The antidepressants and Lithium Flashcards
Define depression and its incidence
disorder of mood
most frequent of mental illnesses
Name the two types of depression
reactive depression: 60%
endogenous depressions: 40%
What is reactive depression?
normal response to loss
what is endogenous depression?
no clear correlation with life events
- unipolar: 25%
- bipolar: 15%
Symptoms of depression (mostly endogenous)
- depressed mood - most of day - everyday
- decreased interest in life in general
- sleep disturbances
- appetite changes
- loss of energy - slowed movements
- feelings of worthlessness: denial of past accomplishments
- guilt
extreme cases:
- intense psychological pain
- recurrent thoughts of death
- loss of cognitive function
Name two factors that cause endogenous depression.
hereditary and environmental factors
What is the biochemical basis of depression?
- depletion of NT in CNS (NE, 5HT)
- any agent that increases NT, may elevate mood
Name the two treatments for depression.
ECT and pharmaco
What does ECT do?
induce seizure
Name 5 clinical uses of antidepressants
- ADD
- bulimia
- depression
- panic attacks
- OCD
What are the two general MOAs for the antidepressants?
- prevent NT reuptake (NE, 5HT)
- prevent NT breakdown
Which class of drug serves as the DOC for antidepressants?
The reuptake inhibitors
Name the first generation reuptake inhibitors
MOA?
amitriptyline
imipramine
these are tricyclic antidepressants
They inhibit NE reuptake - very effective
Name the 7 (bolded) second gen reuptake inhibitors
MOA?
- citalopram
- escitalopram
- fluoxetine
- fluvoxamine
- paroxetine
- sertraline
- vilazodone
MOA: SSRIs - these do inhibit NE, but have a stronger affect of serotonin
Name the 4 third gen reuptake inhibitors
MOA?
- desvenlafaxine
- duloxetine
- milnacipram
- venlafaxine
MOA: SNRI - inhibit reuptake of both serotonin and norepinephrine
Difference among the generations is based on pharmacokinetics
They have the same efficacies
These are not euphoriants - not abused.
Name three additional antidepressants
- buproprion
- mirtazapine
- nefazodone
***there were no notes on these, but were bolded
SE of first gen reuptake inhibitors.
First gen are more likely to cause side effects
-act on multiple receptors
- sedation
- weight gain
- anticholinergic: dry eyes, dry mouth, blurred vision, constipation
- cardiovascular: arrhythmias, decreased BP, alpha1 blockade (hypotension)
Name the SE of second gen reuptake inhibitors.
- GI upset
- nausea
- insomnia
- headache
- decreased libido
Name SE of third gen reuptake inhibitors
similar to second.
-cardio stimulation: increased HR and force of contraction
Describe toxicities of reuptake inhibitors used as antidepressants
TI of 1st gen?
TI of 2nd gen?
With massive overdose:
- seizures
- resp depression
- cardio arrhythmia
- renal failure
1st gen TI: 5-6
2nd gen TI > 1st gen
describe pharmacokinetics and pharmodynamics of antidepressant reuptake inhibitors
- effect may take weeks to develop
- long T1/2 and long Vd
- generally metabolized by P450
- effects are synergistic with alcohol
Name the 3 Monoamine Oxidase (MAO) inhibitors
MOA?
- phenezeline
- isocarboxacid
- tranylcypromine
MOA: irreversibly inhibit metabolism of NE and 5HT - slow onset
What are the toxicities of the MAO inhibitors?
CNS: insomnia, agitation, hallucinations, seizures
- liver toxicity
- weight gain
- hypotension
How do the MAO inhibitors interact with indirect-acting amines?
interaction with indirect acting amines (amphetamine):
-release of NE —> hypertensive crisis
some foods (aged cheese, wines) contain indirect acting amines (tyramine) ——> hypertensive crisis
what should be taken into consideration when prescribing antidepressants to children?
a severe increase in likelihood of suicide
Describe the manic phase of bipolar depression
- euphoric
- irritable
- Increased motor activity / sexual activity
- flight of ideas
- delusions of grandeur
- decreased sleep
- poor judgement
- social intrusiveness
- spending sprees
25-50% attempt suicide - often associated with drug abuse
What are the three Txs for bipolar depression?
- ECT
- antipsychotic drugs: phenothiazines, haloperidol
- Lithium (Li+)
Describe Lithium’s use, MOA
success in nearly 70% px
used prophylactically
little effect on normal individuals
MOA: alter glutamate metabolism, decrease NE release
- given orally (5 - 7 days to work)
- low TI <2
What are the short term, long term and toxicities of Lithium?
Short Term:
- termors
- thirst
- increased urine production (block ADH)
- edema
- weight gain
- nystagmus
Long Term:
- renal damage
- hypothyroidism
Toxicities:
- nausea
- delirium
- coma
OTHER tx of bipolar disorder
Anti-seizure:
- carbamazepine
- lamotripene
- valproic acid
Diuretic:
-acetazolamide
Partial dopamine agonist of 2nd gen antipsychotics:
-aripriprazole aka abilify
