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Psychiatry > SM_117b: Antidepressants > Flashcards

SM_117b: Antidepressants Flashcards

1
Q

Describe indications for antidepressants

A

Indications for antidepressants

  • Generalized anxiety disorder: SSRIs, SNRI, TCA
  • OCD: SSRIs, clomipramine
  • Panic disorder: all antidepressants
  • Social anxiety: SSRIs, SNRIs, MAOis
  • PTSD: SSRIs, venlafaxine
  • ADHD: buproprion
  • Bulimia: SSRIs
  • Premenstrual dysphoric disorder: SSRI, SNRIs
  • Insomnia: mirtazapine, trazodone, TCAs
  • Smoking cessation: bupropion
  • Anxiety and depression symptoms in schizophrenia spectrum illness (with an antipsychotic)
  • Anxiety and depression in bipolar (with mood stabilizer)
  • IBS: SSRIs, TCAs
  • Enuresis: imipramine
  • Chronic pain especially neuropathic pain: TCAs, SNRIs
  • Fibromyalgia: SNRIs
  • Migraines; TCA (amitryptiline)
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2
Q

Monoamine theory of depression states ____

A

Monoamine theory of depression states underlying pathophysiologic basis of depression is a depletion in the levels of serotonin, norepinephrine, and/or dopamine in the CNS

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3
Q

____, ____, and ____ are monoamine neurotransmitters

A

Serotonin, norepinephrine, and dopamine are monoamine neurotransmitters

(NE and dopamine are catecholamines)

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4
Q

Describe the monoaminergic synapse

A

Monoaminergic synapse

  1. Monoamine NTs are synthesized within neurons from common precursors
  2. Synaptic vesicles take up NT via vesicular monoamine transporter
  3. On stimulation, vesicles within nerve terminal fuse with the presynaptic terminal and release NT into synaptic cleft
  4. Released NT interacts with postsynaptic receptors to alter function of postsynaptic cells
  5. Released NT acts on presynaptic autoreceptors in the nerve terminal to suppress further release
  6. Plasma membrane transporter proteins take NT from the synaptic cleft back up into the nerve terminal (aka reuptake)
  7. NT that was reuptaken is degraded or stored in vesicles
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5
Q

Describe treatment principles of antidepressants

A

Treatment principles of antidepressants

  • Take 3-8 weeks to be maximally effective
  • Have equivalent response rates and remission rates
  • Placebo-drug differences are greatest in more severe depression
  • Treat with goal of complete response
  • Full relief requires adequate dose
  • Switch to another first-line depressant if initial trial does not yield substantive improvement
  • Add antidepressant of different class or target residual symptoms with other treatments if partial improvement at the maximally tolerated dose
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6
Q

Common reasons for lack of response include ____, ____, ____, and ____

A

Common reasons for lack of response include wrong diagnosis, inadequate dose, inadequate length of drug trial / not taking properly, refractory illness / psychiatric comorbidity / complex social stressors

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7
Q

Select first-line antidepressant based on ____, ____, and ____

A

Select first-line antidepressant based on side effect profile, past response to treatment, and comorbid medical and psychiatric problems

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8
Q

First-line antidepressants include ____, ____, ____, and ____

A

First-line antidepressants include SSRIs, SNRIs, mirtazapine, and bupropion

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9
Q

Describe common 5HT/NE side effects of antidepressants

A

Common 5HT/NE side effects of antidepressants

  • GI upset (nausea, diarrhea)
  • Anxiety, agitation
  • Insomnia
  • Headahce
  • Sweating
  • Sexual dysfunction
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10
Q

Serious risks of antidepressant treatment include ____, ____, and ____

A

Serious risks of antidepressant treatment include increased suicidal thinking / behavior, manic symptoms in people with undiagnosed bipolar disorder, and serotonin syndrome

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11
Q

Serotonin syndrome is a result of ____ often from ____

A

Serotonin syndrome is a result of increased 5-HT activity in the brain often from combining mutliple serotonergic drugs

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12
Q

Serotonin syndrome involves ____, ____, and ____

A

Serotonin syndrome involves mental status changes, autonomic hyperactivity, and neuromuscular abnormalities

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13
Q

MAOi is contraindicated with SSRI due to risk of ____

A

MAOi is contraindicated with SSRI due to risk of serotonin syndrome

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14
Q

Many antidepressants cause ____ symptoms when stopped

A

Many antidepressants cause withdrawal symptoms when stopped

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15
Q

Antidepressant classes include ____, ____, ____, ____, and ____

A

Antidepressant classes include

  • Selective serotonin reuptake inhibitors
  • Serotonin-norepinephrine reuptake inhibitors
  • Tricyclic antidepressants
  • Monoamine oxidase inhibitors
  • Other
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16
Q

SSRIs act by ____

A

SSRIs act by blocking 5-HT transporter but have different effects at other receptors

(qd dosing, low toxicity)

17
Q

____ has the longest half-life of the SSRIs and requires long washout if cross-tapering to MAOis

A

Fluoxetine (Prozac) has the longest half-life of the SSRIs and requires long washout if cross-tapering to MAOis

18
Q

____ is an SSRI that is a potent CYP2C6 inhibitor, has anticholinergic side effects, and has the shortest half life

A

Paroxetine (Paxil) is an SSRI that is a potent CYP2C6 inhibitor, has anticholinergic side effects, and has the shortest half life

19
Q

____ is an SSRI with higher risk for GI side effects and is often the preferred agent in pregnancy

A

Sertraline (Zoloft) is an SSRI with higher risk for GI side effects and is often the preferred agent in pregnancy

20
Q

____ is an SSRI that has dose-dependent QTc prolongation and should be avoided in people with cardiac comorbidities

A

Citalopram (Celexa) is an SSRI that has dose-dependent QTc prolongation and should be avoided in people with cardiac comorbidities

21
Q

____ is an SSRI that is an enantiomer of citalopram with fewer side effects

A

Escitalopram (Lexapro) is an SSRI that is an enantiomer of citalopram with fewer side effects

22
Q

____ is an SSRI approved only for OCD

A

Fluvoxamine (Luvox) is an SSRI approved only for OCD

23
Q

SNRIs act by ____, are helpful for ____, and have a risk of ____ at higher doses

A

SNRIs act by increasing 5HT at low doses and NE at higher doses, are helpful for neuropathic pain, and have a risk of HTN at higher doses

(venlafaxine, desvenlafaxine, duloxetine)

24
Q

Describe TCAs

A

TCAs

  • Inhibit NE and 5HT reuptake
  • Often used for chronic pain
  • Sedation and weight gain common
  • Anticholinergic side effects common: dry mouth, constipation, urinary retention, blurry vision
  • Cardiovascular side effects common
  • Risk of seizures
  • Lethal in overdose
25
Q

Describe MAOis

A

MAOi

  • Irreversibly inhibit MAO-A and MAO-B enzymes -> prevents degradation of NE, 5HT, and dopmaine -> increased levels of monoamines
  • Orthostatic hypotension and drowsiness common
  • Higher serotonin syndrome risk
  • Requires special diet (avoid tyramine-rich food) or risk hypertensive crisis
26
Q

Person who is on MAOi and eats a lot of food high in tyramine, such as cheese, may experience ____

A

Person who is on MAOi and eats a lot of food high in tyramine, such as cheese, may experience hypertensive crisis

27
Q

____ are a class of antidepressants helpful for neuropathic pain

A

SNRIs are a class of antidepressants helpful for neuropathic pain

28
Q

___ are a class of antidepressants often used for chronic pain

A

TCAs are a class of antidepressants often used for chronic pain

29
Q

Combination of MAOIs and SSRIs/SNRIs may cause ____

A

Combination of MAOIs and SSRIs/SNRIs may cause serotonin syndrome

30
Q

Bupropion is an antidepressant used because it has ____ and ____

A

Bupropion is an antidepressant used because it has no associated sexual dysfunction and lower risk of switch to mania

31
Q

Bupropion has contraindications of ____ and ____

A

Bupropion has contraindications of seizure disorder and eating disorder

32
Q

Mirtazapine has side effects of ____ and ____

A

Mirtazapine has side effects of sedation and weight gain

33
Q

Mirtazapine is an antidepressant used because it has ____ and is ____

A

Mirtazapine is an antidepressant used because it has lower risk of switch to mania and is helpful for elderly patients

34
Q

Trazadone is used to treat ____ but has the side effect of ____

A

Trazadone is used to treat insomnia but has the side effect of priapism

Psychiatry (37 decks)

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