Antidepressants and Mood Stabilizers

Question 1

Recognize the different classes of antidepressants and general ideas about mechanism of action.

Answer 1

SSRIs = block 5HT pre-synaptic reuptake pump 
SNRIs = block 5HT AND NE reuptake pumps
TCAs = block reuptake of 5-HT and NE, (and, to lesser extent, DA), as well as H1, muscarinic cholinergic receptors and α-1
MAOIs = irreversibly inhibit MAO-A and MAO-B --> increase levels of 5-HT and NE
others = Buproprion, Mirtazapine, Trazodone and nefazodone, Vilazodone, VNS, DBS, TMS

Question 2

What are the 3 phases of treatment for mood disorders?

Answer 2

acute tx
continuation phase
maintenance phase

Question 3

What are these drugs:
fluoxetine
paroxetine
sertraline
citalopram
escitalopram
fluvoxamine
vilazodone

Answer 3

SSRIs

Question 4

What are these drugs:
venlafaxine
desvenafaxine
duloxetine
milnacirin
levoilnaciprin

Answer 4

SNRIs

Question 5

What are these drugs:
amitryptiline
nortriptyline
desipramine
imipramine
doxepin
trimipramine
protriptyline
amoxapine

Answer 5

TCAs

Question 6

What are these drugs:
phenelzine
selegeline
tranylcypromine
isocarbxazid

Answer 6

MAOIs

Question 7

Why would you choose a TCA?

Answer 7

very effective
severe depression
can monitor blood levels
fewer SEs

Question 8

Why would you avoid a TCA?

Answer 8

hypotension
orthostasis
dry mouth 
constipation
weight gain
sexual dysfunction
DANGEROUS IN OD- give short supply

Question 9

Name the drug class, based on its SEs:
hypotension
orthostasis
dry mouth 
constipation
weight gain
sexual dysfunction
DANGEROUS IN OD- give short supply

Answer 9

TCAs

Question 10

Why would you choose an MAOI?

Answer 10

effective in non-responsive pts

atypical depression

Question 11

Why would you avoid using an MAOI?

Answer 11

hypotension
orthostasis
dry mouth
constipation
urinary retention
sexual dysfunction
weight gain 
HYPERTENSIVE CRISIS- TYRAMINE RXN

Question 12

Name the drug class, based on its SEs:
hypotension
orthostasis
dry mouth
constipation
urinary retention
sexual dysfunction
weight gain 
HYPERTENSIVE CRISIS- TYRAMINE RXN

Answer 12

MAOIs

Question 13

Why would you choose an SSRI?

Answer 13

safe, effective

also for anxiety, panic, OCD, PTSD, premenstrual dysphoric disorder

Question 14

Why would you avoid SSRIs?

Answer 14

diarrhea
nausea
jitteriness/anxiety
SEXUAL DYSFUNCTION
drug interactions: P450 INHIBITION

Question 15

Name the drug class, based on its SEs:
diarrhea
nausea
jitteriness/anxiety
SEXUAL DYSFUNCTION
drug interactions: P450 INHIBITION

Answer 15

SSRIs

Question 16

What is the best studied, best proven drug for bipolar disorder?

Answer 16

lithium

Question 17

Describe the general timeline of response to antidepressants.

Answer 17

takes weeks to work (4-16 weeks)

Question 18

Discuss issues around treatment of bipolar disorder.

Answer 18

bipolar = 3 phases: manic, depressive, and future episodes
NO drugs truly work in all 3 phases
Mania tx is effective but not so much bipolar depression

Question 19

Describe basic medication strategies for treating bipolar mania and depression.

Answer 19

PT will likely be taking several (3) drugs at once

mania = everything EXCEPT lamotrigine and olanzapine + fluoxetine (Symbyax)
depression = ONLY olanzapine + fluoxetine (Symbyax), quetiapine, and lurasidone

Question 20

What drugs for bipolar disorder are NOT effective for the mania?

Answer 20

lamotrigine

olanzapine + fluoxetine (Symbyax)

Question 21

What drugs for bipolar disorder DO treat the depression?

Answer 21

olanzapine + fluoxetine (Symbyax)
quetiapine
lurasidone

Question 22

What are the following drugs useful for in the tx of bipolar disorder?
olanzapine + fluoxetine
quetiapine
lurasidone

Answer 22

bipolar depression

Question 23

What drugs for bipolar disorder are effective for maintenance?

Answer 23

lithium
lamotrigine
aripiprazole
olanzapine

Question 24

What are the following drugs useful for in the tx of bipolar disorder?
lithium
lamotrigine
aripiprazole
olanzapine

Answer 24

maintenance

Question 25

What drugs for bipolar disorder are effective for relapse prevention?

Answer 25

lithium | olanzapine

Question 26

What are the following drugs useful for in the tx of bipolar disorder? lithium olanzapine

Answer 26

relapse prevention

Question 27

Do you prescribe antidepressants for bipolar depression?

Answer 27

NO

Question 28

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

Answer 28

increases whole-body NE, weakly blocks reuptake of DA

Question 29

What is the mechanism of action of Mirtazapine?

Answer 29

blocks 5-HT2A, 5-HT2C, 5-HT3, α-2-adrenergic receptors

Question 30

This drug increases whole-body NE and weakly blocks reuptake of DA.

Answer 30

Buproprion (Wellbutrin)

Question 31

This drug blocks 5-HT2A, 5-HT2C, 5-HT3, and α-2-adrenergic receptors.

Answer 31

Mirtazapine

Question 32

This drug's most potent action is blockade of post-synaptic 5-HT2, and it blocks reuptake of 5-HT and NE.

Answer 32

Trazodone and nefazodone

Question 33

What is the mechanism of action for Trazodone and nefazodone?

Answer 33

blockade of post-synaptic 5-HT2, and it blocks reuptake of 5-HT and NE

Question 34

How does Vilazodone work?

Answer 34

an SSRI + 5HT1A partial agonist

Question 35

Name the drug that is an SSRI + 5HT1A partial agonist.

Answer 35

Vilazodone

Question 36

What are the positive and negatives to using Buproprion (Wellbutrin)?

Answer 36

``` + = NO sexual dysfunction, NO weight gain, activating - = increased anxiety, jitteriness, ineffective for panic disorder, insomnia, HIGH SZ RISK, contraindicated in EATING DISORDERS ```

Question 37

Name the drug: + = NO sexual dysfunction, NO weight gain, activating - = increased anxiety, jitteriness, ineffective for panic disorder, insomnia, HIGH SZ RISK, contraindicated in EATING DISORDERS

Answer 37

Buproprion (Wellbutrin)

Question 38

What are the positive and negatives to using Mirtazapine?

Answer 38

``` + = Helpful with insomnia, rapid anti-anxiety effect, LOW SEXUAL DYSFUNCTION - = Daytime somnolence, WEIGHT GAIN ```

Question 39

Name the drug: + = Helpful with insomnia, rapid anti-anxiety effect, LOW SEXUAL DYSFUNCTION - = Daytime somnolence, WEIGHT GAIN

Answer 39

Mirtazapine