Antidepressant Drugs Flashcards
Antidepressant drugs
Tricyclics
SSRI
MOAI
NDRI
SNRI
Tricyclics (TCA): amitriptyline (pain), nortriptyline (pain, doxepin, imipramine (enuresis) and clomipramine (ocd).
*USE: *depressions that involve decreased appetite and weight loss, early morning awakening and other sleep disturbances, psychomotor retardation and anhedonia.
- alleviating vegetative, somatic symptoms of depression.
- Takes 2-4 weeks for therapeudic effect, so not for acute suicidality.
- Panic dx, agoraphobia, bulimia, OCD, enuresis, and neuropathic pain.
MODE OF ACTION: block the reuptake of norepinephrine, serotonin and/or dopamine at nerve synapses.
- catecholamine hypothesis: depression caused by a deficiency of norepinephrine. So, TCA by blocking NorEpi reuptake, allows it to increase and decrease symptoms of depression.
Side EFFECTS: cardiotoxic, producing cardiovascular symptoms such as tachycardia, palpitations, hypertension, severe hypotension, cardiac arrhythmia.
- caution for people suffering heart disease
- Anticholinergic Effects: dry mouth, blurred vision, urinary retention, constipation, sex poor, confusion, sleepy, fatigue, weight gain, tremors, parethesia, blood dyscrasia.
- Toxicity: ataxia, impaired concentration, agitation, fever, delirium, seizures, and coma.
- because overdose can be lethal, the TCA are prescribed in small quantitites for those at high risk for suicide. WOW>!
SSRIs
antidepressants cont…
selective serotonin reuptake inhibitor: fluoxetine (prozac), fluvoxamine, paroxetine and sertraline.
USE: treat depression and effective for melancholic depression. OCD, bulimia, Panic Dx and PTSD.
mode of action: block the reuptake of serotonin (increase serotonin levels!).
Side Effects: gastrointenstinal disturbances (nausea, appetite loss, contipation/diarrhea), insomnia, anxiety, headache, dizziness, anorexia, tremor, increase urination and sex dx.
- more advantages than TCAs= less cardiotoxic, safer in overdose, less likely to have cognitive impairments.
- rapid onset of therapeutic effects, most improve w/in 2-4 weeks.
- Are as safe as other antidepressants
- BUT: SSRI w/MAOI can give serotonin syndrome, which gives neurological effects, changes in mental state, and cardiac arrhythmia and can progress to coma/death.
MAOI
antidepressants cont…
Monoamine oxidase inhibitors: isocarboxazid, phenelzine, and tranylcypromine.
USE: treating non-endogenous and atypical depressions that involve anxiety, reversed vegetative symptoms (hypersomnia/hyperphagia), and interpersonal sensitivity.
MODE OF ACTION: inhibit the enzyme monoamine oxidase, which deactivates dopamine, norepinephrine, and serotonin. broad action like TCAs.
Side-EFFECTS: anticholinergic effects, insomnia, agitation, confusion, skin rash, weight gain, edema, headache, dizziness, tremor blood dyscrasia, hypertensive crisis.
- Hypertensive crisis is most dangerous if taken with barbiturates, amphetamines, antihistamines, or with foods containing tyramine (aged cheese, meets, beer, red wine, chicken liver, avo, mananas, fava beans, soy sauce).
- Tyramine Induced Hypertensive Crisis: headache stiff neck, tachychardia, nausea, vomiting, sweating and sensitivity to light.
Newer Antidepressants
NDRI
SNRI
NDRI: Bupropion (wellbutrin) is a norepinephrine dopamine reuptake inhibitor used to treat Major Depression and the depressive phase of Bipolar ds.
- Fewer anticholinergic side effects and less cardiotoxic than TCA, and no sex dysfunction.
- can aggravate pre-existing psychosis/seizures.
- effective for individual who have not responded to other antidepressants.
SNRI: Venlafaxine (effexor) is a serotonin norepinephrine reuptake inhibitor (SNRI) for Major Depression, GAD, social anxiety dx, and OCD.
- certain pain syndromes including fibromyalgia, mixed headaches, backpain, peripheral neuropathic pain.
- less dangerous in overdose and faster onset.
- increase blood pressure, so monitoring is required.
- Duloxetine (cymbalta) is similar to Venlafaxine for depression and GAD.
