Week 7 Antidepressants and Mood Stabilizers Flashcards Preview

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Flashcards in Week 7 Antidepressants and Mood Stabilizers Deck (9)
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1

What are the general categories of treatment of major depressive disorder?

1. psychotherapy
-33% will achieve remission
2. Electroconvulsive therapy (ECT)
-50-70% effective in treating acute episode
-memory loss and headache
-useful for MDD with psychosis
3. Pharmacotherapy
-33% will achieve remission with one antidepressant

2

What is the mechanism of amitriptyline (Elavil), a TCA? Adverse effects? pros?

1. Mechanism: presynaptic NT reuptake inhibition NE/5HT/DA
2. adverse effects:
-sedation-hisatmine, blockade of alpha 1
-orthostatic hypotension, blockade of alpha1
-dry mouth, constipation, cholinergic block
-weight gain-histamine antagonism
-cardiotoxicity/heart block, high lethality in overdose
3. pros
-effective and inexpensive

3

What is the mechanism of fluoxetine (prozac), a SSRI? Adverse effects? pros?

1. mechanism
-presynaptic 5HT reuptake inhibition
2. adverse effects
due to 5HT stimulation
-nausea, diarrhea (5HT3)
-anorgansmia, delayed ejaculation (5HT2), 30-50% sexual side effects
-headache (5HT2)
due to NT reuptake inhibition
-restlessness, insomnia
-FDA approved for children and teens
3. pros
-relatively safe in overdose

4

What is the mechanism of phenelzine (Nardil), a MAOI? Adverse effects? pros?

1. mechanism: inhibits monoamine oxidase, thereby inhibiting breakdown of NT
2. Adverse effects:
-dizziness, orthostatic hypotension (a1 block)
-insomnia (NT reuptake inhibition)
-no aged cheese or wine due to drug interaction
3. pros
-effective and inexpensive

5

What is the mechanism of Mirtazapine (Remeron)? Adverse effects? pros?

1. mechanism: 5HT2 antagonism (5HT2 inhibits DA and 5HT release), improve pre-synaptic 5HT neurotransmission
2. adverse effects
-sedation and weight gain (histamine receptor block)
3. pros
-blocks nausea (5HT3 antagonism)
-low to no sexual dysfunction
-low to no nausea or headache
-increase NE outflow to CNS (a2 antagonism)

6

What is the mechanism of Bupropion (Wellbutrin)? Adverse effects? pros?

1. mechanism: presynaptic NE and DA reuptake inhibition, no 5HT effects
2. adverse effects:
-insomnia, upset stomach
-seizure risk
3. Pros
-low to no sexual dysfunction
-low to no weight gain
-helpful for smoking cessation and ADHD

7

What is the mechanism of Lithium (Eskalith, lithobid, eskalith CR)? Uses? Adverse effects?

1. mechanism: NT stabilization, inhibits excitatory neurotransmitters (NE, DA)
-enhances 5HT to help with depression
-for acute mania, bipolar depression, well established relapse prevention efficacy
-therapeutic plasma level: 0.6-1.5 mEq/L
-renal elimination
-1-3 week onset
2. Adverse effects:
-intentional tremor
-weight gain
-polyuria, polydipsia
-drug interactions: ibuprofen, caffeine

8

What is the mechanism of Valproate (Depakene, Depakote)? Adverse effects? pros?

1. mechanism: facilitates GABA, calming over excited brain areas
-broad spectrum anticonvulsant activity
-for acute mania
-for mixed mania and rapid cycling
-probably relapse prevention, less established
-therapeutic plasma level: 50-125 meg/mo
-wide therapeutic range, less risk of toxicity
-hepatic elimination
-2-7 day onset
2. adverse effects
-sedation, lethargy
-weight gain
-lower risk of intentional tremor
-drug interaction: aspirin, antacids

9

What are approaches to treating bipolar disorder?

-mood stabilizer mono therapy only 50% effective, need multiple meds for better response
-antipsychotics used as adjuncts to mood stabilizers when psychotic symptoms present
-mood stabilizers taken life long
-discontinue antidepressant if patient switches to mania, and need to maintain mood stabilizer

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