Anti-Depressants

Question 1

What are the indications for anti-depressants

Answer 1

Unipolar and bipolar depression 
Organic mood disorders 
Schizoaffective disorder 
Anxiety disorders including OCD
Panic
Social phobia
PTSD

Question 2

What are the different classifications of antidepressants

Answer 2

SSRIs
SNRIs
TCA 
Monoamine Oxidase Inhibitors (MAOIs)
Novel antidepressants

Question 3

What is generally the first line antidepressant class used

Answer 3

SSRI

Question 4

Action of SSRIs

Answer 4

Block pre-synaptic serotonin reuptake

Question 5

Most common SE of SSRIs

Answer 5

GI upset
Sexual dysfunction 
Anxiety 
Restlessness 
Sedation

Question 6

Name 3 types of SRRIs

Answer 6

Sertraline
Fluoxetine
Citalopram
Paroxetine

Question 7

What is the action of SNRIs

Answer 7

Inhibit both serotonin and noradrenergic reuptake like the TCAS but without the antihistamine, antiadrenergic or anticholinergic side effects

Question 8

Which antidepressant is no longer recommended 1st line

Answer 8

TCAs

Question 9

What is the major issue with TCAs

Answer 9

They are lethal in overdose

Question 10

Which 2 types of anti-depressants are rarely used nowadays and if they are it is in secondary care

Answer 10

Monoamine Oxidase Inhibitors

TCAs

Question 11

What can TCAs be very good to treat

Answer 11

Neuropathic pain

Question 12

What is generally 2nd line treatment for depression

Answer 12

Try another SSRI

Then SNRI

Question 13

Prophylaxis with antidepressants after 1 episode

Answer 13

Continue for 6mnths-1yr

Question 14

Prophylaxis with antidepressants after 2 episodes

Answer 14

Continue for 2yrs

Question 15

Prophylaxis with anti-depressants after 3 episodes

Answer 15

Discuss lifelong

Question 16

Rx for treatment resistance depression

Answer 16

Combination of antidepressants e.g SSRI or SNRi with Mirtazepine

Adjunctive treatment with Lithium

Adjunctive treatment with atypical antipsychotic eg Quetipaine, Olanzapine or Aripiprazole

ECT!!

Question 17

What does ECT stand for

Answer 17

Electroconvulsive therapy

Question 18

What are the 2 novel antidepressant drugs

Answer 18

Mirtazapine

Buproprion

Question 19

What class of drug is amitryptiline

Answer 19

TCA

Question 20

Pros of Sertraline

Answer 20

Weak P450 interactions
Short half-life (low build up)
Less sedating than paroxetine

Question 21

Cons of Sertraline

Answer 21

Max. absorption requires a full stomach

no. GI side adverse reactions

Question 22

Pros of paroxetine

Answer 22

Short half life
No build up
Sedating properties offers relief from insomnia and anxiety

Question 23

Cons of paroxetine

Answer 23

Sedating
Weight gain
Likely cause of discontinuation syndrome

Question 24

Which patients is fluoxetine not good for

Answer 24

Patients with hepatic illness

Question 25

Give 2 drug examples of SNRIs

Answer 25

Venlafaxine | Duloxetine

Question 26

Pros of venlafaxine (SNRI)

Answer 26

``` Minimal drug interactions Almost no P450 activity Short ½ life Fast renal clearance Avoids build up ```

Question 27

Cons of venlafaxine

Answer 27

Can cause increased in diastolic BP Can cause bad discontinuation syndrome Sexual side effects >30%

Question 28

Pros of duloxetine (SNRI)

Answer 28

Some data to suggest efficacy for physical depression symptoms of depression

Question 29

Cons of duloxetine (SNRI)

Answer 29

Strong inhibtors: CYP2D^ and CYP1A2 Higher dorp out rate

Question 30

Drug examples of monoamine oxidase inhibitors

Answer 30

Tranylcypromine Phenelzine Isocarboxazid

Question 31

What is the cheese reaction

Answer 31

Hypertensive crisis can develop when monoamine oxidase inhibitor is taken with tyramine rich foods or sympathomimetics

Question 32

Action of monoamine oxidase inhibitors

Answer 32

Bind irreversible to monoamine oxidase thereby preventing inactivation of amines such as Norepinephrine Dopamine Serotonin Leading to increased synaptic levels

Question 33

Side effects of monoamine oxidase inhibitors

Answer 33

``` Orthostatic hypotension Weight gain Dry mouth Sedation Sexual dysfunction Sleep disturbance ```

Question 34

What are the cons of TCAs

Answer 34

Lethal in overdose Can cause QT lengthening syndromes potentially unacceptable side effect profile: Antihistaminic Anticholinergic Antiadrenergic

Question 35

Which has the most effect on BP Venlafaxine or Duloxetine

Answer 35

Venlafaxine

Question 36

Action of mirtazapine (novel)

Answer 36

5HT2 and 5HT3 receptor antagonist

Question 37

What else is Buproprion (novel) used to treat

Answer 37

2nd line agents for ADHD

Question 38

cons of bupropion (novel)

Answer 38

``` May increase seizure risk at high doses Avoid in: Brain injury Bulimia Anorexia ``` Does not treat anxiety

Question 39

Drugs examples of tertiary TCAs

Answer 39

Amitriptyline Doxepin Clomipramine

Question 40

Drug examples of secondary TCAs

Answer 40

Desipramine | Nortriptyline