antidepressants

First Year Studies 6.2 with Kassaw at Baylor College of Medicine

About this deck

By: Justin Lantz
Created: 2011-05-25
Size: 29 flashcards
Views: 9

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venlafaxine

—Both norepinephrine and serotonin presynaptic reuptake inhibition, at high doses dopamine as well —

Side effects similar to SSRIs

—Dose related increase in blood pressure—

Very few drug interactions, very useful in patients on numerous medications —

—Also approved for treatment of Generalized Anxiety Disorder

duloxotine

—Serotonin and norepinephrine reuptake inhibition — —Far less like than Effexor to cause dose related hypertension — —Also indicated for depression and diabetic neuropathic pain but also used for other pain symptoms

mirtazapine

—Complex and unique action of all antidepressants

—Antagonist at central PRESYNAPTIC a 2 adrenergic autoreceptors

——Sedating

—Antihistaminic properties dramatically increase appetite and weight gain is a serious concern.

—Rare cases of agranulocytosis but routine monitoring of CBC has not been recommended.

trazodone

—Rarely used for the treatment of depression at this time. — —Most common use is for insomnia in low doses. Risk of priapism

amitriptyline TCA

—often used in lower doses for pain management —

clomipramine TCA

very serotinergic and used for OCD —

imipramine TCA

used for enuresis

nortriptyline TCA

has useful therapeutic levels

TCA side effects

—Anticholinergic: dry mouth, urinary retention, constipation, blurred vision —Alpha adrenergic blockade: orthostatic hypotension —Antihistamine: sedation, increased appetite and weight gain

TCA safety issues

—TCAs cause prolongation of the QT interval and an EKG must be done prior to starting the medication and periodically during treatment. — —THESE DRUGS ARE VERY LETHAL IN OVERDOSE (2-3 GRAMS ARE LETHAL)

MAOI uses

—Major Depression, particularly the atypical subtype, Anxiety Disorders, Social Phobia, Treatment Resistant Depression — —Generally, older, MAOI-As are rarely used even by most Psychiatrists. Irreversible inhibition lasts for 2 weeks

MAOI risks

—hypertensive crisis when mixed with

Tyramine containing foods, —Drugs with dopamine, —OTC Decongestants, —Serotinergic drugs, —Demerol, —St. John’s Wort, —Tegretol and Trileptal, —Flexeril, —OTC weight loss drugs, —Psychotropics including antidepressants, buspirone, and stimulants

selegiline

—MAOI-B previously used primarily for Parkinson’s disease but was occasionally used “off label” for depresion

—Once daily transdermal system of delivery

Beware of tyramine in diet

nefazodone

—Serotonin presynaptic reuptake inhibitor (like SSRI) —Postsynaptic 5-HT2 receptor antagonist resulting in less anxiety —Sedating —Fewer sexual side effects —Can cause hepatic failure

buproprion

—Mechanism of action not entirely understood but likely dopamine and norepinephrine reuptake inhibition — Few side effects —Some seizure risk, contraindicated if history of seizures

Smoking cessation

No sex side effects/may help

May help ADHD

serotonin syndrome

—Characterized by fever, delirium, hypertension, hypotension, neuromuscular excitability but is uncommon —Risk increases when using more than one serotonergic drug —Can result in death

fluvoxamine

—SSRI — —Approved for the treatment of OCD but is used by some to treat depression —

fluoxetine

—Half life 2-3 days, even longer for active metabolite —Now comes in weekly formulation —Most safety data in pregnancy

sertraline

—Half life of 24 hours, risk of discontinuation symptoms —Weak dopaminergic activity, may be useful after brain injury

paroxetine

—Half life 24 hours —Somewhat sedating, useful in anxiety disorders —Significant 2D6 inhibition —Anticholinergic side effects

citalopram

—Half life of 24 hours —Fewer drug interactions, useful if someone is on numerous medications —Newly introduced enantiomer, escitalopram (Lexapro), with a similar profile and dose ranges of 10-30 mg per day

SSRI side effects

—Sexual dysfunction related to SSRIs is a major side effect and can impact a patient’s quality of life. —Men commonly experience delayed ejaculation (also used in the treatment of premature ejaculation) —Women experience anorgasmia —Patients often reluctant to self disclose these side effects

SSRI discontinuation symptoms

—Occur when an SSRI with a half life of 24 hours or less is stopped abruptly —Unpleasant, but not dangerous —Nausea, irritability, tearfulness, fatigue, dizziness —Avoid by always tapering SSRIs

neurochemistry and ECT

—ECT affects every major transmitter system and are similar to those seen with antidepressant therapy: —Down regulation of the post synaptic β adrenergic receptors —Changes in serotonin receptors and release —Changes in muscarinic, cholinergic, and dopaminergic systems —Changes in second messenger systems

ECT changes

more blood flow/glucose/oxygen/permeability of BBB during seizure, then less after; post ictal decrease is therapeutic

more slow wave activity in PFC; slow waves don't last but therapeutic effect does

ECT indications

—Major Depressive Disorder — —Manic Episodes — —Schizophrenia

ECT for MDD

—Most common indication for ECT — —Fastest and most effective treatment for depression — —70% of patients who fail an antidepressant will respond to ECT — —Particularly useful for patients who are psychotic, suicidal, or refuse to eat — —Should always be used with antidepressant medications

ECT for mania

—Shown to be as effective as lithium — —Current pharmacologic treatments for mania are quickly effective and ECT is reserved for cases where there are specific contraindications to standard treatments — —First trimester pregnancy is one such indication due to the teratogenic effects of many mood stabilizers

ECT for schizophrenia

—If the schizophrenia is characterized by catatonic or mood symptoms it is most likely to show a response to ECT. — —CHRONIC SCHIZOPHRENIA DOES NOT RESPOND TO ECT

About this deck

By: Justin Lantz
Created: 2011-05-25
Size: 29 flashcards
Views: 9

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
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