Antidepressants & Mood Stabilizers

Question 1

Characteristics of depression tx

Answer 1

• SSRIs/SNRIs block reuptake of NTs immeadiately, but effects take weeks
  
  • may be to changes in downstream effects
  • exact mechanism of efficacy unclear
• all pharmacological tx target NT systems
• ECT = only approved tx that produces more rapid response (vs. 4-16 wk delay)
• response rate (reduce sx by 50%) in first 8 weeks = 67%
• 1/3 pts on SSRI will achieve remission
• all FDA-approved drugs have similar efficacy/evidence

Question 2

Types of antidepressants

Answer 2

• Tricyclic antidepressants: block reuptake of 5HT and NE (some DA) + block H1, muscarinic cholinergic, and alpha1 receptors
• SSRIs: block 5HT reuptake
• SNRIs: block NE & 5HT reuptake
• Monoamine Oxidase Inhibitors (MAOIs): inhibit MAO-A/MAO-B ==> increased levels of 5HT and NE
• Other
  
  • Buproprion: increases whole body NE, weakly blocks reuptake of DA

Question 3

TCA side effects

Answer 3

• hypotension
• anticholingeric SE
• weight gain
• sexual SEs
• dangerous in overdose

Question 4

MAOI side effects

Answer 4

• hypotension, dry mouth, constipation, urinary retention, sexual SE, weight gain
• hypertensive crisis – Tyramine reaction
  
  • consumption of tyramine in diet (fermented items, e.g. alcohol or aged cheese) ==> hypertensive reaction

Question 5

SSRI side effects

Answer 5

• diarrhea, nausea
• anxiety
• sexual side effects
• P450 inhibtion ==> drug interations

Question 6

SNRI side effects

Answer 6

• sexual side effects
• sweating
• increased diastolic BP
• withdrawal syndrome (flu-like, “electric shocks”)

Question 7

Buproprion side effects

Answer 7

• NO sexual side effects, weight neutral
• anxiety
• insomnia
• higher seizure risk

Question 8

Mirtazapine side effects

Answer 8

• daytime somnolence
• weight gain

Question 9

Complications of treating bipolar disorder

Answer 9

• bipolar is more complex than unipolar
• different phases require different drugs
• ideal drug: anti-manic, anti-depressive and prevent future episodes

Question 10

Categories of drugs in tx of bipolar

Answer 10

• anti-manic agents
• antidepressant agents
• maintence agents
• relapse prevention agents

Question 11

Examples of anti-manic agents

Answer 11

• atypical antipsychotics
• lithium
• divalproex
• carbamazepine

Question 12

Examples of bipolar antidepressive agents

Answer 12

• quetiapine
• olanzapine+fluoxetine (Symbyax)

Question 13

Characteristics of Lithium

Answer 13

• Pluses: Best studied, best proven drug
  
  • _​_effective anti-manic
  • 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.

Question 14

Characteristics of Divalproex Sodium

Answer 14

• Pluses:
  
  • Anti-manic agent
  • Individualized treatment (based on weight)
  • rapid loading
  • safe and effective
• Minuses:
  
  • Not proven as preventative agent
  • weight gain
  • sedation
  • not effective in bipolar depression

Question 15

Characteristics of Atypical Antipsychotics

Answer 15

• Pluses:
  
  • 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