Antidepressants

Question 1

Citalopram (Celexa)

Answer 1

SSRIs

Dose: 20-40mg/day

Side Effects: GI (D/N), sexual (decreased libido), sleep (insomnia), sweating, Na+, mania.

Black Box: Increase suicidal ideation up to 25yo

Interactions: weak 2D6 inhibition
Can increase MAO-I’s and TCA levels

Other: QTc prolongation average 18msec at 60mg/day
(>480msec – risk of Torsade’s)

Question 2

SSRIs

Answer 2

citalopram
escitalopram
fluoxetine
paroxetine
sertraline
fluvoxamine

Question 3

Venlafaxine/ ER (Effexor/XR)

Answer 3

SNRIs

Dose: 75 – 375mg/day

Side Effects: GI (D/N), sexual (decreased libido), sleep (insomnia), sweating, Na+, mania.Diastolic blood pressure increase (adrenergic activation)

Black Box: SI up to 25yo

Interactions: very weak 2D6 -, slight increase of MAO-I & TCA’s

Other: dual re-uptake >225mg/day
discontinuation sx’s can be bad (very quick half life- present with sweating, pain, neck stiffness)

Question 4

SNRIs

Answer 4

venlafaxine
desvenlafaxine
duloxetine

Question 5

Nortriptyline (Pamelor)

Answer 5

TCA

Dose: 75 – 150mg/day

Level:50 – 150 ng/ml

Side effects: wt gain, sedation, ACh, hypotension, arrhythmia, sexual, sweating

Interactions: 2D6 inhibition
MAO-I, TCA’s, tramadol
Other: Lethal in overdose (LD50
is 2000-3000mg)

Question 6

TCAs

Answer 6

chlomipramine- 5HT only (OCD)
nortyptiline
imipramine
amitryptiline
desipramine

Question 7

Bupropion (Wellbutrin/SR/XL, Zyban)

Answer 7

NDRI

Dose: XL 150 – 450mg/day

Side effects: Insomnia, tremor, tinnitus, seizures

Interactions: 2D6 -, MAO-I, TCA, tramadol, levodopa

Other: avoid in eating d/o’s and seizure d/o’s
least likely to cause mania
may reduce sexual side effects because no 5HT

could also do smoking cessation (Zyban) because blocks nicotinic receptors

Question 8

MAO-Is

Answer 8

Phenelzine (Nardil)
Developed as TB drug
sedating

Tranylcypromine (Parnate)
Developed as Amphetamine
stimulating

Question 9

miratazapine (Remeron)

Answer 9

NaSSA

Dose: 15-45mg/day

Side effects: sedating!, wt gain! (histamine)

Interactions:no P450
Do not combine w/ MAO-I
Other:low sexual SE’s

Question 10

SARIs

Answer 10

nefazodone
trazodone

dual uptake (5HT and NE)

Question 11

diazepam (valium)

Answer 11

BZD- anxiety

Dose: 4 - 40mg/day

Half-life: 20-50 hours

Side effects: sedation, depression, amnesia, ataxia, dependence, (90 hour delay) withdrawal

Interactions: CNS depressants, (opiates), cimetidine.
Other: 
Hepatically cleared
Active metabolites
flumazenil - reverses

dont like to give to people with CBT b/c amnesia

Question 12

zolpidem (ambien)

Answer 12

a1 selective BDZ

mediate sleep, but also affects memory

“sleep walking”- technically awake but absense of memory

Question 13

Buspirone (buspar)

Answer 13

5HT-1A partial agonist

For GAD and to Augment MDD

Dose: 15 – 45mg/twice a day
Side effects: Dizziness, HA, sedation, nervous/restless

Interactions: MAO-I

Other: No sexual SE, No dependence, No withdrawal
Takes 4 weeks + to work