Drug Treatments Flashcards
SSRIs
- Prozac (fluoxetine)
- Paxil (paroxetine)
- Zoloft (sertraline)
- Celexa (citalopram)
- Lexapro (escitalopram)
SNRIs
- Effexor (venalafaxine)
- Pristiq (desvenlafaxine)
- Cymbalta (duloxetine)
Side Effects
- 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
Tricyclics
- Tofranil (imipramine)
- Elavil (amitriptyline)
- Similar response rate as SSRIs, but lethal overdose potential
- Until 20 yrs ago most popular antidepressant; now less widely used
Atypical Antidepressants
- 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
St. John’s Wart (hypericum)
- 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)
Amount of people taking antidepressants that do not meet criteria for depression?
over 60%
Amount od patients that see a primary dr and not a psychiatrist?
3 out of 4
Efficacy Rates
- Short term: Full recovery: 25-35%
- Favorable response: 40-60%
STAR*D Trial
> 4,000 patients start on Celexa. keep trying new meds until patients recovers.
< 6% of all pts fully recovered for one year.
New kid on the block… SSRI+?
Viibryd
Antidepressant use since 1990?
- 400% increase
- 4x as many anti d-s as before, no drop in MDD
Viibryd
SSRI that also effects post-synaptic serotonin receptors (not more effective)
How many Americans take anti-d’s over the age of 12?
1 out of 9 over the age of 12 take anti-d’s
short term
full recovery
“favorable response” to SNRIs and SSRIs (?)
full recovery: ~25-35%
“favorable..”: 40-60% (so fifty percent don’t have a stellar response)
