of high response rate
• major weight gain

Question 6

St. John’s Wart (hypericum)

Answer 6

• Largest U.S. study: St John’s = placebo, but both = Zoloft
• acts like and ssri in the brain
• but companies say: st. john’s wort: ineffective for MDD because didn’t beat placebo.
  but Zoloft = GOOOOOD! (when not really)

Question 7

Amount of people taking antidepressants that do not meet criteria for depression?

Answer 7

over 60%

Question 8

Amount od patients that see a primary dr and not a psychiatrist?

Answer 8

3 out of 4

Question 9

Efficacy Rates

Answer 9

• Short term: Full recovery: 25-35%

- Favorable response: 40-60%

Question 10

STAR*D Trial

Answer 10

> 4,000 patients start on Celexa. keep trying new meds until patients recovers.
< 6% of all pts fully recovered for one year.

Question 11

New kid on the block… SSRI+?

Answer 11

Viibryd

Question 12

Antidepressant use since 1990?

Answer 12

• 400% increase

- 4x as many anti d-s as before, no drop in MDD

Question 13

Viibryd

Answer 13

SSRI that also effects post-synaptic serotonin receptors (not more effective)

Question 14

How many Americans take anti-d’s over the age of 12?

Answer 14

1 out of 9 over the age of 12 take anti-d’s

Question 15

short term
full recovery
“favorable response” to SNRIs and SSRIs (?)

Answer 15

full recovery: ~25-35%

“favorable..”: 40-60% (so fifty percent don’t have a stellar response)

Question 16

Placebo vs. No Treatment?

Answer 16

Placebo KICKS ASS. b/c patient thinks they are on medicine. But, trained clinician can tell who is on drug and who is not (via side effects)

Question 17

Across 47 studies in FDA database….

Answer 17

meds beat placebo in fewer than half of studies.

- overall, placebo ~ 80% of drug response

Question 18

Iatrogenic

Answer 18

• illness caused by meds

- treatment is supposed to be helpful but causes negative effects

Question 19

NOCEBO

Answer 19

negative effects of a placebo study