Major Depressive Disorder AND Anxiety Flashcards by Taylor Fergel

SSRI examples? MOA?

sertraline, (es)citalopram, fluoxetine, fluvoxamine, paroxetine.
inhibit reuptake of 5HT into the presynaptic neuron, increasing 5HT levels in the synaptic cleft.

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SNRI examples? MOA?

(des)venlafaxine, duloxetine, levomilnacipran.
inhibit the reuptake of both 5HT and NE.

5HT - seretonin.
NE - norepinephrine.

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TCA examples? MOA?

amitriptyline, nortriptyline, clomipramine.
block the reuptake of NE and 5HT, but also affect histamine and muscarinic receptors.

dirty SNRIs

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MAOi examples? MOA?

Moclobemide, Selegiline (reversible)
Phenelzine, Tranylcypromine, Isocarboxazid (irreversible)

inhibit monoamine oxidase (enzymes that break down 5HT, NE, and DA), increasing levels of these NTs.

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NDRI example? MOA?

Bupropion.
Weakly inhibit the enzymes involved in the uptake of the neurotransmitters NE and DA from the synaptic cleft.

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NaSSA example? MOA?

Noradrenergic and specific serotonergic antidepressant (NaSSA)

Mirtazapine.
Alpha-2 andrenergic antagonist and alpha-2 heteroreceptor antagonist as well as by blocking 5-HT2 and 5-HT3 receptors.

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Serotonin modulators examples? MOA?

Trazodone, Vilazodone, Vortioxetine.
Inhibit serotonin reuptake, while also modulating specific serotonin receptors, like 5-HT1A, 5-HT3, and 5-HT7.

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NMDA receptor antagonist examples? MOA?

Esketamine.
Acts as a non-competitive antagonist of the N-methyl-D-aspartate (NMDA) receptor.

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Benzodiazepines examples? MOA?

-pam, lorazepam, diazepam, clonazepam.
enhance the effect of GABA at GABA-A receptors (neural inhibition).

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Buspirone MOA?

partial agonist at 5HT1A receptors (NO GABA)!

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First line antidepressants for MDD?

SSRIs, SNRIs, bupropion, Mirtazapine, Vilazodone, Vortioxetine.

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Second line options for MDD?

TCAs, Moclobemide, Trazodone, Quetiapine,

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Third line options for MDD?

MAOi’s.

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Which antidepressents do not cause sexual dysfunction?

More favourable: Desvenlafaxine, bupropion, mirtazapine, vilazodone, vortioxetine.
Neutral: sertraline, levomilnacipran.

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Onset of action of oral antidepressants?

1st week: decreased aggitation + anxiety, improved sleep + appetite.
1-3 wks: increased activity + sex drive, improved self-care, concentration, memory, cognition.
4-8 wks +: releif of depressed mood, return of experiencing pleasure, subsiding suicidal thoughts.

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SSRI AEs?

HANDS
- Headache
- Anxiety
- Nausea
- Diarrhea + other GI disturbances
- Sleep disturbance
also anticholinergic.

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Potential reasons for non-response? (7)

comorbid disorders (inc. substance abuse)
incorrect diagnosis
inadequate dose + duration
non-adherence to tx
persistent AEs
PK + PD factors
unaddressed psychosocial/psychological issues

How many will fail to acheive remission w/ initial pharmacotherapy?

2/3 of patients.

Adjuctive meds for MDD?

1st and 2nd line

1st: aripiprazole, brexpiprazole.
2nd: bupropion, IN esketamine, IV ketamine, olanzapine, quetiapine, risperidone, lithium, cariprazine, mirtazepine/mianserin, modafinil, triiodothyronine.

1st line options for GAD?

SSRIs, SNRIs, pregabalin.

2nd or 3rd line options for GAD?

TCAs (2nd or 3rd), BZDs (2nd), Buspirone (2nd), second gen antipsychotics (3rd line).

1st line options for panic disorder?

SSRIs + SNRIs.

1st line for SAD?

SSRIs, SNRIs, + Pregabalin

1st line agents for PTSD?

and PTSD nightmares.

SSRIs + SNRIs.
Prazosin for nightmares.

1st line agents for OCD?

SSRIs + SNRIs.

What agents should be AVOIDED in PSTD?

BZDs.

When should BB's be used in anxiety?

For performance related SAD.

Considerations for bupropion?

it is activating, risk of seizures. avoid if seizure hx, eating disorder hx, or lyte disturbances.

Considerations for Buspirone?

slow onset, modest efficacy. may be useful to augment therapy in partial responders. avoid if comorbid depression.

Considerations for citalopram?

Lower risk for insomnia, agitation, DDIs compared to other SSRIs. Dose dependent risk of QT prolongation.

Duloxetine considerations?

May be useful for comorbid pain. increased withdrawal, insomnia, + agitation compared to SSRIs. avoid if liver disease or heavy ETOH use.

Escitalopram considerations?

lower risk insomnia, agitation, + DDIs compared to other SSRIs.

Fluoxetine considerations?

more activating than other SSRIs. self-tapering due to long half-life. DDIs!!!

Fluvoxamine considerations?

withdrawal sxs if not tapered. Risk of DDIs due to CYP1A2 + 2C19 inhibition.

Hydroxyzine considerations?

useful for comorbid insomnia. dose-related anticholinergic effects (limits clinical use).

Imipramine considerations?

Anticholinergic, cardiotoxic in OD. Not well tolerated.

Mirtazepine considerations?

Helpful w/ comorbid insomnia. lower doses more sedating. may increase appetitie + weight.

Paroxetine considerations?

compared to other SSRIs - more sedating, less agitation, more constipation, withdrawal. weight gain., DDIs. AVOID IN PREGNANCY.

Pregabalin considerations?

Sedation and dizziness common. Weight gain.

Quetiapine considerations?

concerns for metabolic ADEs, sedation, EPS.

Sertraline considerations?

compared to other SSRIs - insomnia, agitation, dizziness.

Venlafaxine considerations?

compared to other ADs - insomnia or agitation, increased BP. possible benefit for comorbid pain. Few DDIs, withdrawal sxs. better evidence for psychological sxs (ruminative worry).