Antidepressants

Question 1

SSRIs

Answer 1

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac, Prozac Weekly)
Paroxetine (Paxil, Paxil CR, Pexeva)
Sertraline (Zoloft)

Question 2

SSRI Action

Answer 2

Block the synaptic reuptake of serotonin

Question 3

SSRI s/e

Answer 3

Agitation, insomnia, HA, N/V, sexual dysfunction, and hyponatremia

Question 4

SSRI notes

Answer 4

First line of treatment for major depression
Some SSRIs activate and others sedate; choice depends on patient symptoms
Risk of lethal overdose minimized with SSRIs

Question 5

TCAs

Answer 5

Amitriptyline (generic only)
Amoxapine (generic only)
Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Maprotiline (generic only)
Nortriptyline (Aventyl, Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

Question 6

TCA Action

Answer 6

Inhibit the synaptic reuptake of serotonin and norepinephrine.

Question 7

TCA s/e

Answer 7

Dry mouth, constipation, urinary retention, blurred vision, hypotension, cardiac toxicity, sedation

Question 8

TCA notes

Answer 8

Therapeutic effects similar to SSRIs, but side effects are more prominent
May work better in melancholic depression and in people with comorbid medical conditions
Some therapeutic serum levels may be monitored

Question 9

MAOIs

Answer 9

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (Emsam Transdermal System Patch)
Tranylcypromine (Parnate)

Question 10

MAOI Action

Answer 10

Inhibits the enzyme monoamine oxidase, which normally breaks down neurotransmitters, including serotonin and norepinephrine

Question 11

MAOI s/e

Answer 11

Insomnia, nausea, agitation, and confusion; hypertensive crisis

Question 12

MAOI notes

Answer 12

Efficacy similar to other antidepressants, but strict dietary (tyramine) restrictions and potential drug interactions make this drug class less desirable

(cheese, processed meat [sausage, salami, pickled/smoked fish], fermented foods [kimchi, sauerkraut], imported beer, avocado, soybeans, banana, figs, yeast, fava beans, chocolate [large amt], caffeine [large amt])

Question 13

MAOI warning

Answer 13

Contraindicated in people taking SSRIs, used cautiously in people taking TCAs; tyramine-rich food could bring about a hypertensive crisis
Many other strong drug and dietary interactions

Question 14

TCA warning

Answer 14

Lethal in overdose

Use cautiously: in older adults with cardiac disorders, elevated intraocular pressure, urinary retention, hyperthyroidism, seizure disorders, and liver or kidney dysfunction

Question 15

SSRI warning

Answer 15

Discontinuation syndrome with dizziness, insomnia, nervousness, irritability, nausea, and agitation may occur with abrupt withdrawal (depending on half-life); TAPER SLOWLY