Antidepressants, Anti-manic drugs & Mood Stabilizers Flashcards Preview

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Flashcards in Antidepressants, Anti-manic drugs & Mood Stabilizers Deck (28):
1

block 5HT pre-synaptic reuptake pump

• SSRIs:

2

block NE and 5-HT reuptake pumps

• SNRIs:

3

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

• Mirtazapine:

4

increases whole-body NE, weakly blocks reuptake of DA

• Buproprion

5

most potent action is blockade of post-synaptic 5-HT2. Block reuptake of 5-HT and NE.

• Trazodone and nefazodone

6

block reuptake of 5-HT and NE, (and, to lesser extent, DA), as well as H1, muscarinic cholinergic receptors and a-1.

• Tricyclics:

7

irreversibly inhibit MAO-A and MAO-B, increasing levels of 5-HT and NE.

• MAOIs

8

a new antidepressant, is an SSRI + 5HT1A partial agonist.

• Vilazodone,

9

• Pluses: Time-tested, very effective, more effective in severe depression, can monitor blood levels. Newer TCAs (secondary amines such as desipramine and nortriptyline) have fewer side effects than older TCAs (tertiary amines, such as imipramine and amitryptyline)
• Minuses: Hypotension, orthostasis, anticholinergic side effects, weight gain, sexual side effects, dangerous in overdose (10 day supply can be lethal)

TCAs

10

• Pluses: Can be very effective in non-responsive patients, especially atypical depression, time-tested.
• Minuses: Hypotension, orthostasis, dry mouth, constipation, urinary retention, sexual side effects, weight gain, hypertensive crisis--Tyramine reaction

MAOIs

11

• Pluses: Safe, effective, multiple indications: Generalized Anxiety Disorder, social anxiety, panic, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Premenstrual Dysphoric Disorder
• Minuses: Diarrhea, nausea, jitteriness/anxiety, sexual side effects, drug interactions: P450 inhibition

SSRIs

12

• Pluses: Some evidence more effective than SSRIs, safe, better tolerated than TCAs, multiple indications
• Minuses: Sexual side effects, sweating, increased diastolic blood pressure, withdrawal syndrome (flu-like, “electric shocks”)

SNRIs

13

TCAs

• Pluses: Time-tested, very effective, more effective in severe depression, can monitor blood levels. Newer TCAs (secondary amines such as desipramine and nortriptyline) have fewer side effects than older TCAs (tertiary amines, such as imipramine and amitryptyline)
• Minuses: Hypotension, orthostasis, anticholinergic side effects, weight gain, sexual side effects, dangerous in overdose (10 day supply can be lethal)

14

SSRIs

• Pluses: Safe, effective, multiple indications: Generalized Anxiety Disorder, social anxiety, panic, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Premenstrual Dysphoric Disorder
• Minuses: Diarrhea, nausea, jitteriness/anxiety, sexual side effects, drug interactions: P450 inhibition

15

MAOIs

• Pluses: Can be very effective in non-responsive patients, especially atypical depression, time-tested.
• Minuses: Hypotension, orthostasis, dry mouth, constipation, urinary retention, sexual side effects, weight gain, hypertensive crisis--Tyramine reaction

16

SNRIs

• Pluses: Some evidence more effective than SSRIs, safe, better tolerated than TCAs, multiple indications
• Minuses: Sexual side effects, sweating, increased diastolic blood pressure, withdrawal syndrome (flu-like, “electric shocks”)

17

• Pluses: No sexual side effects, weight neutral, activating.
• Minuses: Increased anxiety, jitteriness, ineffective in panic disorder, insomnia, higher seizure risk (contraindicated in eating disorder patients and those with seizure disorder)

Bupropion

18

• Pluses: Helpful with insomnia, rapid anti-anxiety effect, low incidence of sexual side effects
• Minuses: Daytime somnolence, weight gain


Mirtazapine

19

• Pluses: Best studied, best proven drug, effective anti-manic, reasonable preventative agent, some antidepressant effect, anti-suicidal properties, neuro-regenerative effects, inexpensive.
• Minuses: Tremor, nausea, diarrhea, taste, thirst, cognitive dulling, narrow therapeutic window (0.6-1.2 mEq/l), toxic/lethal in overdose, renal effects, decreased urine concentration, diabetes insipidus, hypothyroidism.

Lithium

20

Bupropion

• Pluses: No sexual side effects, weight neutral, activating.
• Minuses: Increased anxiety, jitteriness, ineffective in panic disorder, insomnia, higher seizure risk (contraindicated in eating disorder patients and those with seizure disorder)

21


Mirtazapine

• Pluses: Helpful with insomnia, rapid anti-anxiety effect, low incidence of sexual side effects
• Minuses: Daytime somnolence, weight gain

22

Lithium

• Pluses: Best studied, best proven drug, effective anti-manic, reasonable preventative agent, some antidepressant effect, anti-suicidal properties, neuro-regenerative effects, inexpensive.
• Minuses: Tremor, nausea, diarrhea, taste, thirst, cognitive dulling, narrow therapeutic window (0.6-1.2 mEq/l), toxic/lethal in overdose, renal effects, decreased urine concentration, diabetes insipidus, hypothyroidism.

23

• Pluses: Individualized treatment (based on weight), rapid loading (20-30 mg/kg), safe and effective.
• Minuses: Not proven as preventative agent, weight gain, sedation, not effective in bipolar depression

Divalproex Sodium

24

• Pluses: All are anti-manic, reasonably safe & effective, different routes of administration (injection, dissolvable tabs), rapid dose titration
• Minuses: Weight gain, risk of metabolic effects/diabetes, risk of increased cholesterol/lipids, expensive, are they any better than typical antipsychotics?

Atypical Antipsychotics

25

• No large, randomized, adequately controlled and powered studies have shown that antidepressants are effective in the treatment of bipolar depression. There is some evidence that antidepressants can worsen the course of bipolar disorder.
• Best treatments for bipolar depression at present are (in descending order of efficacy): quetiapine, lamotrigine, Olanzapine/fluoxetine combination, lithium (unclear whether combined with antidepressant).

Bipolar Depression

26

Divalproex Sodium

• Pluses: Individualized treatment (based on weight), rapid loading (20-30 mg/kg), safe and effective.
• Minuses: Not proven as preventative agent, weight gain, sedation, not effective in bipolar depression

27

Bipolar Depression

• No large, randomized, adequately controlled and powered studies have shown that antidepressants are effective in the treatment of bipolar depression.

28

Atypical Antipsychotics

• Pluses: All are anti-manic, reasonably safe & effective, different routes of administration (injection, dissolvable tabs), rapid dose titration
• Minuses: Weight gain, risk of metabolic effects/diabetes, risk of increased cholesterol/lipids, expensive, are they any better than typical antipsychotics?