Antidepressant Drugs

Question 0

Global antidepressant SFx

Answer 0

All antidepressants have the potential to lower seizure threshold, especially when paired with the consumption of alcohol. ll antidepressants may increase suicidal ideation and attempts, especially in young adults.

Question 1

BIogenic Amine Theory of Depression

Answer 1

The idea that there is a biological predispostion for depression as a result of abnormal function of monoamine neurotransmission.

Question 2

MAOIs

Answer 2

Monoamine oxidase inhibitors. Used less commonly than other antidepressants because of severe SFx profile: weakness, dizziness, HA, tremors and HTN. Can also ptoentiate effects of sympathomimetics.

Question 3

Tyramine and MAOIs

Answer 3

MAO is required to breakdown tyramine. Foods with high levels of tyramine (aged cheese, soy products, raisins, meats and red wine). Increased absorption of intact tyramine can raise catecholamine levels and create severe hypertensive emergenices

Question 4

Amitryptyline (Elavil)

Answer 4

Tricyclic antidepressant used for MDD, bipolar d/o, migraine prophylaxis and chronic pn.
MAO - CNS modulation of 5-HT and NE reuptake. Increases levels of these NT. PO or IV, usually hs.
SFx - Dizziness, dorwsiness, dry mouth, constipation, urinary retention, HA, blurred vision. DO NOT discontinue abruptly - may cz lethargy, HA, flu-like sxs.

Question 5

Fluoxetine (Prozac)

Answer 5

SSRI used for MDD, OCD, bulimia and panic d/o.
MAO - Decreases 5-HT reuptake at presynaptic cleft to increase 5-HT levels available postsynapitcally. PO. halflife of 48-72h.
SFx - serotonin syndrome, fever, agitation, diarrhea, HTN, sexual dysfunction.

Question 6

Duloxetine (Cymbalta)

Answer 6

Serotonin and NE reuptake inhibitor (SNRI). Used for MDD, GAD, fibromyalgia and peripheral nerve pn.
MOA - SNRI
SFx - HA, somnolence, fatigue, nausea, xerostomia, insomnia, ED. BLACK BOX WARNING FOR SUICIDAL IDEATION.

Question 7

Bupropion (Wellbutrin)

Answer 7

NE and Dopa reuptake inhibitor (NDRI). Nicotinic receptor agonist. Used for MDD, ADD, BPD, smoking cessation.
MOA - Blockade of NA and dopa reuptake in synaptic cleft.
SFx - Ha, insomnia, dry mouth, tremors, restlesness, agitation, anxiety, sweating, dizziness.

Question 8

Zyban for smoking cessation

Answer 8

Started 5-7 days before smokers desired quit date. Dose 150mg qd for 5 days, then 150mg BID for up to 12 weeks (or as long as 6 mo to prevent recidivism).

Question 9

Levomefolic Acid (Deplin)

Answer 9

MTHF “medical food”. Comes in 7.5mg and 15mg dosages. Rx only. For managing suboptimal levels of MTHF in depressed pts.