Drugs Flashcards
Time-tested, very effective
More effective in severe depression
Blood levels
Tricyclic Antidepressants (TCAs)
Safe, effective
Multiple indications: GAD, social anxiety, panic, OCD, PTSD, PMDD
Selective Serotonin Reuptake Inhibitors (SSRIs)
Hypotension, orthostasis
Anticholinergic side effects, weight gain
Sexual side effects
Dangerous in overdose: 10 day supply can be lethal
Tricyclic Antidepressants (TCAs)
Some evidence more effective
Safe, better tolerated than TCAs
Multiple indications
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Can be very effective in non-responsive patients, especially *atypical depression
Time-tested
Monoamine Oxidase Inhibitors (MAOIs)
atypical: more sleep and food. Leadlimbs
No sexual side effects
Weight neutral
Buproprion
Diarrhea Nausea Jitteriness/Anxiety Sexual side effects Drug interactions: P450 inhibition
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRI also good in bulimia
Sexual side effects are the worst
Hypotension, orthostasis Dry mouth, constipation, urinary retention Sexual side effects Weight gain Hypertensive crisis--Tyramine reaction
Monoamine Oxidase Inhibitors (MAOIs)
lethal interactions DDI
“Libby”
Sexual side effects Sweating Increased diastolic blood pressure Withdrawal syndrome Flu-like, “electric shocks”
Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
Increased anxiety, jitteriness, ineffective in panic
Insomnia
**Higher seizure risk: contraindicated in eating disorder patients and those with seizure disorder
Buproprion
NO SEX SIDE EFFECTS
Weight neutral
Helpful with insomnia
Rapid anti-anxiety effect
Low incidence of sexual side effects
Mirtazapine
Summary of Antidepressants: A Treatment with Limitations
All are monoamine-based
All have modest efficacy
All have relatively slow onset
All have tolerability issues, especially in the long-term
effects on glycogen synthase kinase-3beta and protein kinase C may lead to neuroplastic changes associated with mood stabilization.
Lithium:
Daytime somnolence
Weight gain
Mirtazapine
principal mechanism of action believed to be the inhibition of the transamination of GABA.
Divalproex
Best studied, best proven drug Effective anti-manic, reasonable preventative agent, some antidepressant effect Anti-suicidal properties Neuro-regenerative effects Cheap $4 generic program
Lithium
Individualized treatment (based on weight) Rapid loading (20-30 mg/kg) Safe and effective
Divalproex Sodium
Tremor, nausea, diarrhea, taste, thirst, cognitive dulling
Narrow therapeutic window (0.6-1.2 mEq/l)
Toxic/lethal in overdose
Renal effects
Decreased urine concentration (20-30% of pts)
Diabetes insipidus
5-10% Hypothyroidism
Lithium
Not proven as preventative agent
Weight gain, sedation
Not effective in bipolar depression
Divalproex Sodium
All are anti-manic
Reasonably safe & effective
Different routes of administration
Atypical/Second Generation Antipsychotics
Mania: multiple medications effectively treat it
Bipolar depression: very difficult to treat; quetiapine, lurasidone, lithium and possibly lamotrigine are best treatments thus far
Antidepressant use in bipolar disorder is controversial and not well proven.
Prevention:___________________
lithium, aripiprazole, olanzapine, lamotrigine
Prevention of Future Episodes Bipolar
Lithium: best established Lithium + divalproex: Very good, but many side effects Aripiprazole Olanzapine Lamotrigine
Mania: multiple medications effectively treat it
Bipolar depression: very difficult to treat; ___________________ are best treatments thus far
Antidepressant use in bipolar disorder is controversial and not well proven.
Prevention: lithium, aripiprazole, olanzapine, lamotrigine
quetiapine, lurasidone, lithium and possibly lamotrigine
Mania: multiple medications effectively treat it
Bipolar depression: very difficult to treat; quetiapine, lurasidone, lithium and possibly lamotrigine are best treatments thus far
Antidepressant use in bipolar disorder is __________________
Prevention: lithium, aripiprazole, olanzapine, lamotrigine
controversial and not well proven.
Weight gain
Risk of diabetes
Risk of increased cholesterol/lipids
Expensive
Atypical/Second Generation Antipsychotics
