T41f Antidepressants Flashcards
Amitriptyline
Tricyclic anti-depressant (TCA). nonspecific blockade of 5HT NE reuptake
TX. major depression, phobic/panic anixiety, OCD, neuropathic pain (migraine, trigeminal neuralgia, shingles by decreasing descending pain control fiber APs thru NE), enuresis.
ADV. antimuscainic and anti-alpha (quinidine like effects). drug interactions with MAO inhibitos, SSRIs, meperidine (hypertensive crisis, serotonin syndrome). Prevents antihypertensive actions of alpha 2 agonists and guanethidine.
Amoxapine
Tricyclic anti-depressant (TCA). nonspecific blockade of 5HT NE reuptake
TX. major depression, phobic/panic anixiety, OCD, neuropathic pain, enuresis.
ADV. antimuscainic and anti-alpha (quinidine like effects). drug interactions with MAO inhibitos, SSRIs, meperidine (hypertensive crisis, serotonin syndrome). Prevents antihypertensive actions of alpha 2 agonists and guanethidine.
Bupropion
Atypical antidepressant. dopamine and serotonin reuptake inhibitor (wellbutyrin remarketed zyban)
TX. smoking cessation by mimeking mesolimbing recenter center
ADV. seizures. but less sexual side effects than SSRIs
Citalopram
SSRI - prototype (first line antidepression prototype - prozac) block reuptake serotonin (long term use downregulates inhibiroty presynaptic 5HT1b receptors) little other effects.
DOA. takes several weeks for effect.
TX. first line major depression, OCD, bulimia, anxiety disorder, premenstrual dyphoric disorder. pre-mature ejaculation
ADV. anxiety, agitation, (benzodiazepine given first few weeks - alprazolam then taper) bruxism (teeth grinding increased 5HT), sexual dysfunction (anorgasmia), weight loss. serotinin syndrome (MAO inhibitors, meperidine, TCAs)
Clomipramine
Tricyclic anti-depressant (TCA). nonspecific blockade of 5HT NE reuptake
DOA. very nearly an SSRI.
TX. major depression, phobic/panic anixiety, OCD, neuropathic pain, enuresis.
ADV. antimuscainic and anti-alpha (quinidine like effects). drug interactions with MAO inhibitos, SSRIs, meperidine (hypertensive crisis, serotonin syndrome). Prevents antihypertensive actions of alpha 2 agonists and guanethidine.
Desipramine
Tricyclic anti-depressant (TCA). nonspecific blockade of 5HT NE reuptake
TX. major depression, phobic/panic anixiety, OCD, neuropathic pain, enuresis.
ADV. antimuscainic and anti-alpha (quinidine like effects). drug interactions with MAO inhibitos, SSRIs, meperidine (hypertensive crisis, serotonin syndrome). Prevents antihypertensive actions of alpha 2 agonists and guanethidine.
Doxepin
Tricyclic anti-depressant (TCA). nonspecific blockade of 5HT NE reuptake
TX. major depression, phobic/panic anixiety, OCD, neuropathic pain, enuresis.
ADV. antimuscainic and anti-alpha (quinidine like effects). drug interactions with MAO inhibitos, SSRIs, meperidine (hypertensive crisis, serotonin syndrome). Prevents antihypertensive actions of alpha 2 agonists and guanethidine.
Duloxetine
anti.depressant. serotonin norepinephrine reuptake inhibitor (SNRI).
TX. analgesic in neuropathic PAIN or fibromyalgia (decrease descending pain control fiber inhibit reuptake NE/5HT ). Diabetic neuropathy.
less ANS quinidine like side effects
Escitalopram
SSRI - prototype (first line antidepression prototype - prozac) block reuptake serotonin (long term use downregulates inhibiroty presynaptic 5HT1b receptors) little other effects.
DOA. takes several weeks for effect.
TX. first line major depression, OCD, bulimia, anxiety disorder, premenstrual dyphoric disorder. pre-mature ejaculation
ADV. anxiety, agitation, (benzodiazepine given first few weeks - alprazolam then taper) bruxism (teeth grinding increased 5HT), sexual dysfunction (anorgasmia), weight loss. serotinin syndrome (MAO inhibitors, meperidine, TCAs)
Fluoxetine
SSRI - prototype (first line antidepression prototype - prozac) block reuptake serotonin (long term use downregulates inhibiroty presynaptic 5HT1b receptors) little other effects.
DOA. takes several weeks for effect.
TX. first line major depression, OCD, bulimia, anxiety disorder, premenstrual dyphoric disorder. pre-mature ejaculation, analgesic in neuropathic PAIN (descrese descending control fibers -inhibit NE reuptake)
ADV. anxiety, agitation, (benzodiazepine given first few weeks - alprazolam then taper) bruxism (teeth grinding increased 5HT), sexual dysfunction (anorgasmia), weight loss. serotinin syndrome (MAO inhibitors, meperidine, TCAs)
inhibits CYP2D6: can cause seizures or serotonin syndrome when administered within 2 weeks of with MAOI.
Fluvoxamine
SSRI - prototype (first line antidepression prototype - prozac) block reuptake serotonin (long term use downregulates inhibiroty presynaptic 5HT1b receptors) little other effects.
DOA. takes several weeks for effect.
TX. first line major depression, OCD, bulimia, anxiety disorder, premenstrual dyphoric disorder. pre-mature ejaculation
ADV. sedation. anxiety, agitation, (benzodiazepine given first few weeks - alprazolam then taper) bruxism (teeth grinding increased 5HT), sexual dysfunction (anorgasmia), weight loss. serotinin syndrome (MAO inhibitors, meperidine, TCAs)
Imipramine
Tricyclic anti-depressant (TCA). nonspecific blockade of 5HT NE reuptake
DOA.** blocks serotonin tranporters.** it’s metabolite, desipramine, blocks NE transporters.
TX. major depression, phobic/panic anixiety, OCD, neuropathic pain, enuresis. (decreasesphase IV slow wave sleep (last pahse before REM sleep) where children wet their beds.)
ADV. antimuscainic and anti-alpha (quinidine like effects including urinary retension). drug interactions with MAO inhibitos, SSRIs, meperidine (hypertensive crisis, serotonin syndrome). Prevents antihypertensive actions of alpha 2 agonists and guanethidine.
Maprotiline
Tricyclic anti-depressant (TCA). nonspecific blockade of 5HT NE reuptake
TX. major depression, phobic/panic anixiety, OCD, neuropathic pain, enuresis.
ADV. antimuscainic and anti-alpha (quinidine like effects). drug interactions with MAO inhibitos, SSRIs, meperidine (hypertensive crisis, serotonin syndrome). Prevents antihypertensive actions of alpha 2 agonists and guanethidine.
Mirtazapine
Atypical antidepressant. alpha 2 antagonist thereby increasing NE synthesis and release
TX. anorhexia. low dose for insomnia.
ADV. weight gain
Nefazodone
Atypical antidepressant. serotonin antagonist and reuptake inhibitor (SARI)
TX. depression with insomnia and depression with anxiety.
ADV. hepatotoxic. sedative, cardiac arrhythmias (reflex tachycardia in ortho hypotension) and priapism (ejaculation) due to strong alpha 1 blockade.
