Psychiatry Drugs for Depression Flashcards
What are the SSRIs?
Uses?
SEs
5-HT specific Reuptake Inhibitors
Fluoxetine
Paroxetine
Sertraline
Citalopram
Used for Depression General Anxiety Disorder OCD Bulemia SOCIAL PHOBIAS PTSD
Symptoms may get worse before they get better so give at low doses first
SEs
Fewer than the TCAs, main one is sexual dysfunction ie anorgasmia and decreased libido–>decreased compliance
May see bruxism (grinding of teeth)
Serotonin Syndrome with any drug that increases 5-HT
What is serotonin syndrome? What can treat it?
Increased neuromusc activity
–ie clonus, increased reflexes, muscle rigidity
Increased neuro: Confusion, agitation
Increased autonomic: Incr HR, BP, Hyperthermia
Treat with Cyproheptadine
What are the SNRIs and what do they treat?
Venlafaxine, Duloxetine
Depression (Venlafaxine: generalized anxiety and panic disorders)
Block 5-HT & NE REUPTAKE
SE: Increased BP, sedation, nausea
What is duloxetine implicated for causing?
Diabetic peripheral neuropathy
What are the Tricyclic Antidepressants?
Divided into Tryptylines & Ipramines
Tryptylines
Amitryptyline (Trigeminal Neuralgia, shingles, basically nerve pain) & Nortryptyline
Ipramines
Imipramine, Desipramine, Clomipramine
Randoms
Doxepin & Amoxapine (can cause drug induced Parkinsons)
What do the TCAs treat and how do they work?
Major Depression, OCD (clomipramine), fibromyalgia (amitryptyline)
Block 5-HT & NE reuptake, also some a-1 block
Block the Na fast Channell (phase 0) which can lead to arrythmias bc will cause a prolonged QRS. could cause the 3 Cs: Cardiotox, Convulsions, Coma. Treat cardiotox with NaHCO3
SEs Sedation
a1 block–>postural hypotension
anti-cholinergic–>tachy, urinary retention, dry mouth (mostly with ami), confusion in elderly
Desi good for causing seizures
What are the MAO Inhibitors
How do they work?
MAO Takes Pride In Shanghai
Tranylcypromine (MAO A&B)
Phenelzine
Isocarboxazid
Selegiline (MAO-B)
Non selective MAO Inhibitor, increase levels of amine NTs –>NE, DA, 5-HT
Used for atypical depression
What are the SEs with MAO Inhibitors?
Contras?
SEs:
Hypertensive crisis esp with tyramine ingestion, chocolate, wine, avocados, cheese
CNS stimulation
Contras:
SSRIs, TCAs, ST. JOHNS WORT, Meperidine, dextromethorphan (to prevent serotonin syndrome)
What the hell is dextromethorphan?
Opiod Analgesic that does cough suppression. Antagonizes NMDA glutamate receptors. Give naloxone for OD
What is bupropion?
Used for?
SEs
Atypical Antidepressant also smoking cesation
Incr NE & DA
SEs: stimulating ie seizures esp in bulemics, tachy, insomnia so obv non sedating, but no sex SEs
Also does appetite suppression and non addictive
Opposite of Mirtazapine
Mirtazapine
Uses
SEs?
Atypical Antidepressants
a2 antag–>Incr release of NE, 5-HT3
Potent 5-HT2 & 5-HT3 antagonist
Sedation (depressed pts with insomnia may like this)
Increase appetite –>weight gain (good for eating disorders or old folks)
Dry mouth
Trazadone (Trazabone)
Uses
SEs
Blocks 5-HT2 & a1
Use for Insomnia bc need too much to be an antidepressant
Causes sedation, priopism (keep the erection, cant cum so good for premature ejaculation)
Postural HypoTN bc strong a1 block
