Exam 10: Antidepressants Flashcards
What are two Tricyclic Antidepressants?
Imipramine
Amitriptyline
What are Imipramine and Amitriptyline?
Tricyclic Antidepressants
Name 6 SSRIs
Fluoxetine Fluvoxamine Sertraline Paroxetine Citalopram Escitalopram
Name 2 SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)
Venlafaxine
Duloxetine
Name 4 second generation (atypical) antidepressants
Trazodone
Nefazodone
Bupropion
Mirtazepine
Name 1 Selective Norepinephrine Reuptake Inhibitor
Atomoxetine
Name 3 MAO Inhibitors
Phenelzine
Tranylcypromine
Selegiline
Name 4 Mood Stabilizers
Lithium carbonate
Valproic Acid analogs
Carbamazepine
Clonazepam
Fluoxetine category
SSRI
Fluvoxamine category
SSRI
Sertraline category
SSRI
Paroxetine category
SSRI
Citalopram category
SSRI
Escitalopram category
SSRI
Venlafaxine category
SNRI
Duloxetine category
SNRI
Atomoxetine category
Selective Norepinephrine reuptake inhibitor
Phenelzine category
MAO Inhibitor
Tranylcypromide category
MAO Inhibitor
Selegiline category
MAO Inhibitor
Lithium category
Mood stabilizer
Valproic acid analog category
Mood stabilizer
Carbamazepine category
Mood stabilizer
Clonazepam category
Mood stabilizer
What are three first line drug categories for depression?
Tricyclics
SSRIs
Miscellaneous Second gen antidepressants (Atypical)
What is a second line category of drug for depression?
MAO Inhibitors
What is an anti anxiety drug that is thought to have antidepressant activity?
Alprazolam (Xanax)
What is a problem with the use of antidepressants in Manic Depressive Disorders?
They can help with depression, but may trigger a switch to the manic phase
What is the main benefit of SSRIs over Tricyclics?
They are safer, not really more efficacious.
What can’t you eat if you’re on MAO inhibitor?
foods that contain Tyramine will cause a massive release of catecholamines
What is a side effect that is pronounced in Trazodone and Nefazodone?
Very sedating
Imipramine Pharmacological Effects (5) (prototype for antidepressants)
- Sedation
- Antidepressant effects develops slowly over 2-4 weeks
- Can also treat OCD, panic attacks, generalized anxiety disorder, social phobias
- CNS Stimulation (usually at higher doses)
- Decreased seizure threshold
Imipramine mechanism of action (2) (other antidepressants)
- Inhibits reuptake of NE, 5-HT and/or DA
2. Adaptive changes in receptors and signaling pathways
What is special about Bupropion?
It has the most major effect on DA reuptake inhibition (most others barely affect this or don’t at all)
What side effects are not seen in SSRIs?
Cardiovascular side effects because they don’t affect NE and don’t have anticholinergic activity
What is an additional mechanism seen in second gen antidepressants (not SSRIs or Tricyclics)?
Blockage of alpha 2 receptors
Can affect the cardiovascular system
Which of the first line antidepressants has the worst anticholinergic effect? the least?
Amitriptyline is the worst
SSRIs have the least effect
What are cardiovascular effects of antidepressants? Why?
Postural hypotension due to alpha blockade
Tachycardia (NE, anticholinergic)
Arrhythmias
CNS side effects of antidepressants
Tremor Agitation, anxiety, irritability switch to manic phase parkinsonism increased risk of seizures
What antidepressants are most/least likely to cause weight gain?
Most = tricyclics Least = SSRIs
What is a potentially fatal side effect of antidepressants?
blood dyscrasias
How can antidepressants affect sex?
Impotence or delay of orgasm in males due to alpha blockade (very common)
retrograde ejaculation can occur
What is the traditional antidote to tricyclic toxicity?
Bicarb (alkalinize the urine)
What is a major consideration when prescribing drugs to a depressed person?
They may be suicidal. The drugs you give them may be used to commit suicide
What is a potential interaction of MAO inhibitors?
Serotonin syndrome can happen if switch patients between MAOIs and tricyclics/SSRIs too quickly
What are some other uses of antidepressants?
Enuresis (imipramine) intractable pain from neuropathies chronic pain cocaine/amphetamine dependence Anxiety/panic disorders OCD
What is a consideration when prescribing antidepressants to children?
May increase suicidal ideation, especially shortly after drug therapy is initiated.
What effects are different about Amitryptiline vs Imipramine
Amitriptyline has more sedative and anticholinergic activity than imipramine
Fluoxetine
Prototype SSRI
Treats depression, OCD, GAD, PMMD, eating disorders
Long acting, takes a while to work
Liver metabolism- drug interactions (CYP)
sertraline
SSRI
Less drug interactions than Fluoxetine
Paroxetine
SSRI
SHORTER ACTING than Fluoxetine and Sertraline
More weight gain than other SSRIs
Citelopram and Escitalopram
Newest SSRIs
Similar to Sertraline (fewer drug interactions than Fluoxetine)
What is an advantage of Fluoxetine?
Longer acting, protects against discontinuation symptoms
Fluvoxamine uses (2)
- Antidepressant used in foreign countries
2. Used of Obsessive Compulsive disorder in the USA
Bupropion mechanism
Selectively blocks DA reuptake
Bupropion effects
“Psychic energizer” with mild stimulant activity
Disadvantage of Bupropion
More likely to cause seizures than other antidepressants
Bupropion use
Treatment of nicotine, cocaine, amphetamine dependence
Bupropion advantage
Less likely to cause sexual side effects than other antidepressants
Uses of Venlafaxine (2)
- Depression
2. Generalized anxiety disorder
Venlafaxine effects
Improve mood, energize depressed patients
May work in patients who do not respond to SSRIs
Venlafaxine side effects
Stimulant-like effects (sweating, nausea, anxiety, nervousness)
Duloxetine uses
Musculoskeletal and neuropathic pain as well as depression/anxiety
Trazodone/Nefazadone mechanism
Serotonin reuptake inhibitor that also blocks 5-HT receptors (idk how this makes sense)
Trazodone/Nefazadone side effects (2)
- Priapism/sexual dysfunction in males
2. highly sedating
Mirtazapine mechanism
Blocks alpha-2 receptors, enhancing serotonin and NE release
Also blocks some types of serotonin receptors
Mirtazapine side effects
Anticholinergic, hypotension, tachycardia (similar to tricyclics)
In whom is Mirtazapine especially effective
Depression with high levels of anxiety
Atomoxatine use
ADHD in children and adults
Atomoxatine side effects
Appetite suppression, increased BP, tachycardia, sexual dysfunction in adult males
How do MAO inhibitors take effect?
Slowly, take weeks to develop
MAO inhibitors side effects
Orthostatic hypotension, hypertension, GI effects, CNS stimulation, liver damage
What is a severe problem with MAO inhibitors?
If taken with foods containing lots of Tyramine can cause hypertension, fever, convulsions.
Same can happen if the patient has a pheochromocytoma or is on sympathomimetics
MAO inhibitor uses (3)
- Depression (second line)
- Bulimia, OCD, PTSD
- Narcolepsy
Lithium effects on the CNS
On most people it has no affect
On people with bipolar disorder it is a mood stabilizer
Lithium Mechanism
May alter metabolism of phospholipids that are involved in the phospholipid signaling pathway
May also affect distribution of ions or the release of neurotransmitters
Pharmacokinetic consideration of Lithium
Excreted by kidney, use with caution in patients with impaired renal function
What can early lithium toxicity mimic?
Alcohol intoxication
What are 4 patents who shouldn’t get Lithium?
- Pregnancy
- Renal impairment
- CV disease
- thyroid disease
What are 4 drugs used to treat manic depression?
- Lithium
- Carbamazepine
- Valproic Acid
- Clonazepam
What do you need to do before giving an MAO inhibitor?
Make sure that they’ve stopped taking tricyclics long enough
What drug is preferred for MILD depression with anxiety?
Alprazolam (Xanax)
