Serotonin syndrome is most common in what combo?
MAOI with another serotonergic agent
What antidepressant carries the hugest risk of withdrawal symptoms
Paxil
How long is an adequate trial of an antidepressant?
6-8 weeks
What is in the combo Symbyax?
Olanzapine + fluoxetine
Which antidepressants are started in pregnancy?
SSRIs
Which SSRI is not recommended in pregnancy?
Paxil
New warning from FDA SSRIs use in pregnancy can cause what risk?
Persistent pulmonary hypertension in the newborn
What agents are preferred in postpartum depression?
SSRIs
Tricyclics
Natural products depression?
St. John’s wort
SAMe
Three negative things about St. John’s wort
Drug interactions
Serotonergic
Photosensitizer
Use Symbyax when?
Resistant depression
Which SSRI has the most drug interactions?
Fluvoxamine
SSRI can cause what kind of side effects?
Sexual
Which SSRI is the most activating and should be taken when?
Fluoxetine
In the morning
Fluvoxamine is only approved for what?
OCD
If cardiac risk present, avoid what SSRI?
Citalopram
Use which SSRI in cardiac patients?
Setraline
Physical symptoms of depression improve after how long of treatment?
Within a few weeks
antidepressant that has SSRI and 5HT1A partial agonist activity
Viibryd
What advantage does Viibryd have over SSRIs and SNRIs?
Less sexual side effects
Fluoxetine inhibits what CYPs?
2D6
2C19
Paxil inhibits what CYP?
2D6
All SSRIs and SNRIs increase what risk with anticoagulants and anti platelets?
Bleeding
What three antidepressants are SNRI?
Venlafaxine
Duloxetine
Desvenlafaxine
SNRIs cause what 2 NE related side effects
Increase in BP
Excessive sweating
Which SNRI carries highest of raising blood pressure?
Venlafaxine
Especially at higher doses
Which SNRI can you see a ghost tablet?
Desvenlafaxine
Although less than SSRIs, SNRIs can also cause what SE?
Sexual dysfunction
What 4 MOAs do TCAs have?
Inhibit re uptake of NE
Inhibit re uptake of 5HT
Blocks ACh receptors
Blocks histamine receptors
TCAs have what toxicity in overdose?
Cardiotoxicity
TCAs cause what group of SE?
Anticholinergic
Blocks ACh receptors
What 2 other unpleasant SE can TCAs cause?
Vivid dreams
Weight gain
TCAs are metabolized by what CYP?
2D6
TCAs have what additive risk?
QT prolongation
Will vivid dreams with TCAs go away?
Yes
TCAs can increase what vital sign?
BP
Blocks NE reuptake
Monoamine oxidase does what?
Breaks down catecholamines
What is the brand name of the selegiline patch?
EMSAM
Selegiline has what MOA?
MAOI B selective inhibitor
MAOIs cause what when used with other antidepressants?
Hypertensive crisis
Allow a wash out period of how long when switching to or from an MAOI?
2 week
Exception to 2 week wash out period when switching to or from MAOI?
Fluoxetine
Wait 5 weeks
Avoid what kinds of foods with MAOIs?
Tyramine rich foods
Change EMSAM patch how often?
Daily
What three agents are NDRIs?
Buproprion
Mirtazapine
Trazodone
Bupropion has what special indication?
Seasonal effective disorder
Bupropion is used for what random indication?
Smoking cessation
DNE what mg/day in bupropion? Why?
450 mg
Increases seizure risk
Bupropion has no effect on serotonin and therefore no _____ SE?
Sexual
Bupropion is CI in what two disease states?
Seizures
Anorexia / bulimia
Bupropion has what beneficial SE?
Weight loss
Mirtazapine causes what 2 SE?
Sedation
Weight gain
Trazodone can cause what medical emergency?
Priapism
Antipsychotics are approved for what kind of depression?
Treatment-resistant depression
All antipsychotics increase risk of what in elderly people with psychosis or dementia?
Death
What antipsychotics are approved in treatment resistant depression?
Abilify
Symbyax
Seroquel