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Flashcards in Antidepressants Deck (23):
1

what can antidepressants be used to treat

unipolar and bipolar depression
organic mood disorders
schizoaffective disorders
anxiety (OCD, Panic, Social Phobia, PTSD)
premenstrual dysphoric disorder

2

what are the broad classes of antidepressants

TCAs - tricyclic
MAOIs - monamine oxidase inhibitors
SSRIs - selective seratoin reuptake inhibitors
SNRIs - seratonin/noradrenaline reuptake inhibitors
Novel

3

what are the two classes of TCAs and how do they differ

teritary - act on serotonin receptors

secondary - block noradrenaline

4

give examples of tertiary TCAs

imipramine
amitryptyline
doxepin
clomipramine

5

give examples of secondary TCAs

Desipramine
Nortryptyline

6

what are the side effects of TCAs

antihistamimic
- sedation, weight gain

anticholinergic
- dry mouth/eyes, constipation, decreased memory, delirium

Antiadrenergic
- orthostatic hypotension, sedation, sexual dysfunction

SE less bad for secondary TCAs

7

What are the side effects for MAOIs

ortho HT
weight gain
dry mouth
sedation
bad sleep
decreased sexual function

8

what is the action of MAOIs

bind MAO - increase synaptic levels

9

what are the complications of MAOIs

hypertensive crisis - avoid tyramine foods/sympathomimetics

seratonic syndrome - don't take with SSRIs (wait at least 2 weeks before going between meds - 5 for fluoxetine)

10

when are MAOIs particularly useful

as a last line treatment in treatment resistant patients

11

what are the side effects of SSRIs

GI upset
sexual dysfunction
anxiety
restlessness
nervousness
insomnia
fatigue
sedation
dizziness

12

what are the complications of SSRIs

discontinuation syndrome from SSRIs with a short half life

toxic build up in liver if long half life

13

what is the action of SSRIs

block presynaptic uptake of serotonin

14

give three examples of less sedative SSRIs

Sertraline - short t1/2

Citalopram - mid t1/2

Fluoxetine - long t1/2

15

give three examples of more sedative SSRIs

paroxetine - short t1/2

escitalopram - mid t1/2

fluroxamine - long t1/2

16

which SSRI is best used in an emergency for an acute response or remission

escitalopram

17

What are the side effects of SNRIs

sexual dysfucntion, nausea (venlafaxine)

18

what is the action of SNRIs

inhibit serotonin and noradrenaline

19

give examples of SNRIs

veblafaxine - short t1/2 (but nausea and increased BP)

Duloxetine - very good for depression, anxiety and neuropathic pain

20

What are the two novel antidepressants

Mirtazapine

Buproprion

21

what are some pros and cons of mirtazapine

pros
5HT2/5HT3 receptor antagonist
good to augment SSRIs

cons
increases serum cholesterol
sedating at lover doses
weight gain

22

what are some pros and cons of buproprion

pros
good to augment treatments
reuptake inhibition of dopamine + NE
no weight gain
no sexual dysfunction
no sedation
secondary ADHD agent so can work for both

cons
increased seizure risk
not good for anxiety

23

what can be done if treatment resistance occurs

combination: SSRI or SNRI + Mirtazepine
Use adjunctive Lithium
Use adjunctive atypical antipsychotic
ECT