Lecture: antidepressants

Question 1

To be diagnosed with depression:

Answer 1

Symptoms must be present most of the day, nearly every day, for at least 2 weeks

Depressed mood
Loss of pleasure or interest
Insomnia	(or sometimes hypersomnia)
Anorexia	(or sometimes hyperphagia)
Mental slowing and loss of concentration
Feelings of guilt, worthlessness, and helplessness
Thoughts of death and suicide
Overt suicidal behavior

Question 2

Depression can be caused by (3) factors.

Answer 2

environmental, genetic, and biologic

Question 3

The majority of persons who commit suicide have been diagnosed with ___. So ask!!

Answer 3

major depression

Question 4

What is treatment for depression?

Answer 4

antidepressants,
psychotherapy,
ECT,
transcranial magnetic stimulation

Question 5

What is the time course for antidepressants?

Answer 5

initial response 1-3 weeks
Maximal response ~ 12 weeks
Failure no response in 1 month

Question 6

What are the 5 classes of antidepressants

Answer 6

selective serotonin reuptake inhibitors (SSRIs),
serotonin/norepinephrine reuptake inhibitors (SNRIs),
tricyclic antidepressants (TCA),
monoamine oxidase inhibitors (MAOIs), atypical antidepressants

Question 7

Selective serotonin reuptake inhibitors (SSRIs)

Answer 7

• most commonly prescribed antidepressants
• fewer significant adverse effects than TCAs and MAOIs

Side effects: sexual dysfunction, weight gain, nausea, headache, agitation, serotonin syndrome, withdrawal

interactions: MAOIs, antiplatelet and anticoagulants, TCAs and lithium, NSAIDs

Question 8

What is serotonin syndrome?

Answer 8

The side effect of SSRIs that occur 2-72 hours after taking a drug. It can end in death. It stops when drugs are stopped.

Symptoms include:”SRI”
S: sweaty and hot (fever)
R: Rigid muscles, restlessness, and agitation (tremors and hyperreflexia)
I: increased heart rate (tachycardia)

Question 9

What are some common SSRI’s?

Answer 9

fluoxetine, citalopram, escitalopram, fluvoxamine, paroxetine, and sertraline

Question 10

What are some common SNRIs?

Answer 10

venlafaxine, desvenlafaxine, duloxetine, and levominacipran.

Question 11

Tricyclic antidepressants (TCA)

Answer 11

used for depression, bipolar disorder, and fibromyalgia

They block norepinephrine.

Question 12

Adverse effects of TCAs are:

Answer 12

sedation,
orthostatic hypotension,
anticholinergic effects (can’t see, can’t pee, can’t spit, can’t shit),
and the most dangerous is cardiac toxicity

Toxic levels can cause dysrythmias, anticholinergic effects, and CNS depression

8 times the normal dose = OD

Question 13

TCA suffixes

Answer 13

-ipramine, -tyline
and doxepin

most common are: 
amitriptyline "Amy trips on things", 
doxepin, 
nortriptyline,
imipramine "inhibits my peeing"

Question 14

If someone ODs on TCA, give them:

Answer 14

IV sodium bicarbonate (for dysrythmias), and gastroclebage (activated charcoal)

Question 15

Monoamine Oxidase Inhibitors (MAOI)

Answer 15

are used for depression (most often), bulimia nervosa, agoraphobia, ADHD, OCD, and panic attacks.

they work by inhibiting MAO thereby promoting epinephrine, norepinephrine, serotonin, and dopamine.

Question 16

MAOI adverse effects include:

Answer 16

CNS stimulation, orthostatic hypotension and hypertensive crisis ( with tyramine)

For a HTN crisis give IV vasodilators such as sodium nitroprusside, phentolamine, and lebetalol.

Question 17

a hypertensive crisis presents with:

Answer 17

severe headache, tachycardia, HTN, N/V, confusion, profuse sweating, stroke, and even death

Question 18

____ have many interactions. Therefore tell patients to avoid all medications unless approved by provider.

Answer 18

MAOIs

Question 19

___ is a stimulant and suppresses the appetite. It is often combined with SSRI’s to counteract sexual dysfunction and weight gain.

Answer 19

bupropion

Question 20

___ is very sedating and is often used for antidepressant induced insomnia.

Answer 20

trazodone “Trance-e-done - puts in trance”