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3rd Year - Psychiatry > 4.1. Psychopharmacology - Anti-Depressant's > Flashcards

4.1. Psychopharmacology - Anti-Depressant's Flashcards

1
Q

What are the Indications for the use of Antidepressants?

A
  1. Unipolar / Bipolar Depression
  2. Anxiety Disorders - Including OCD / Panic / Social Phobia / PTSD
  3. Organic Mood Disorders
  4. Schizophrenia
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2
Q

How is selection of Antidepressants made?

A

Efficacy is Similar so:

  1. Past History of Response
  2. Side Effect Profile
  3. Coexisting Medical Condition
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3
Q

With Antidepressants, How long is the Delay (typically) before Symptoms improve?

A

Therapeutic Dose is achieved (before symptoms improve) after 2-4 weeks

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4
Q

With Antidepressants, When / How should a change in medication be sought?

A

If there is no improvement seen after a Trial of Adequate Length (at least 2 Months) and Adequate Dose, either Switch to another Agent or Augment with another Agent

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5
Q

What are the Different Classifications of Antidepressants?

A
  1. Tricyclic Antidepressants (TCA)
  2. Monoamine Oxidase Inhibitors (MAOI’s)
  3. Selective Serotonin Reuptake Inhibitors (SSRI’s)
  4. Serotonin / Noradrenaline Reuptake Inhibitors (SNRI’s)
  5. Novel Antidepressants
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6
Q

What are the Features of Tricyclic Antidepressants (TCA’s)?

A
  1. Very Effective
  2. Potentially Unacceptable Side Effect Profile - Anti-Histaminic / Anti-Cholinergic / Anti-Adrenergic
  3. Lethal In Overdose - Even 1 weeks supply
  4. Can cause QT Lengthening
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7
Q

What are Tertiary Tricyclic Antidepressants (TCA’s)?

A
  1. They have Tertiary Amine Side Chains

2. Side Chains are prone to Cross-React with other types of Receptors - leads to more Side Effects

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8
Q

What are Secondary Tricyclic Antidepressants (TCA’s)?

A

Metabolites of Tertiary Amine’s which primarily block Noradrenaline
Note - Side effects are the same as Tertiary Tricyclic Antidepressants (TCA’s)

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9
Q

How do Monoamine Oxidase Inhibitors (MAOI’s) work?

A

They bind Irreversibly to Monoamine Oxidase - preventing inactivation of Amines (Noradrenaline / Dopamine / Serotonin).
This causes an Increase in the Synaptic Levels
Note - These are very effective for resistant depression

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10
Q

What are the Side-Effects of Monoamine Oxidase Inhibitors (MAOI’s)?

A
  1. Orthostatic Hypotension
  2. Weight Gain
  3. Dry Mouth
  4. Sedation
  5. Sexual Dysfunction
  6. Sleep Disturbance
  7. Cheese Reaction - Hypertensive Crisis when eating Tyramine-Rish Foods / Sympathomimetics
  8. Serotonin Syndrome
    Note - Wait 2 weeks between switching from SSRI to MAOI
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11
Q

What are the Features of Selective Serotonin Reuptake Inhibitors (SSRI’s)?

A
  1. They block the Pre-Synaptic Serotonin reuptake
  2. Treat both Anxiety and Depressive Symptoms
  3. Very Little risk of Cardiotoxicity
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12
Q

What are the Side-Effects of Selective Serotonin Reuptake Inhibitors (SSRI’s)?

A
  1. Activation Syndrome - gets worse before better
  2. G.I. Upset
  3. Sexual Dysfunction
  4. Anxiety / Restlessness / Nervousness
  5. Insomnia
  6. Fatigue / Sedation / Dizziness
  7. Discontinuation Syndrome
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13
Q

What are the different types of Selective Serotonin Reuptake Inhibitors (SSRI’s)?

A
  1. Paroxetine
  2. Sertraline
  3. Fluoxitine (Prozac)
  4. Citalopram
  5. Escitalopram
  6. Fluvoxamine
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14
Q

What are the Advantages / Disadvantages of Paroxetine?

A

Advantages:

  1. Short 1/2 life with no active metabolites
  2. Sedation properties

Disadvantages:

  1. More Anti-Cholinergic Effects - Sedating / Weight Gain
  2. Likely to cause Discontinuation Syndrome
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15
Q

What are the Advantages / Disadvantages of Sertraline?

A

Advantages:

  1. Weak P450 interactions
  2. Short 1/2 life with lower build-up of metabolites
  3. Less sedating than Paroxetine

Disadvantages:

  1. Maximum Absorption requires a Full Stomach
  2. Increase number of GI Adverse Drug Reaction
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16
Q

What are the Advantages / Disadvantages of Fluoxetine (Prozac)?

A

Advantages:

  1. Long 1/2 Life - Less Discontinuation Syndrome
  2. Initially Activating - Increase Energy

Disadvantages:

  1. Long 1/2 Life - Active Metabolites may build up
  2. Significant P450 interactions
  3. Initial Activation - May increase Anxiety / Insomnia
  4. More likely to induce Mania than other SSRI’s
17
Q

What are the Advantages / Disadvantages of Citalopram?

A

Advantages:

  1. Low inhibition of P450 Enzymes
  2. Intermediate 1/2 Life

Disadvantages:

  1. Dose-Dependent QT interval Prolongation
  2. Can be Sedating
  3. GI Side-Effects
18
Q

What are the Advantages / Disadvantages of Escitalopram?

A

Advantages:

  1. Low inhibition of P450 Enzymes
  2. Intermediate 1/2 Life
  3. More effective than Citalopram in cute setting

Disadvantages:

  1. Dose-Dependent QT interval Prolongation
  2. Nausea / Headache
19
Q

What are the Advantages / Disadvantages of Fluvoxamine?

A

Advantages:

  1. Shortest 1/2 Life
  2. Has some Analgesic Properties

Disadvantages:

  1. Shortest 1/2 Life
  2. G.I. Distress / Headaches / Sedation / Weakness
  3. Strong inhibitor of some P450 Enzymes
20
Q

What are the Features of Serotonin / Norepinepherine Reuptake Inhibitors?

A
  1. Inhibits Serotonin and Noradrenergic Reuptake - Like TCA’s but without the Side-Effects
  2. Used for Depression / Anxiety / (Possibly) Neuropathic Pain
21
Q

What are the Different Types of Serotonin / Norepinephrine Reuptake Inhibitors?

A
  1. Venlafaxine

2. Duloxetine

22
Q

What are the Advantages / Disadvantages of Venlafaxine?

A

Advantages:

  1. Minimal Drug Interactions / No P450 Activity
  2. Short 1/2 Life + Fast Renal Clearance

Disadvantages:

  1. Increase in Diastolic Blood Pressure
  2. Nausea
  3. Discontinuation Syndrome
  4. QT Prolongation
  5. Sexual Side-Effects
23
Q

What are the Advantages / Disadvantages of Duloxetine?

A

Advantages:

  1. Efficacy for the Pysical Symptoms of Depression
  2. Less Blood PRessure increase, compared to Venlafaxine

Disadvantages:

  1. P450 inhibitor
  2. Cannot Break Capsule - active ingredient not stable in the stomach
  3. Higher Drop-Out Rate
24
Q

What are the types of Novel Antidepressants?

A
  1. Mirtazapine

2. Buproprion

25
Q

What are the Advantages / Disadvantages of Mirtazapine?

A

Advantages:

  1. Good Augmentation Strategy with SSRI’s
  2. Can be used as a Hypnotic

Disadvantages:

  1. Increases Serum Cholesterol
  2. Very Sedating
  3. Associated with Weight Gain
26
Q

What are the Advantages / Disadvantages of Buproprion?

A

Advantages:

  1. Good Augmenting Agent
  2. Low Side-Effect problems
  3. Second Line ADHD agent
Disadvantages:
1. Increase of Seizure Risk at high dose
2. Does not treat Anxiety
3. Has Abuse Potential
Note - Mechanism of Action = SNRI

3rd Year - Psychiatry (23 decks)

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