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Antidepressants Flashcards

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1
Q

What do monoamines refer to?

A

Serotonin (5-HT), Norepinephrine (NE), and Dopamine (DA)

These are chemicals that help brain cells communicate and regulate mood, energy, focus, and motivation.

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2
Q

According to the ____ theory of depression, what causes depression?

A

Monoamine theory

This theory states that depression occurs when there is too little serotonin, norepinephrine, and dopamine.

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3
Q

What are the major classes of antidepressants?

A
  • SSRIs – Selective Serotonin Reuptake Inhibitors
  • SNRIs – Serotonin-Norepinephrine Reuptake Inhibitors
  • Atypicals
  • TCAs – Tricyclic Antidepressants
  • MAOIs – Monoamine Oxidase Inhibitors

Mnemonic: ‘Some Sad Adults Try Meds’

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4
Q

What is the #1 reason people stop taking antidepressants?

A

Sexual side effects

This includes loss of libido, erectile dysfunction, and delayed orgasm.

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5
Q

What is the mechanism of action (MOA) of SSRIs?

A

They block the reuptake of serotonin, increasing serotonin levels in the brain

Mnemonic: ‘Suck Stops, Serotonin Stays’

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6
Q

What is the first-line treatment for Major Depressive Disorder?

A

SSRIs

Examples include Fluoxetine (Prozac), Sertraline (Zoloft), and Escitalopram (Lexapro).

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7
Q

What is the advantage of SSRIs over other classes?

A

Fewer side effects and safer in overdose

They are less likely to cause serious problems if taken in high doses.

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8
Q

True or False: GI side effects from SSRIs are transient (1–2 weeks)?

A

True!

Nausea and diarrhea are common but usually resolve after 1–2 weeks.

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9
Q

Which SSRI has the longest half-life?

A

Fluoxetine (Prozac)

Its half-life is 4–6 days, reducing the risk of withdrawal symptoms.

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10
Q

Which SSRI is FDA-approved for OCD?

A

Fluoxetine (Prozac)

Also approved: Fluvoxamine (Luvox), Sertraline (Zoloft).

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11
Q

Which SSRI has the shortest half-life and significant side effects?

A

Paroxetine (Paxil)

It has a high risk of withdrawal and sexual dysfunction.

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12
Q

What are the class side effects of SSRIs?

A
  • GI upset (nausea, diarrhea)
  • Sexual dysfunction
  • Headache
  • Insomnia or sedation
  • Anxiety (initially)

Mnemonic: ‘SICK SEX HEAD’

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13
Q

Which SSRI is most lethal in overdose due to QTc prolongation?

A

Citalopram (Celexa)

At doses over 40mg, it poses a risk for deadly heart arrhythmias.

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14
Q

Which SSRI has the most GI side effects and should be taken with food?

A

Sertraline (Zoloft)

It can cause diarrhea.

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15
Q

Which SSRI is considered safest during pregnancy or nursing?

A

Sertraline (Zoloft)

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16
Q

Duloxetine and Venlafaxine are examples of which class?

A

SNRIs = Serotonin-Norepinephrine Reuptake Inhibitors

They increase both serotonin and norepinephrine by blocking their reuptake.

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17
Q

What are the examples of SNRIs?

A
  • Duloxetine = Cymbalta
  • Venlafaxine = Effexor

Duloxetine is great for depression and chronic pain. Venlafaxine requires blood pressure monitoring.

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18
Q

Fluoxetine, Paroxetine, Sertraline, and Citalopram are examples of what class?

A

SSRIs – Selective Serotonin Reuptake Inhibitors

Mnemonic: ‘First People Start Crying’ = F, P, S, C

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19
Q

Bupropion is in which class?

A

Atypical antidepressant

It boosts dopamine and norepinephrine without affecting serotonin.

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20
Q

What is the mechanism of action of Bupropion (Wellbutrin)?

A

Inhibits reuptake of norepinephrine & dopamine

It avoids sexual side effects.

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21
Q

What are the target symptoms for Bupropion?

A
  • Fatigue
  • Poor concentration
  • Low motivation
  • Smoking cessation
  • ADHD off-label

Mnemonic: ‘Bupropion Boosts Brainpower’

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22
Q

What are the contraindications for Bupropion?

A
  • Seizure disorder
  • Eating disorders
  • Abrupt alcohol/benzo withdrawal

Higher seizure risk with eating disorders.

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23
Q

Which antidepressant has less GI distress, is weight neutral, and has low sexual side effects?

A

Bupropion (Wellbutrin)

It is often used when SSRIs cause sexual dysfunction.

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24
Q

What is the mechanism of action of Trazodone?

A

Serotonin antagonist and reuptake inhibitor

It boosts serotonin but also blocks certain receptors, causing sedation.

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25
Which antidepressant is associated with prolonged erection (priapism)?
Trazodone (Desyrel) ## Footnote Risk of >4 hr erection is a medical emergency.
26
What is a great antidepressant for the elderly with insomnia & weight loss?
Mirtazapine (Remeron) ## Footnote It is sedating at lower doses and increases appetite.
27
Which class has the most anticholinergic, antiadrenergic, antihistaminic, and cardiac effects?
TCAs (Tricyclic Antidepressants) ## Footnote They affect many receptors, leading to various side effects.
28
What are common side effects of TCAs?
* Dry mouth * Constipation * Sedation * Weight gain * Blurry vision * Orthostatic hypotension * Arrhythmias ## Footnote Mnemonic: 'Too Many Crappy Adverse effects'
29
Which antidepressant class is most lethal in overdose?
TCAs – especially Amitriptyline ## Footnote Even small overdoses can be fatal.
30
Which TCA is used for enuresis (bedwetting)?
Imipramine (Tofranil) ## Footnote It reduces bladder contractions.
31
Which TCA is used for OCD?
Clomipramine (Anafranil) ## Footnote It is highly serotonergic.
32
Which TCA is used for chronic pain, migraines, and insomnia?
Amitriptyline (Elavil) ## Footnote Low-dose is for pain and sleep relief, while high-dose treats depression.
33
Which TCA is considered safest in the elderly?
Nortriptyline (Pamelor) ## Footnote It is better tolerated than Amitriptyline.
34
Which TCA has EPS side effects?
Amoxapine ## Footnote It blocks dopamine, increasing the risk of extrapyramidal symptoms.
35
Which TCA is most lethal in overdose?
Amitriptyline (Elavil) ## Footnote It can cause arrhythmias, seizures, and coma.
36
What is the management of TCA overdose?
* Activated charcoal * Cardiac monitoring * IV sodium bicarbonate ## Footnote Sodium bicarbonate is the antidote for cardiotoxicity.
37
What is the mechanism of action of MAOIs?
They block monoamine oxidase, increasing serotonin, dopamine, and norepinephrine ## Footnote Mnemonic: MAOIs = Makes All Our Inside chemicals increase!
38
What diet is required for patients on MAOIs?
Tyramine-restricted diet ## Footnote To prevent hypertensive crisis.
39
What is needed when switching from SSRI to MAOI?
2-week washout (5 weeks for fluoxetine) ## Footnote To prevent serotonin syndrome.
40
What happens when MAOI is combined with tyramine-rich food?
Hypertensive crisis ## Footnote Signs include headache, stiff neck, high BP, and chest pain.
41
Give examples of tyramine-rich foods.
* Aged cheese * Smoked meats * Red wine * Fermented/aged foods * Pickled items * Soy sauce & sauerkraut ## Footnote Mnemonic: 'Cheese, Chianti, Cured meats = Crisis!'
42
Which MAOI patch has no dietary restrictions?
Selegiline (Emsam) 6mg patch ## Footnote At higher doses, dietary restrictions still apply.
43
Which antidepressants have the lowest sexual dysfunction risk?
Bupropion (Wellbutrin) and Mirtazapine (Remeron)
44
What are the treatments for SSRI-induced sexual dysfunction?
* Lower the dose * Drug holiday * Switch to bupropion or mirtazapine ## Footnote Mnemonic: 'Bupropion brings the bedroom back'
45
What are the symptoms of Antidepressant Discontinuation Syndrome?
* Flu-like symptoms * Insomnia * Nausea * Imbalance * Sensory disturbances * Hyperarousal ## Footnote Mnemonic: 'FINISH'
46
What are the symptoms of Serotonin Syndrome?
* Shivering * Hyperreflexia & myoclonus * Increased temperature * Vital sign instability * Encephalopathy * Restlessness * Sweating ## Footnote Mnemonic: 'SHIVERS'
47
Which antidepressants are FDA-approved for pediatric use?
* Fluoxetine (Prozac) * Escitalopram (Lexapro) * Sertraline (Zoloft) ## Footnote Prozac is the ONLY SSRI approved for MDD in children ≥8 yrs.
48
What is the Black Box Warning for kids and teens taking antidepressants?
Increased risk of suicidal thoughts/behavior ## Footnote This occurs especially in the first few weeks of treatment.
49
What are sedating antidepressants used for?
* Trazodone * Mirtazapine (Remeron) * Amitriptyline (TCA) * Doxepin (TCA) * Paroxetine (Paxil) ## Footnote Use these at night for patients with insomnia or poor appetite.
50
What are activating antidepressants used for?
* Fluoxetine (Prozac) * Sertraline (Zoloft) * Bupropion (Wellbutrin) * Venlafaxine (Effexor) ## Footnote Use these in the AM as they boost energy and mood.
51
Quick recap: What is the half-life of Fluoxetine (Prozac)?
Long half-life, less withdrawal ## Footnote It is effective and has a lower risk of withdrawal symptoms.
52
Quick recap: What is the half-life of Paroxetine (Paxil)?
Short half-life, more withdrawal, more sexual side effects ## Footnote It requires careful monitoring for side effects.
53
Quick recap: What is the benefit of Wellbutrin (Bupropion)?
Energizing, no sexual side effects, seizure risk ## Footnote It is often used when other antidepressants are ineffective.
54
Quick recap: What is the benefit of Remeron (Mirtazapine)?
Great for sleep/appetite, no sexual side effects
55
Quick recap: What is the risk associated with TCAs?
Lethal in overdose, anticholinergic effects ## Footnote They require careful prescribing due to potential side effects.
56
Quick recap: What is the risk associated with MAOIs?
Watch the cheese to prevent hypertensive crisis
57
What does FINISH stand for in relation to SSRI withdrawal?
* Flu-like symptoms * Insomnia * Nausea * Imbalance * Sensory disturbances * Hyperarousal
58
What does SHIVERS stand for in relation to Serotonin Syndrome?
* Shivering * Hyperreflexia & myoclonus * Increased temperature * Vital sign instability * Encephalopathy * Restlessness * Sweating
59
What is the Black Box warning in youth regarding antidepressants?
Increased risk of suicidal thoughts/behavior
60
What is the antidote for cardiotoxicity?
Sodium bicarbonate ## Footnote Sodium bicarbonate is used in cases of cardiotoxicity due to its ability to counteract acidosis and improve cardiac function.
61
Mneumonic to help remember sedating antidepressants that are often used at night to help with insomnia and appetite
“Take My Ass Down Peacefully”** helps you remember the most sedating antidepressants used at night: • Take = Trazodone – great for sleep, low dose used just for insomnia • My = Mirtazapine – boosts appetite and helps with sleep, often used in frail or underweight patients • Ass = Amitriptyline – a TCA often used for chronic pain and sleep • Down = Doxepin – another TCA, very sedating, sometimes prescribed specifically for insomnia • Peacefully = Paroxetine (Paxil) – the most sedating SSRI, often causes weight gain too

Antidepressants (2 decks)

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