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Flashcards in Mental Health Medications Deck (36):

non-selective norepinephrine-serotonin Reuptake Inhibitors

for anxiety, panic attacks, chronic pain
2 to 4 weeks for full therapeutic effect
not first-line, can easily overdose
previously known as TCAs. ofranil), desipramine (Norpramin), amitriptyline (Elavil) and doxepin (Sinequan.
effects NE, 5-HT, Ach, histamine
inc NE and 5-HT
less expensive, equally efficacious, more SE


seratonin-norepinephrine reuptake inhibitors (SNRI)

treating depression, sleep, pain disorders, anxiety, general anxiety, social phobia, add, eating disorders, possibly neuropathic pain
like TCS without antihistamine, antiadrenergic or anticholinergic SE
less protein binding that SSRI, less drug-drug interactions than SSRI,
Venlafaxine (Effexor and effexor SR)
Duloxetine (cymbalta)
desvenlafaxine (Pristiq)
may be good for double depression and melancholic depression


Norepinephrine-dopamine reuptake inhibitors

bupropion (wellbutrin)
for depression, add, social phobia, good for substance abuse, eating disorder, nicotine withdrawal d/t occupying DA receptors in reward center
affects frontal cortex, limbic system, caudate and brainstem,
mild DA reuptake, no effect on 5HT
NE in frontal cortex-activates and calms
DA blockade has compensatory 5HT increase
, nucleus acumbens
increases well being and satisfaction


serotonin agonist reuptake inhibitor - triazolopyridines

sexual SE, weight gain SE
blocks othe 5HT receptor subtypes, inc anxiolytic and antidepressant
trazodone (Desryl) and nefazodone (BBW - hepatotoxicity, lots of drug-drug)


norepinephrine and serotonin specific agonist

mirtazepine (Remeron)
5HT agonist and reuptake inhibitor that blocks the reuptake of NE and somatodendritic reuptake of 5HT, nore NE in cleft
bad-block histamine-->drowsiness and weight gain
pro-very effective for anxiety/depression, w/o 5-HT SE like sexual or GI
more adverse rxn's at lower and higher doses


norepinephrine-specific reuptake inhibitors

atomoxetine (strattera) - for ADD, nonstimulant
inc NE in frontal cortex, executive functions improve. good for depression with hypersomnolence, amotivation, poor decision making


benzodiazepen gaba-ergic

potential for cognitive impairment, tolerance and dependence
immediate relief
act on chloride ion channels of gaba receptors, enhance gaba neurotransmission
fast acting


nonbenzodiazepine gaba agonist

buspirone, for anxiety. doesn't act directly on GABA, agonist to 5HT and DA, main action on limbic system
con-2-3 time/day dosing, mild effects, 2 to 3 week lag time
pro-minimal SE


anxiety-goals of treatment

accepting partial response
provide adequate trial of meds (8-12 weeks)
must provide optimize dosage range and give regular f/u


depression treatment goals

reduce symptoms
imp QOL and daily function
eliminate SI
minimize adverst tx effects
prevent relapse


anxiety med classes

neural pathways are 5-HT, NE and GABA
nonselective norepi-5-HT reuptake inh
SSRI, SNRI, serotonin agonists
benzo and betablockers to a lesser extent



depression, anxiety, OCD, panic attacks
SE-n/v/diar, sexual dysfunction, HA, insomnia
2 to 4 weeks for effects
anxiety resolves better than depression, but may need higher dose


beta-adrenergic blockers

good for panic disorders with sympathetic nervous system arousal (sob, tachycardia, clammy skin, blurred vision)


medical causes of depression

hypothyroid, malignancies (brain tumor), chronic renal failure, autoimmune disorders, ciochemical lesions in midbrain and brainstem, like huntington's and parkinson's


meds associated with depression

clonidine, hydralazine, methyldopa, interferons, reserpine, OCP, steroids/adrenocorticotropic hormone, isotretinoin


labs for depression

CBC w/ diff, thyroid, RPR, UDS, VitD?, testosterone?


Paxil (paroxetine)

PRO-short half life, sedating properties, good for anxiety and insomnia
CON-CYP2D6 inhibitor, sedating, wt gain, anticholinergic effects, d/c syndrome


Sertraline (zoloft)

PRO weak p450, slight cyp2d6, short half live, less sedating
CON needs full stomach to absorb, inc GI SE


Fluoxetine (prozac)

take in the am
PRO long-half life, less d/c syndrome, good for med non-compliance, easy taper
CON - long half live, metabolites may build up
sig p450 interactions (bad if lots of meds)
more likely to cause mania



PRO- low P450, fewest drug-drug int, low d/c syndrome
CON- sedating, GI SE,
prolong QT at high doses


venlafaxine (effexor)

PRO - no P450, minimal drug-drug, short half-life, fast renal clearance (good for gero)
CON-may in BP 10-15 in diastole,
d/c syndrom is bad, 2 week taper
QT prolongation
sexual SE highest, >30%


cymbalta (duloxetine)

PRO - helps with phys sx
less BP inc
CON - CYP2d6 and CYP1a2
can't break capsule



novel antidepressant
PRO -good augment to SSRI, hypnotic at low doses s/t antihistamine effect
CON-inc cholesterol in 20-15%, ing tri in 6%
sedating at low dose, activating at 30 mg and above
weight gain below 45 mg


buproprion (wellbutrin)

PRO - good augmenting agent
reuptake inhibition of dopamine and NE
no sw gain, sexual SE, sedation or cardiac probs, low induction of mania
2nd line ADHD med
CON - may inc seizure risk
avoid in TBI, bulimia, anorexia
doesn't treat anxiety, may worsen and cause agitation/insomnia
abuse potential, psychotic sx at high doses


SSRI least likely to cause GI upset, HA, and insomnia

citalopram, celexa or lexapro. sertraline is the worst,


SSRI least likely to cause drug interactions

citalopram, escitalopram


SSRI least likely to cause withdrawal symptoms

fluoxetine (prozac)


SSRI most likely to cause withdrawal symptoms

paroxetine (paxil), zoloft preferrable for pregnant and elderly


serotonin syndrome precipitating drugs

SSRI, 2nd gen antidepressants, linezolid, tramadol, meperidine, fentanyl, ondansetron, sumatriptan, MDMA, LSD, St John's wort, ginseng


serotonin syndrome clinical presentation

HTN, hyperreflexia, tremor, clonus, hyperthermia, hyperactive bowel sounds, diarrhea, agitation, coma, onset within hours, mydriasis


neuroleptic malignant syndrome

d2 blocking antipsychotics
severe parkinsonism, HTN, hyperthermia, onset within minutes, tachycardia


TCA adverse effects

Tertiary -inc anticholinergic, inc serotonin reuptake antagonism, inc ortho hypo, inc sedation, inc r/f seizures, more cardiac SE and weigh gain
Secondary - inc NE reuptake antagonism
do EKG before starting


TCA, tertiary amines

amitriptyline, clomipramine, doxepin (good for sleep), imipramine


TCA, secondary amines

desipramine, nortriptyline
less SE than tertiary


antidepressant withdrawal

FINISH = flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, hyperarousal, starts 24-72 h after last dose. lasts 1-3 weeks


herbal tx for depression

St John's Wort (lots of drug-drug), tryptophan (caution in epilepsy, renal excretion), SAM-e