Final: Antidepressants

Question 1

imipramine (TCA)

Answer 1

Worry about hypotension, anticholinergic, and CV effects

Adverse effects: CNS and peripheral nervous system, anticholinergic effects, withdrawal syndrome, effects may be intolerable to some patients

Drug-drug: Cimetidine, fluoxetine, ranitidine, oral anticoagulants

Question 2

Phenelzine (MAOI)

Answer 2

Works by allowing serotonin, dopamine, and norepinephrine to accumulate

Contraindications: Black box warning for possible suicidal ideation

Adverse effects: More serious or fatal than other antidepressants, GI effects, CV effects

Drug-drug: Tyramine foods, other antidepressants, other sypathomimetic drugs, insulin or oral antidiabetic agents

Question 3

Fluoxetine

Answer 3

SSRI Takes up to 4 weeks for full effect
First line of therapy for depression and anxiety disorders

Treatment of depression, OCD, bulimia, anxiety

Caution: Impaired renal function, severely depressed/suicidal PTs

Adverse effects: Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness, sweating, rash, n/v/d, dry mouth, anorexia, sexual dysfunction, URI, weight loss, fever

Drug-drug: MAOIs, TCAs, drugs that raise 5HT levels, aspirin, NSAIDs, antiplatelet drugs, drugs that affect coagulation

Question 4

Serotonin Syndrome

Answer 4

Rare but potentially lethal adverse effect, occurs within 3 days of starting treatment

Symptoms: Confusion, agitation, disorientation, hallucinations, delirium, seizures, hyperreflexia, tremors, coma, tachycardia, labile blood pressure, diaphoresis, fever, n/v/d, abdominal pain, sweating, fever, agitation