Psychopharmacology - Antidepressants Flashcards
Selective serotonin reuptake inhibitors (SSRIs) examples.
- Citalopram
- Sertaline (often used in those with a previous myocardial infarction)
- Fluoxetine (has a long half life)
- Paroxetine
SSRI uses
Treats both anxiety and depressive symptoms.
SSRI side effects
- GI upset
- Sexual dysfuction
- Hyponaetrarmia in the elderly
- Discontinuity syndrome
- Serotonin syndrome
Tricyclic antidepressants examples
- Amytriptyline
- Imipramine
- Clomipramine
TCAs uses
DOBS
- Depression
- OCD (clomipramine)
- Bed wetting (imipramine)
- Sometimes neuropathic pain (amitriptyline)
TCAs side effects
Linked to receptor blockade:
- anti-adrenergic
- postural hypotension
- anti-muscarinic
- dry mouth
- constipation
- memory deficits and potentially delirium
- anti-histaminergic
- weight gain
- drowsiness
Toxicity = the 3 Cs
- Convulsions
- Coma
- Cardiotoxicity
Serotonin noradrenaline reuptake inhibitors (SNRIs) examples.
- Venlafaxine
- Duloxetine
SNRIs uses
- Depression
- Generalised anxiety disorder (Venlafaxine)
- Peripheral neuropathy (Duloxetine)
SNRIs side effects
- Increased blood pressure
- Nausea
- Sedation
Monoamine oxidase inhibitors (MAOIs) examples.
- Selegiline
- Moclobemide (reversible inhibitor of monoamine oxidase A [RIMA])
MAOIs uses
HAD
- Hypochondriasis
- Anxiety
- Depression
Selegiline is a MAO-B inhibitor that is licenced for use in Parkinsons disease.
MAOIs side effects
- Antimuscarinic
- dry mouth
- constipation
- memory deficits and potentially delirium
- The Cheese Reaction
- hypertensive crisis that occurs with ingestion of tyramine cntaining substances (eg. cheese, pickled herring, soybean products)
- Serotonin Syndrome
- can develop if take MAOI with meds that increase serotonin or have sympathomimetic actions
Alpha 2 antagonist example
Mirtazapine
Alpha 2 antagonist (Mirtazapine) uses
- Depression
- PTSD
Alpha 2 antagoinst (Mirtazapine) side effects
- Increased appetite and weight
- Dry mouth
- Sedation
Which antidepressant could be used for neuropathic pain?
Amitriptyline
Which antidepressant could be used for peripheral neuropathy?
Duloxetine
Which antidepressant can be used in Parkinson’s disease?
Selegiline
Symtoms of discontinuity syndrome:
- Shivering
- Anxiety
- Headache
- Nausea
- Dizziness
Serotonin syndrome symptoms:
- Muscle rigidity
- Seizures
- Cardiovascular collapse
- Hyperthermia
How is serotonin syndrome treated?
Cyproheptadine
How can serotonine syndrome be avoided?
To avoid need to wait 2 weeks before switching from an SSRI to an MAOI. The exception is fluoxetine where need to wait 5 weeks because of long half-life.
How long should antidepressants be continued after symptoms have ceased?
- 1st time - at least 6 months
- 2nd time - 2 years
- 3rd time - consider lifelong prophalaxis
How is treatment resistance managed?
- Combination of antidepressants eg SSRI or SNRI with Mirtazepine
- Adjunctive treatment with Lithium
- Adjunctive treatment with atypical antipsychotic
- ECT
