Mood and Affect

Question 1

tricyclic antidepressants (TCAs)

Answer 1

amitriptyline, doxepin

• blocks neuronal reuptake of norepinephrine and serotonin

Adverse Effects: drowsiness, sedation, suicide ideations, vision disturbances, dry mouth, orthostatic hypotension, arrhythmias, urinary retention, constipation, photosensitivity

• Can’t see, pee, spit, sh*t

Interactions: Antiemetics (5HT3; risk for serotonin syndrome); MAOIs (severe excitation); St. John’s Wort (Risk for serotonin syndrome); Oral contraceptives (increase drug levels); smoking (lower drug levels)

Question 2

monoamine oxidase inhibitors (MAOIs)

Answer 2

phenelzine

• increase epinephrine, norepinephrine, serotonin in CNS; inhibits MAO (MAO enzyme breaks down norepinephrine and serotonin)

adverse effects: sleep disturbances, dizziness, myoclonic movements, orthostatic hypotension, dry mouth, constipation, urine retention, hypertensive crisis, liver toxicity

interactions: Tyramine foods (risk of hypertensive crisis), insulin/hypoglycemics, antihypertensives (have increased effects), Ginseng (adverse effects)

Question 3

selective serotonin reuptake inhibitors (SSRIs)

Answer 3

citalopram, fluoxetine, paroxetine, trazodone

• enhances serotonin in CNS by inhibiting reuptake of serotonin

adverse effects: insomnia, dizziness, impaired concentration, tremors, suicide ideations, orthostatic hypotension, tachycardia, prolonged QTI, dry mouth, constipation, dysmenorrhea, altered libido, weight gain/loss

Interactions: antiarrhythmics (cause prolonged QTI), MAOIs (severe excitation, hyperpyrexia, seizures w/ high doses), TCAs (risk of serotonin syndrome, St. John’s Wort (serotonin syndrome)

Question 4

mirtizaprine

Answer 4

other antidepressants

• enhance serotonin activity in CNS

Adverse effects: insomnia, abnormal dreams, dizziness, impaired concentration, agitation, hypotension, HTN, increased appetite, constipation, taste disturbance, urinary frequency, weight gain, muscle aches, dry mouth

Contraindications: MAOI, antiemetics, St. John’s Wort

• monitor for suicidal thinking, sedative effects
• may not reach therapeutic effects for 4 weeks

Question 5

bupropion

Answer 5

Other Antidepressant

• Unknown, but thought to weakly inhibit norepinephrine, dopamine and serotonin reuptake in the CNS neurons

Adverse effects: insomnia, abnormal dreams, dizziness, impaired concentration, akinesia, agitation, hypotension, tachycardia, HTN, dry mouth, constipation, taste disturbance, urinary frequency, dysmenorrhea, altered libido, muscle aches, photosensitivity

Contraindications: SSRIs, MAOI, St. John’s Wort (Serotonin Sydrome), Nicotine replacement agents

• observe for suicidal thinking/behavior, sedative effects
• drug may take 4 weeks to reach therapeutic effect

Question 6

typical antipsychotics

Answer 6

haloperidol, thioridazine

Treats: Schizophrenia

• block dopamine receptors; prevent stimulation of postsynaptic neurons by dopamine

Contraindications: dementia (CV events/death), parkinson’s (further decrease dopamine), history of seizures (possible neuro-sensitivity), glaucoma (can worsen)

Adverse Affects: dystonia, neuroleptic malignant syndrome, akathisia, pseudoparkinsonism, tardive dyskinesia, anticholinergic effects (dry mouth, flushing, constipation, urinary retention)

Question 7

atypical antipsychotics

Answer 7

clozapine, risperidone

• block dopamine/serotonin receptors; help alleviate some unpleasant effects of typical antipsychotics

Adverse effects: weight gain, hypersalivation, sedation, agranulocytosis (low WBC’s)

Contraindications: dementia, QT syndrome, Antiarrhythmic (prolonged QTI), antihypertensives (have increased effects)

Question 8

bipolar medications

Answer 8

lithium

• stabilizes neurotransmitter glutamate (shapes learning and memory) via sodium channels

Treats: Acute mania/bipolar disorder

Adverse effects: drowsiness, restlessness, confusion, incoordination, palpitations, hypotension, metallic taste, urinary incontinence, erectile dysfunction, hyperglycemia, hypothyroidism, hyponatremia, dry mouth, visual disturbances, drying/thinning of hair, seizures, bradycardia, arrhythmias, renal toxicity

Contraindications: MAOI/TCA/SSRI (Serotonin Syndrome), Antihypertensive (Have increased effects), Antiarrhythmic (Prolonged QTI)