Antidepressants Flashcards
(23 cards)
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
what are the broad classes of antidepressants
TCAs - tricyclic
MAOIs - monamine oxidase inhibitors
SSRIs - selective seratoin reuptake inhibitors
SNRIs - seratonin/noradrenaline reuptake inhibitors
Novel
what are the two classes of TCAs and how do they differ
teritary - act on serotonin receptors
secondary - block noradrenaline
give examples of tertiary TCAs
imipramine
amitryptyline
doxepin
clomipramine
give examples of secondary TCAs
Desipramine
Nortryptyline
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
What are the side effects for MAOIs
ortho HT weight gain dry mouth sedation bad sleep decreased sexual function
what is the action of MAOIs
bind MAO - increase synaptic levels
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)
when are MAOIs particularly useful
as a last line treatment in treatment resistant patients
what are the side effects of SSRIs
GI upset sexual dysfunction anxiety restlessness nervousness insomnia fatigue sedation dizziness
what are the complications of SSRIs
discontinuation syndrome from SSRIs with a short half life
toxic build up in liver if long half life
what is the action of SSRIs
block presynaptic uptake of serotonin
give three examples of less sedative SSRIs
Sertraline - short t1/2
Citalopram - mid t1/2
Fluoxetine - long t1/2
give three examples of more sedative SSRIs
paroxetine - short t1/2
escitalopram - mid t1/2
fluroxamine - long t1/2
which SSRI is best used in an emergency for an acute response or remission
escitalopram
What are the side effects of SNRIs
sexual dysfucntion, nausea (venlafaxine)
what is the action of SNRIs
inhibit serotonin and noradrenaline
give examples of SNRIs
veblafaxine - short t1/2 (but nausea and increased BP)
Duloxetine - very good for depression, anxiety and neuropathic pain
What are the two novel antidepressants
Mirtazapine
Buproprion
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
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
what can be done if treatment resistance occurs
combination: SSRI or SNRI + Mirtazepine
Use adjunctive Lithium
Use adjunctive atypical antipsychotic
ECT
