PSYCH: DEPRESSION MEDS Flashcards
What medication is the gold standard for depression?
SSRI
Makes more serotonin available at the synapse
Side Effects of SSRI’s
GI upset
Fatigue
Dry Mouth
Decreased libido
What happens if an SSRI is abruptly discontinued?
Can develop SSRI Discontinuation Syndrome
Pt will feel like they have the flu
Celexa (citalopram) Lexapro (escitalopram) Prozac (fluoxetine) Luvox (fluvoxamine) Paxil (paroxetine) Zoloft (sertraline)
SSRI’s
What is the feel good neurotransmitter?
Serotonin
Serotonin Syndrome
Accumulation of Serotonin
Usually caused by a combination of substances
Everything is elevated, may be fatal
What combination can cause Serotonin Syndrome?
SSRI + MAOI
SSRI + ecstasy
St. John’s Wart
Patients need weeks between SSRI’s and MAOI’s or St.John’s Wart
What are the initial symptoms of Serotonin Syndrome? What might it progress to?
Initial symptoms: MS changes (restless/agitated), lethargy, flushing, confusion, tremors, diaphoresis, and ataxia
May progress to: hyperthermia, renal failure, hypertonicity, seizure, may be FATAL
SNRI
dual action on serotonin and norepinephrine
Possible side effects of SNRI’s
Cardiovascular risk
NV
Weight gain
Somatic symptoms (body ache)
Effexor XR (venlafaxine)
Cymbalta (fluoxetine)
Pristiq (desvenlafaxine)
SNRI’s
Side effects of Cymbalta?
Constipation
Headache
Nausea
What SNRI is good for body aches?
Cymbalta
Which SNRI has less sexual dysfunction?
Pristiq
single dose
NDRIs
Norepi and Dopamine Reuptake Inhibitors
Wellbutrin Wellbutrin XL (bupropion)
NDRI
No weight gain
Nausea and headache
Few sexual side effects
Wellbutrin is also commonly used for ______ ?
Smoking Cessation
A major risk factor of Wellbutrin is …
Decreased Seizure Threshold
Serotonin Antagonist & Reuptake Inhibitors
addresses the sleep and appetite more than anything
Serzone (nefazadone) - hepatotoxicity
**Deseryl (trazedone) - powder doses for sleep only or augmentation (give at night)
Oleptro (pt may feel hungover)
** Remeron (mirtazapine) - helps sleep & appetite (causes weight gain)
SARI’s
This type of medication can have an anticholinergic effect
TCA
What is an anticholinergic effect? What population is at greatest risk?
DRY Elderly (possible orthostatic HTN and increased risk for dysrhythmia)
Elavil (amitriptyline) Sinequan (doxepin) Silenor (newer doxepin) Tofranil (imipramine) Anafranil (clomipramine)
TCA’s
MAOI
Contraindicated with many things and not given often
What is contraindicated with MAOI’s
Nothing containing tyramine
No aged food
No fermented foods
No OTC meds (not even a little bit)
What could potentially happen if a person taking an MAOI eats food containing tyramine
HTN crisis (1st sign is headache commonly in back of head) Can cause stroke
Nardil (heneizine)
Parnate (tranlcypromine)
Marplan (isocarboxacid)
Emsam (selegiline) transdermal patch
MAOI’s
Atypical Antipsychotics
Not first generation and used for depression
Used for augmentation (helps to rapidly control sx)
Atypical Antipsychotics are most commonly used to tx ….
Schizophrenia
This medication is given in low doses to rapidly control symptoms of severe depression
Atypical Antipsychotics
Zyprexa
Seroquel
Abilify
Atypical Antipsychotics
Zyprexa and Seroquel carry a risk for …
Metabolic Syndrome (fat gain; ex: fatty liver)
