Treatment of Depression

Question 1

How soon do most antipressants have an effect?

Answer 1

6-8 wks; Roughly 2 wks until sleep, mood or irritability improve

Question 2

What is Cognitive Behavioral Therapy?

Answer 2

Help rethink conclusions which don’t make sense.

Question 3

Name the SSRIs

Answer 3

Fluoxetine, Sertraline, Escitalopram

Question 4

Pharmacokinetics of Fluoxetine

Answer 4

Inhibits CYP2D6; Has the longest half-life

Question 5

Pharmacokinetics of Sertraline and Escitalopram

Answer 5

Fewest drug interactions out of the SSRIs

Question 6

Side effects of SSRIs

Answer 6

Diarrhea, nausea, sexual dysfunction, SI, May worsen anxiety

Question 7

Name the SNRIs

Answer 7

Venlafaxine, Desmethylvenlafaxine, Duloxetine

Question 8

MOA of SNRIs

Answer 8

Inhibits reuptake of NE and 5HT

Question 9

Discuss Buproprion

Answer 9

Inhibits DA and NE transport; Used for depression.
Low risk for sexual dysfunction.
CI in epilepsy and eating disorders (Seizure risk)

Question 10

Discuss Mirtazapine

Answer 10

5HT blockade and A2 antagonist (inc NE)

Causes weight gain and sedation

Question 11

Discuss Trazodone

Answer 11

Used for insomnia; Can cause Priapism

Question 12

Name the TCAs

Answer 12

Amitriptyline, Desipramine, Imipramine, Nortriptyline

Inhibits NE uptake

Question 13

Side effects of TCAs

Answer 13

Orthostatic hypotension, dry mouth, blurry vision
Nortriptyline is best for elderly
Overdose MAY CAUSE CARDIAC ARRHYTHMIA

Question 14

MOA of MAOIs

Answer 14

prevent breakdown of NE, 5HT, DA, Epi, tyramine

Question 15

Name the MAOIs

Answer 15

Phenelzine, Seligeline, Tranylcypromine

Question 16

Side effects of MAOIs

Answer 16

Hypertensive crisis; First symptom may be headache.

Tx: A-antagonisht like phentolamine or Nefidipine

Question 17

What is Serotonin Syndrome?

Answer 17

Excess Serotonin caused by MAOIs

1. Mental Status Change
2. Autonomic hyperactivity
3. NM abnormalities

Question 18

What are MAOIs best used for?

Answer 18

Atypical depression;

excessive sleep, eating and limp paralysis