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Flashcards in Antidepressants and mood stabilizers Deck (9)
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1

Class of antidepressants

-TCA (tricyclic amides): inhibition of presynaptic reuptake of NE/5HT/DA (ex: amitriptyline)
-SSRI: inhibition of presynaptic reuptake of 5HT (ex: fluoxetine)
-MAOI: inhibition of monoamine oxidase (ex: phenelzine)
-Others: 5HT2 antagonism (mirtazapine), DA reuptake inhibitor (bupropion)
-Rx can be acute (6-8 wks), months-years (continuation or maintenance), or be lifelong (maintenance)
-Rx of antidepressants to someone w/ bipolar d/o can trigger a manic phase

2

Amitriptyline (Elavil)

-TCA: inhibits the reuptake of NE, 5NT, and DA
-Causes sedation (inhibits histamine), dizziness (inhibits a1 adrenergic), dry mouth and constipation (inhibits cholinergic)
-Is effective and inexpensive
-Major problem: chance of cardiotoxicity/heart block in OD (need ECG baseline and to monitor)

3

Fluoxetine (prozac)

-SSRI
-Causes nausea and diarrhea (agonist of 5HT3)
-Causes headache, sexual changes like delayed ejaculation (agonist of 5HT2)
-30-50% have sexual side effects
-Safety in OD, does not cause sedation

4

Phenelzine (Nardil)

-MAOI
-Causes dizziness and postural hypotension (a1 inhibition)
-Increases wakefulness and causes insomnia
-Hypertensive crisis when mixed w/ pseudoephedrine or tyramine (no aged cheese or wine)

5

Mirtazapine (Remeron)

-5HT2 antagonism
-No sexual side effects, nausea, or headache
-Blocks histamine but less sedation due to NE increase
-Main common adverse effect: sedation (due to blocking histamine) and significant weight gain

6

Bupropion (wellbutrin)

-DA/NE reuptake inhibitor
-Helps in cessation of smoking and ADHD
-No sexual dysfunction, no weight gain
-Common adverse effect: insomnia, upset stomach
-Seizure risk: not used in those w/ epilepsy/seizures or those w/ eating d/o particularly bulimia

7

Mood stabilizers

-Rx for bipolar disorder, are taken lifelong to prevent relapse of illness
-Either lithium (more lethal in OD) or valproate (less lethal in OD)

8

Lithium

-Eskalith, lithobid
-Excreted unchanged thru renal
-Inhibits excitatory NT (NE, DA) release, enhances 5HT to help deal w/ depression
-Effective in both stages of the disease, best relapse prevention
-Onset 1-2 wks (less lipophilic), lethal in OD
-Therapeutic level: .6-1.5 mEq/L
-Drug interactions: ibuprofen, caffeine

9

Valproate

-Depakene, Depakote
-Facilitates GABA activity, broad-spectrum anticonvulsant
-For acute mania, mixed mania (rapid cycling)
-Less established relapse prevention
-Onset 2-5 days (lipophilic), much safer in OD
-Hepatic elimination
-Therapeutic level: 50-125 mg/L

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