Unit 26 Medications for Mood Disorders Flashcards
What receptors do antidepressants effect?
Serotonin and Norepinephrine
What are the Antidepressant categories?
Selective Serotonin Reuptake Inhibitors (SSRI’s)
Selective Serotonin-Norepinephrine Reuptake Inhibitors (SSNRI’s)
Heterocyclic Antidepressants (trcyclics-TCA’s)
Monamine Oxidase Inhibitors (MAOI’s)
MISC
How long could antidepressants take to work?
up to 6-8 weeks
could not work right away
During the “first break” treatment how long should the patient be on the antidepressants for?
6-12 months
What are adverse effects common to most antidepressants?
Anticholinergic effects (dry mouth, blurry vision, constipation, drowsiness, difficulty urinating)
- Weight gain
- Sexual side effects
(Withdraw effects may occur)
What is the black box warning for antidepressants?
-Watch for personality changes leading to suicide
(PT will physically feel better but mind needs to catch up)
-Greater risk for suicide because they begin to have more energy
Name and describe Selective Serotonin Reuptake Inhibitors. What Rx has a specific washout period?
fluoxetine (Prozac) *washout period
paroxetine (Paxil)
sertraline (Zoloft)
citalopram (Celexa)
First line therapy for depression
Useful for anxiety, eating disorders, OCD
Side effects: Insomnia/somnolence (sleepiness)
Anxiety, agitation, restlessness, nausea
Watch out for SSRI discontinuation because of serotonin syndrome!
What is Serotonin Syndrome?
Potentially life threatening serotonin overdose to anything that increases serotonin.
Other meds that contribute are:
MAOI’s, St. John’s Wort, and Lithium.
No lab test, just supportive treatment.
What are Serotonin Syndrome symptoms? (think the clinical triad)
Cognitive symptoms: Mental confusion, hypomania, hallucinations, agitation, headache, coma, vivd dreams
Autonomic: Shivering, sweating, fever, hypertension, tachycardia, nausea, diarrhea (flu-like symptoms)
Somatic: myoclonus/clonus (muscle twitching), hyperreflexia, tremor.
Name and describe Selective Serotonin/Norepinephrine Reuptake Inhibitors (SSNRI’s).
venlafaxine (Effexor)
may increase BP
duloxetine (Cymbalta)
Can also treat fibromyalgia
Side effects/less effects:
Less weight gain
Less sexual dysfunction
Better at treating anxiety
Name and describe Heterocyclics/TCA’s.
amitriptyline (Elavil)
clomipramine (Anafranil)
imipramine (Tofranil)
- oldest class
- 70% effective
- Also inhibits NE and 5-HT2 reuptake
- Start low, go slow
- 4-8 weeks for full effect
- also for chronic pain
- OVERDOSE DANGEROUS so usually only given 1 week prescriptions
Side effects/Adverse reactions: *
- *Anticholinergic effects such as dry mouth, blurred vision, constipation, difficulty urinating)
- Photosensitivity
- Decreased seizure threshold
Name and describe Monamine Oxidase Inhibitors (MAOI’s).
- phenelzine (Nardil)
- isocarboxazid (Marplan)
- tranylcyromine (Parnate)
- Has many Rx and food interactions (such as *Tyramine)
- Inhibits monamine oxidase enzyme that breaks down NE and 5-HT2
- Assume the drug is not safe with anything Rx or OTC unless you have other info!
- Give adequate washout time of 10 days prior to OR Sx or other meds
Side effects: Orthostatic hypotension Edema Constipation Hypomania Insomnia
What is Tyramine and what foods contain it?
- Natural product of bacterial fermentation that displaces NE from storage vessels which increases BP.
- MUST BE AVOIDED WHEN TAKING MAOI’s
Found in: Anything aged Wine Cheese Pepperoni Beer Processed foods
Regarding antidepressant medications, when could a hypertensive crisis happen?
A hypertensive crisis will happen if you mix MAOI’s with Tyramine.
S/S are same as those of severe HTN: Headache Nosebleeds Tachycardia N/V Diaphoresis Chest pain/come/stroke
What medications are also now used as adjunct medication with antidepressants?
Atypical antipsychotics medications
“pine, oles, ones”
