Week 13 - Antidepressants (broad brush) Flashcards
Examples of selective serotonin reuptake inhibitor (SSRI)
- Fluoxetine
- Sertraline
- Citalopram
- Escitalopram
- Paroxetine
Example of serotonin partial agonist reuptake inhibitor (SPARI)
Vilazodone
Examples of selective norepinephrine reuptake inhibitor (SNRI)
- Venlafaxine
- Duloxetine
- Desvenlafaxine
Examples of TCAs
- Amitriptyline
- Nortriptyline
- Imipramine
- Doxepin
- Despiramine
Examples of atypical antidepressants
- Buproprion
- Mirtazapine
- Nefazodone
- Trazodone
- Vortioxetine
Off-label uses for antidepressants
- Anxiety
- Bulimia
- Fibromyalgia
- Smoking cessation
- Migraine prophylaxis
- ADHD in adults
- IBS
- Premature ejaculation
- Diabetic peripheral neuropathy
- Postherpetic neuralgia
True/False: Clinically relevant improvement for depression w/ antidepressants might only occur in patients w/ severe depression
True
- May be effective in first two weeks of treatment (most often takes 4-8 weeks to see improvement)
- Sertraline, escitalopram, venlafaxine, and mirtazapine more effective in reducing depression symptoms other than non-TCAs
Efficacy of antidepressants in children and adolescents
Children - antidepressants do not appear effective
Adolescent - SSRIs, not TCAs, more effective
- SSRIs associated with increased SI
Fluoxetine (SSRI): medication pearls
- LEAST likely to cause weight gain
- Can be activating (start low, go slow)
- Long half-life
Paroxetine (SSRI): medication pearls
- Interacts w/ a lot of other medications
- BAD withdrawal symptoms
- Causes weight gain
- Sedating (not for the elderly)
Citalopram (SSRI): medication pearls
-
Black box warning: QT prolongation
- Max dose 40mg daily
- 20mg daily if over 60 years old
Escitalopram (SSRI): medication pearls
- Weight neutral
- Neither sedating nor activating
Venlafaxine and desvenlafaxine (SNRI): medication pearls
Monitor HR and BP (increases are dose dependent)
Mirtazapine (atypical): medication pearls
- Low dose causes sedation
- As dose increases, sedative factor diminishes
Bupropion (atypical): medication pearls
- Avoid in seizure-risk patients
- Avoid in those w/ anxiety
- Causes increase in norepinephrine
- May be helpful for ADHD
- Eeyore depression
TCAS: medication pearls
- Highly cardiotoxic
- Fatal in OD
- Secondary to life-threatening arrhythmias
- Narrow TI
- Weight gain
- Orthostatic hypotension
MAOIs: medication pearls
- Interacts w/ tyramine to cause HTN crisis
- Dangerous in OD
- Many drug-to-drug interactions
- Requires washout period from other medications
SSRIs and SNRIs: general ADRs
- N/V/D
- Agitation
- Insomnia
- Sexual side effects
- Serotonin syndrome
- Increased risk for upper GI bleeding
- Hyponatremia
- QT prolongation w/ citalopram
SNRIs: general ADRs
Noradrenergic side effects of tachycardia, dry mouth, diaphoresis, constipation
TCAs: general ADRs
- Cardiovascular disease, arrhythmias
- Orthostatic hypotension
- Anticholinergic side effects
- Dry mouth, blurred vision, constipation, urinary hesitancy, memory impairment, confusion, aggravation of angle closure glaucoma
- Sedation
MAOIs: general ADRs
- HTN crisis
- Orthostatic hypotension
- Serotonin syndrome
Which three medications cause weight gain?
- Paroxetine
- Mirtazapine
- Amitriptyline
If no response is seen in 4-8 weeks with the maximally tolerated dose, what should the prescriber do?
Switch to a different antidepressant within the same or different class
How long should therapy continue after a patients complete remission of symptoms?
Antidepressant therapy should continue for at least 4-9 months
