Off Label Psychopharmacology

Question 1

Pramipexole mechanism of action and off label used

Answer 1

• D3 agonist
• Unipolar depression
• ADJUNCT bipolar depression

Question 2

Possible side effects found with Pramipexole

Answer 2

• Nausea, headache, Somnolence, orthostasis, edema

- Rare: Psychosis, sleep attack, withdrawal

Question 3

What agent can be used for generalized anxiety disorder (off label)

Answer 3

-Pregabalin

Question 4

Pregabalin mechanism of action and off label uses

Answer 4

• Alpha 2 delta Ca channel antagonist
• General anxiety disorder
• Social anxiety disorder

Question 5

Possible side effects found with Pregabalin

Answer 5

• Somnolence, dizziness, aesthenia, weight gain, headache

- Rare: Edema, abuse, hypersensitivity, ED

Question 6

Which PTSD symptoms can Prazosin help treat as an augmenting agent

Answer 6

-PTSD symptoms as a whole

Question 7

Prazosin mechanism of action

Answer 7

• Alpha 1 antagonist
• Studied only as COMBO therapy
• Do NOT use as monotherapy

Question 8

Possible adverse effects seen with Prazosin

Answer 8

• Dizziness, drowsiness, headache, aesthenia, nausea, palpitations
• Rare: Edema, orthostasis, syncope, polyuria, constipation, xerostomia

Question 9

Pros and Cons of Prazosin/ Quetiapine

Answer 9

Prazosin: 
-Better tolerated
-Cannot be used as monotherapy 
Quetiapine:
-Can be used as monotherapy 
-Generally less tolerable than prazosin

Question 10

Lithium off label uses

Answer 10

-Augmentation of TCA in major depressive disorder

Question 11

Possible adverse effects seen with lithium

Answer 11

• Hypothyroidism, renal dysfunction, tremor, drowsiness

- Rare: Seizure, coma, arrhythimia, death

Question 12

Liothyronine MoA

Answer 12

• Active thyroid (T3)

- Augmentation of TCA therapy in major depressive disorder

Question 13

Possible adverse effects seen with Liothyronine

Answer 13

• Arrhythmia

- Tachycardia, hypotension, MI, heart failure, HTN, osteoporosis

Question 14

Off label drugs to treat unipolar or bipolar depression augmentation

Answer 14

• Modafinil/Armodanfinil

- Eicosapentaenoic Acid

Question 15

Off label drugs to treat resistant bipolar mania

Answer 15

-Tamoxifen

Question 16

Off label drugs to treat highly resistant unipolar depression

Answer 16

• MAOI + TCA

- MAOI + Stimulant

Question 17

Off label drugs to treat major depressive disorder

Answer 17

-Buprenorphine

Question 18

Off label drugs to treat resistant OCD

Answer 18

-Clomipramine + Fluvoaxamine

Question 19

Off label drugs to treat antidepressant related sexual dysfunction

Answer 19

• Sildenafil
• Bupropion
• Buspirone

Question 20

Off label drugs to treat schizophrenia (augmentation)

Answer 20

-Cannabidiol

Question 21

Give a rational combination for maintenance treatment of bipolar disorder

Answer 21

-Lithium + Olanzapine

Question 22

Give a combination that could be used for highly resistant major depressive disorder

Answer 22

-Adding amitriptyline to phenelzine

Question 23

Give a rational treatment option for a patient with persistent depressive disorder

Answer 23

-Imipramine + lithium+ bethanechol