Drugs

Question 1

Time-tested, very effective
More effective in severe depression
Blood levels

Answer 1

Tricyclic Antidepressants (TCAs)

Question 2

Safe, effective

Multiple indications: GAD, social anxiety, panic, OCD, PTSD, PMDD

Answer 2

Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 3

Hypotension, orthostasis
Anticholinergic side effects, weight gain
Sexual side effects
Dangerous in overdose: 10 day supply can be lethal

Answer 3

Tricyclic Antidepressants (TCAs)

Question 4

Some evidence more effective
Safe, better tolerated than TCAs
Multiple indications

Answer 4

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Question 5

Can be very effective in non-responsive patients, especially *atypical depression
Time-tested

Answer 5

Monoamine Oxidase Inhibitors (MAOIs)

atypical: more sleep and food. Leadlimbs

Question 6

No sexual side effects

Weight neutral

Answer 6

Buproprion

Question 7

Diarrhea
Nausea
Jitteriness/Anxiety
Sexual side effects
Drug interactions: P450 inhibition

Answer 7

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRI also good in bulimia

Sexual side effects are the worst

Question 8

Hypotension, orthostasis
Dry mouth, constipation, urinary retention
Sexual side effects
Weight gain
Hypertensive crisis--Tyramine reaction

Answer 8

Monoamine Oxidase Inhibitors (MAOIs)

lethal interactions DDI
“Libby”

Question 9

Sexual side effects
Sweating
Increased diastolic blood pressure
Withdrawal syndrome
Flu-like, “electric shocks”

Answer 9

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Question 10

Increased anxiety, jitteriness, ineffective in panic
Insomnia
**Higher seizure risk: contraindicated in eating disorder patients and those with seizure disorder

Answer 10

Buproprion

NO SEX SIDE EFFECTS
Weight neutral

Question 11

Helpful with insomnia
Rapid anti-anxiety effect
Low incidence of sexual side effects

Answer 11

Mirtazapine

Question 12

Summary of Antidepressants: A Treatment with Limitations

Answer 12

All are monoamine-based
All have modest efficacy
All have relatively slow onset
All have tolerability issues, especially in the long-term

Question 13

effects on glycogen synthase kinase-3beta and protein kinase C may lead to neuroplastic changes associated with mood stabilization.

Answer 13

Lithium:

Question 14

Daytime somnolence

Weight gain

Answer 14

Mirtazapine

Question 15

principal mechanism of action believed to be the inhibition of the transamination of GABA.

Answer 15

Divalproex

Question 16

Best studied, best proven drug
Effective anti-manic, reasonable preventative agent, some antidepressant effect
Anti-suicidal properties
Neuro-regenerative effects
Cheap
$4 generic program

Answer 16

Lithium

Question 17

Individualized treatment (based on weight)
Rapid loading (20-30 mg/kg)
Safe and effective

Answer 17

Divalproex Sodium

Question 18

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

Answer 18

Lithium

Question 19

Not proven as preventative agent
Weight gain, sedation
Not effective in bipolar depression

Answer 19

Divalproex Sodium

Question 20

All are anti-manic
Reasonably safe & effective
Different routes of administration

Answer 20

Atypical/Second Generation Antipsychotics

Question 21

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:___________________

Answer 21

lithium, aripiprazole, olanzapine, lamotrigine

Question 22

Prevention of Future Episodes Bipolar

Answer 22

Lithium: best established
Lithium + divalproex: Very good, but many side effects
Aripiprazole
Olanzapine
Lamotrigine

Question 23

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

Answer 23

quetiapine, lurasidone, lithium and possibly lamotrigine

Question 24

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

Answer 24

controversial and not well proven.

Question 25

Weight gain
Risk of diabetes
Risk of increased cholesterol/lipids
Expensive

Answer 25

Atypical/Second Generation Antipsychotics