Exam 5 (final) - Watts Antidepressants Flashcards
brain-derived neurotrophic factor (BDNF) effect on depression (neurotrophic hypothesis)
stress and pain decrease BDNF levels in animals
-has antidepressant activities in animals
-depressed pts have less BDNF
-antidepressant meds increase BDNF
-some drugs cause decreased BDNF levels (glucocorticoids)
targets of fluoxetine and trazodone
5HT-2 reuptake receptors
targets of desipramine and maprotiline
NE reuptake receptors
targets of MAOi
MAO (block conversion to metabolites?)
Why is there a delay in clinical effect for some antidepressants?
-reason that therapy takes about 2-3 weeks before effectiveness
reason is not really known for sure
mechanism of MAOis
inhibit Monoamine Oxydase in presynaptic neuron
-importance of this is NE and 5HT is normally degraded by MAO
-now more 5HT and NE is released from vesicles into synapse
MAO inhibitors “severe” SE
HA
drowsiness
dry mouth
weight gain
orthostatic hypotension
sexual dysfxn
MAOi clinical pearls
avoid foods with tyramine (many but some examples are cheeses, sour cream, liver, lots of meats like pepperoni, beer, red wine, avocados, bananas)
tricyclic antidepressants (tertiary amines) MOA
inhibit both NE and 5HT reuptake via NET and SERT
tricyclic antidepressants (tertiary amines) SE
sedation (most of any class for depression)
weight gain (most of any class for depression)
heart conduction disturbances
tricyclic antidepressants (tertiary amines) options
imipramine (Tofranil)
amitriptyline (Elavil)
trimipramine (Surmontil)
clomipramine (Anafranil)
doxepin (Adapin, Sinequan)
tricyclic antidepressants (secondary amines) options
desipramine (Norpramin)
nortriptyline (Pamelor)
pretriptyline (Vivactil)
maprotiline (Ludiomil)
tricyclic antidepressants (secondary amines) SE
less but still some of:
sedation
weight gain
anticholinergic effects
autonomic effects
cardiovascular effects
general all TCA SE
weight gain
anticholinergic effects
neuro
CV (in elderly)
SSRIs MOA
inhibit 5HT presynaptic neuron receptors
-increases amount of 5HT in synapse
-5HT in synapse stays there longer and remains active longer