Pharmacology for Depressive Disorders

Question 1

What are some examples of SNRI medications? When would you consider prescibing an SNRI?

Answer 1

Duloxetine
Venlafaxine
Desvenlafaxine
Levomilnacipran

first line for depressive disorders

Considered to be a bit stronger than SSRI due to NE uptake inhibition and contributes to pain control- though this increases activation, HTN, sweating

Question 2

List an example of a multimodal antidepressant and circumstances in which you would use this

Answer 2

Vortioxetine
theoretical enhanced cognitive function
less withdrawal
less sexual dysfunction

Question 2

What class of medication does Wellbutrin belong to? When would you prescribe this medication?

Answer 2

NDRI
First line for depressoive disorders
Buproprion is activating and manages anergia, a motivation, hypersombia
2nd line for ADHD
used in smoking cessation

Question 3

What medication is used for depression and IBS- constipation subtype and why?

Answer 3

Serotonin partial agonist and reuptake inhibitor (SPARI)
VIlazodone
acts on serotonin receptor in brain AND gut
causes diarrhea

Question 4

what class is mirtazapine

Answer 4

nonadrenergic and specific serotonergic agent

good for comorbid anxiety, insomnia, nausea, weight loss
basically used to improve sleep and increase appetite
may reverse sexual dysfunction

Question 5

trazodone

Answer 5

serotonin antagonist reuptake inhibitor
low dose- only for sedation
high dose- antidepressant but very sedating and therefore second line

Question 6

What are the side effects of TCAs? What are the safety?

Answer 6

Anticholinergic- M1 blockade- dry mouth, blurry vision, constipation, urinary retension
Dizziness- postural hypotension due to alpha blockade
Sedation- alpha 1 and H1 blockade
Weight gain- H1 blockade

Question 7

What are examples of TCAs and when should they be used?

Answer 7

second line because of side effect burden
useful in insomnia and pain syndromes

amitryptaline, clomipramine, desipramine, nortriptyline

CLOMIPRAMINE is extremely helpful in OCD but again second line because of side effects

VERY toxic in OD

Question 8

Reversible MAO

Answer 8

Moclobemide
Second line
well tolerated
useful for social anxiety
no sexual dysfunction
no dietary restrictions

Question 9

Irreversible MAO

Answer 9

third line due to drug interactions
specialized diet needed because of tyramine
SEROTONIN SYNDROME with SSRI

Question 10

How to prevent serotonin syndrome when switching from MAOI to SSRI or vice versa

Answer 10

MAOI to SSRI 10 day washout
SSRI to MAOI 5 half-life washout