Just drugs for Depression- Depression ppt Flashcards
Selective Serotonin Reuptake Inhibitors (SSRIs) examples
Fluoxetine (Prozac, Sarafem)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Paroxetine (Paxil, Pexeva)
Citalopram (Celexa)
Escitalopram (Lexapro, Cipralex)
Selective Serotonin Reuptake Inhibitors (SSRIs) side effects
feeling agitated, shaky or anxious
feeling or being sick
diarrhea or constipation
headache or dizziness
blurred vision
dry mouth
sexual dysfunction/ decreased libido
insomnia
sweating
Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
Desvenlafaxine (Pristiq)
Duloxetine (Cymbalta)
Levomilnacipran (Fetzima)
Venlafaxine (Effexor XR)
Serotonin/Norepinephrine Reuptake Inhibitors side effects
Common Side Effects
Nausea
Headache
Nervousness
Sweating
Insomnia*
Hypertension*
Sexual dysfunction*
Tricyclic Antidepressants
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Clomipramine (Anafranil)
Imipramine (Tofranil)
Doxepin (Silenor)
Tricyclic Antidepressants: management pearls
Administer at bedtime to reduce daytime sedation
Orthostatic hypotension: teach pts to sit or lie down when feeling lightheaded
Most dangerous adverse effect: Cardiac toxicity*
Tricyclic Antidepressants side effects sentence
Hot as a hare,
blind as a bat,
dry as a bone,
red as a beet,
mad as a hatter.
Monoamine Oxidase Inhibitors
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (Emsam)
How often are MAOIs used?
rarely used due to side effect profile
Hypertensive crisis
-Severe headache, confusion
-Tachycardia, hypertension, profuse sweating
-Nausea and vomiting
-Stroke and death
To prevent hypertensive event while taking MAOIs:
avoid aged meat, bananas, smoked fish, cheese, wine, beer
Treatment for Hypertensive crisis caused by MAOIs
Treatment: Intravenous vasodilator
Labetalol, sodium nitroprusside, phentolamine
Atypical Antidepressants
Bupropion
When do effects of Bupropion begin?
Antidepressant effects begin in 1 to 3 weeks. A delayed antidepressant effect.
Bupropion can be given with what to increase effect?
Can be given with Paroxetine to augment effect.
Advantages of taking atypical antidepressants like Bupropion
No Weight gain
No Sexual dysfunction
No Sedation
Assist with smoking cessation
Disadvantages of taking atypical antidepressants like Bupropion
No as effective as SSRI
Can increase anxiety
Bupropion side effects
Lowers seizure threshold*
Do not give to an anorexic/bulimic patient or patient with a seizure disorder
Insomnia, agitation, tremor
Weight loss
Nausea, GI upset, take w/food, constipation
Blurred vision, dizziness, headache, dry mouth
Tachycardia
What kind of pts should you avoid giving bupropion to?
Lowers seizure threshold*
Do not give to an anorexic/bulimic patient or patient with a seizure disorder
Serotonin Syndrome- when does it begin?
Often begins within 72 hours after treatment
Effects of Serotonin Syndrome?
Altered mental status (agitation, anxiety, confusion, disorientation, hallucinations, and impaired concentration)
Fever, excessive sweating, incoordination, hyperreflexia, and tremor
What causes Serotonin Syndrome?
Concurrent use of MAOIs and other SSRI agents that raise serotonin*
How does Serotonin syndrome stop?
Spontaneously resolves after discontinuing the drug*
What happens if medication is not stopped when patient has serotonin syndrome?
Can lead to death if medication is not discontinued*
Drug interactions that cause Serotonin Syndrome
MAOIs + SSRIs
SSRIs + SSRIs
Saint John’s Wort
Since MAOIs + SSRIs may cause serotonin syndrome, how should you take these or switch between them?
Minimum 14 day wash-out period required when switching to or from an SSRI
St. John’s wort
Causes serotonin syndrome
Not FDA approved
What is the difference between Sustained Release and Extended Release?
The differences between Wellbutrin XL and Wellbutrin SR are found in the dosing. XL stands for extended release; it only needs to be taken once per day. SR stands for sustained release; it may be taken twice per day.
Rule for XL and SR drugs?
Swallow the tablets whole. Don’t crush, split, or chew them.
Other medical treatments and psychotherapy for Depression (other then drugs)
- Electroconvulsive therapy (ECT)
- Psychotherapy (combined with medications)
- Cognitive behavioral therapy (CBT): focus on cognitive distortions
Electroconvulsive therapy (ECT)
A brief electrical current is passed through the brain to produce generalized seizures lasting 25 to 150 seconds
In general, initial responses to antidepressants won’t develop until when?
Initial response develops after 1 to 3 weeks
Maximal responses for antidepressants will be seen when?
Maximal responses may not be seen for 12 weeks
