Medications for Depressive Disorders

Question 0

Tricyclic Antidepressant Medications:

Medications

Answer 0

1. Anafranil
2. Amitriptyline (Elavil)
3. Tofranil
4. Norpramn

Question 1

Four main groups

Answer 1

1. Tricyclic Antidepressants (TCAs)
2. Selective Serotonin Reuptake Inhibitors (SSRIs)
3. Monoamine Oxidase Inhibitors (MAOIs)
4. Atypical Antidepressants

Question 2

Tricyclic Antidepressant Medications:

Action

Answer 2

Works by blocking reuptake of norepinephrine and serotonin in the nerve cells of the brain, there by intensifying the effects and prolonging the mood lightening effect of the neurotransmitters.

Question 3

Tricyclic Antidepressant Medications:

Side effect

Answer 3

1. Sedation, best taken before bed, do not take w/ Alcohol
2. Orthostatic Hypotension
3. Anticholinergic effects- dry mouth, blurred vision, photophobia, urinary retention, constipation, Tachycardia
4. Decrease seizure threshold
5. Excessive sweating
6. Toxicity- cardiac toxicity- dysrhythmias, mental confusion…

Question 4

Selective Serotonin Reuptake Inhibitors:

Medications

Answer 4

1. Celexa
2. Lexapro
3. Prozac
4. Paxil
5. Zoloft

Question 5

Selective Serotonin Reuptake Inhibitors:

Action

Answer 5

1. Work by preventing reuptake of serotonin in the nerve cells of the brian. This intensifies the effects of serotonin and prolongs the mood lightening effect of any released serotonin.

Question 6

Selective Serotonin Reuptake Inhibitors:

Side effects

Answer 6

1. May cause suicidal thoughts
2. Sexual dysfunction
3. CNS Stimulation (Take med in the morning, avoid caffeine)
4. Serotonin Syndrome- 2-72 hrs after start, Mental confusion, abd pain, diarrhea, agitation, fever, anxiety, hallucination, tremors
5. Withdrawal syndrom
6. Hyponatremia- watch w/diuretics
7. GI Bleeding- watch with anti-coags. (take w/food)
8. Bruxism (excessive grinding of teeth or clenching of jaw)

Question 7

Monoamine Oxidase Inhibitors:

Medications

Answer 7

1. Nardil

2. Parnate

Question 8

Monoamine Oxidase Inhibitors:

Action

Answer 8

1. Block MAO in the brain, thereby increasing the amount of norepinephrine, dopamine, and serotonin available for transmission of impulses. Intensifies responses & relieves depression.

Question 9

Monoamine Oxidase Inhibitors:

Side-effects

Answer 9

1. CNS Stimulation (give in morning)
2. Orthostatic Hypotension
3. HYPERTENSIVE CRISIS (headache, nausea, increased BP, HR)

Question 10

Monoamine Oxidase Inhibitors:

Medication&Food Interactions

Answer 10

1. Prozac (SSRI) is slow to leave body- must discontinue 5 weeks prior to starting MAOI. When on SSRI and starting MAOI discontinue 14 days prior.
2. Antihypertensives- may cause hypotensive crisis
3. Tyramine-rich foods-> HYPERTENSIVE CRISIS

Question 11

Tyramine-rich foods

Answer 11

1. meats
2. beer & wine
3. aged cheese
4. avocados
5. figs
6. bananas
7. protein, dairy

Question 12

Atypical Antidepressants:

Medications

Answer 12

1. Wellbutrin
2. Effexor
3. Cymbalta

Question 13

Atypical Antidepressants:

Action

Answer 13

1. Inhibit dopamine uptake

Question 14

Atypical Antidepressants:

Side effects

Answer 14

1. Headache, dry mouth, GI distress, constipation, increased HR, restlessness, insomnia,
2. suppression of appetite-> weight loss
3. Seizures, especially at high doses.
   Discontinue MAOIs 2 weeks prior.

Question 15

Patient Education:

Answer 15

1. Therapeutic effects may not show until 1-3 weeks, full effects 2-3 months.
2. Sudden discontinuation-> relapse
3. therapy usually continues for 6 months-1 yr. or longer