Antidepressants

Question 1

What are antidepressants used to treat?

Answer 1

Affective Disorders

Question 2

What are the affective disorders antidepressants treat?

Answer 2

Depressed mood and anhedonia (inability to experience pleasure)
Sleep disturbances
Feelings of hopelessness
Poor concentration
Suicidal tendencies

Question 3

Biogenic Amine Theory of Affective Disorders
- hypothesis

Answer 3

Major depressive disorders (MDD) arise from a functional deficiency in the biogenic amines (serotonin, 5-HT; norepinephrine, NE or DA) in the CNS, while mania results from a functional excess

Question 4

Biogenic Amine Theory of Affective Disorders
- Mechanism

Answer 4

TCAs and SSRIs block the re-uptake of biogenic amines at adrenergic and serotonergic nerve terminals
MAOIs prevents degradation of these NTs

Question 5

How long does it take for TCAs and SSRIs to take effect?

Answer 5

2-4 weeks

Question 6

Tricycle antidepressants (TCA)

Answer 6

Primarily inhibit NE and 5-HT reuptake at adrenergic and/or serotonergic nerve terminals
Anticholinergic side effects

Question 7

Anticholinergic side effects

Answer 7

Dry mouth
Blurred vision (cycloplegia)
GI upset

Question 8

TCA
- Types

Answer 8

Amitriptyline
Imipramine

Question 9

Amitriptyline

Answer 9

Used to treat patients with neuropathic pain

Question 10

Amitriptyline
- active metabolite

Answer 10

Nortiptyline

Question 11

Imipramine

Answer 11

Used clinically to treat enuresis (bed wetting)

Question 12

Imipramine
- active metabolite

Answer 12

Desipramine

Question 13

Selective serotonin reuptake inhibitors (SSRIs)

Answer 13

Increase 5-HT levels by inhibiting its re-uptake in the neuronal synapse
Fewer anticholinergic side effects, less sedation, and orthostatic hypotension

Question 14

SSRIs
- Types

Answer 14

Fluoxetine (Prozac)
Paroxetine
Sertraline (Zoloft)
Escitalopram

Question 15

Monoamine oxidase inhibitors
- Types

Answer 15

Phenelzine
Tranylcypromine
Selegiline

Question 16

MOI
- Phenelzine

Answer 16

Irreversible inhibitor of MAO-A and MAO-B

Question 17

MOI
- Tranylcypromine

Answer 17

Irreversible inhibitor of MAO-A and MAO-B

Question 18

MOI
- Selegiline

Answer 18

MAO-B selective inhibitor increases DA in synapse; used as an adjunct with L-DOPA to treat Parkinson’s Disease

Question 19

Selegiline
- Main use

Answer 19

Helpful in PD
Used in adjunct to L-Dopa

Question 20

Atypical Antidepressant Drugs
- Types

Answer 20

Bupropion
Venlafaxine
Duloxetine

Question 21

Atypical Antidepressant Drugs
- Burproprion

Answer 21

DA and NE uptake blocker

Question 22

Atypical Antidepressant Drugs
- Venlafaxine and Duloxetine

Answer 22

SNRI- 5-HT and NE re-uptake blockade

Question 23

Side Effects - TCAs
- Antagonist actions at

Answer 23

H1 receptors
Muscarinic receptors
Alpha1-adrenoceptors

Question 24

H1 antagonist

Answer 24

Sedation

Question 25

Muscarinic antagonist

Answer 25

Atropine-like effects (dry mouth, blurred vision, cycloplegia, constipation, urinary retention)

Question 26

Alpha1 adrenoceptor antagonist

Answer 26

Orthostatic hypotension Tachycardia (problematic in elderly patients)

Question 27

CNS toxicity

Answer 27

Delirium Confusion

Question 28

Cardiac toxicity (in overdose)

Answer 28

Na+ and Ca++ channel blockers QT prolongation

Question 29

Sweating Myoclonus

Answer 29

Muscle twitching (sign of toxicity)

Question 30

Weight gain

Answer 30

Major compliance issue

Question 31

Side Effects- MAOIs

Answer 31

Hypertensive Crisis Serotonin Syndrome CNS SE Anticholinergic effects and orthostatsis Sexual dysfunction Wt gain (not with selegiline)

Question 32

Side Effects- MAOIs - Hypertensive Crisis

Answer 32

Patients should be put on tyramine-restricted diets

Question 33

Side Effects- MAOIs - HTN Crisis TX

Answer 33

Hydralazine Labetalol

Question 34

Side Effects- MAOIs - Serotonin Syndrome

Answer 34

High fever Chills Diarrhea Agitation Motor dysfunction (myoclonus, tremor, ataxia and weakness)

Question 35

Side Effects- MAOIs - Serotonin Syndrome TX

Answer 35

Ice packs Cyproheptadine (serotonin block)

Question 36

Side Effects- MAOIs - CNS SE

Answer 36

Headache Insomnia

Question 37

Atypical SE

Answer 37

Bupropion

Question 38

Atypical SE - Bupropion

Answer 38

May induce seizures Dry mouth Insomnia Wt loss

Question 39

Atypical SE - Bupropion TX

Answer 39

Lowers seizure threshold

Question 40

All antidepressants can cause

Answer 40

Sexual dysfxn - inhibited ejaculation in men and impaired orgasm in women

Question 41

Boxed warnings of antidepressants

Answer 41

Antidepressants increase risk of suicidal thinking and behavior in children, adolescents and young adults