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46 Cards in this Set
- Front
- Back
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Fluxetine?
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Prozac
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Sertraline?
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Zoloft
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Paroxetine?
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Paxil
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Fluvoxamine?
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Luvox
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Escitalopram?
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Lexapro
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Paroxetine side effects?
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Weight gain, antichonergic affects (dry mouth, constipation, decreased cogn), CR has less side affects
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SSRI's?
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Fluxetine (Prozac), Setraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro) Fluvoxamine (Luvox)
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Serotonergic effects?
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Activation/sedation, nausea, sleep distrubances, sexual side affects, weight gain
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Venlafaxine
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Effexor®
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Venlafaxine
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5HT reuptake inhibition across dosage range; NE reuptae inhibition at doses >200mg/day; dose related increases BP
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Venlafaxine
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Adverse events; nausea GI complaints, insomnia, sexual side effects; increased BP, sweating, agitation
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Desvenlafaxine
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Pristiq® active metabolite of venlafaxine
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Desvenlafaxine
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adverse events; similar to venlafaxine; GI, nausea, BP, sexual dysfx, etc
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Duloxetine
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Cymbalta BalancedNEand5HTreuptakeinhibitionacross dosage range• DAapprovedforneuropathicpainassociated with DM
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Duloxetine
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Cymbalta AdverseEffects: – Similar to venlafaxine – Significant rates of nausea
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Atypical antidepressants
• Bupropion |
Wellbutrin MOA; inhibition of DA & NE reuptake; also FDA apvd for smoking cessation (Zyban)
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Bupropion
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Adverse effects – Lowers seizure threshold Contraindicated for patients with seizure disorder or undergoing alcohol or sedatives withdrawal
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Bupropion
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other side effects– Low incidence of sexual side effects compared to SSRIs/SNRIs
• lack of serotonergic activity + dopamine increase |
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Atypical antidepressants
• Mirtazapine |
Remeron MOA: enhances NE and 5HT activity
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Atypical antidepressants
• Mirtazapine |
adverse effect; Weight gain can be significant – low rate of sexual dysfunction
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Atypical antidepressants
• Mirtazapine |
Sedating antihistaminic effect
• Taken at bedtime • May be useful when insomnia is part of the presentation of depression • Sedation is more common at lower doses than at higher doses – Increase NE effect outweighs the antihistamine effect |
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Tricyclic antidepressants
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MOA:inhibition of NE and 5HT reuptake – Potency and selectivity vary among various agents
Lethal in overdose(aslittleas3xdailydose) |
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Tricyclic antidepressants
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Effect many other receptor systems,making for an unfavorable side effect profile
– Anticholinergic – dry mouth, dry eyes, constipation, blurred vision – Alpha-adrenergic orthostasis – Very sedating |
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Tricyclic antidepressants
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Weight gain,glucose dysregulation,effects on
cardiac conduction Effective for the treatment of DM neuropathy |
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Trazodone
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Desyrel MOA: enhances 5HT activity • Very sedating – used to treat insomnia
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Trazodone
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Doses <300 mg used for insomnia • Antidepressant activity at higher doses • Sedation, nausea, GI upset, priapism
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Monoamine Oxidase Inhibitors
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MAOIs Older agents not typically used anymore, except in treatment resistant depression
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Monoamine Oxidase Inhibitors
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MAOIs
Lots of food and drug interactions as well as significant side effects |
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Assessment of depressive symptoms
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trained clinician should make diagnosis; Use of clinical rating scales allow an “objective” assessment of symptom severity and treatment effectiveness
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Assessment of depressive symptoms
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common rating Scales –
HAM-D – used for clinical trials in the US – MADRS – used for clinical trials in Europe – QIDS – clinician- or patient-rated – BDI – patient-rated scale – PHQ-9 – patient-rated scale |
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Response definition
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significant reduction in, but not complete resolution of depressive symptoms
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Remission definition
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complete resolution of depressive symptoms
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Recovery definition
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sustained remission of at least 6 months
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Relapse definition
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Return of depressive symptoms within 6 months of achieving remission
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Recurrence definition
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Successive episode of MDD after recovery from initial episode of MDD
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Phases of Treatment
Acute Phase |
Initial 6-12 weeks of treatment
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Phases of Treatment
Continuation Phase |
Treatment bridging remission to recovery –
Typically 6-9 months – Continuation of antidepressant at full therapeutic dosage– Antidepressant may be discontinued at the conclusion of the continuation phase |
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Continuation Phase
Maintenance Phase |
Continuation of an antidepressant at full therapeutic dosage for extended periods of time, perhaps indefinitely
• Not necessary for all patients • May be beneficial in patients at high risk of relapse or recurrence – Patients with history of recurrence and/or risk factors for recurrence |
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Choosing an antidepressant treatment
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Choosing an antidepressant treatment
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Choosing an antidepressant treatment
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Individually, response to specific agents is generally unpredictable
– Past history of response to a particular agent may predict future response – History of family member with response to a particular agent may predict response |
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Choosing an antidepressant treatment
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Past history of response – Side effect profile – Comorbid psychiatric or medical conditions – Potential for drug interactions
– Cost |
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The goal of antidepressant treatment
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Remission is the goal of treatment for MDD
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The goal of antidepressant treatment
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Results in improved overall functioning – Decreases the risk of experiencing another
episode of depression – Increases amount of time until another episode in those who experience recurrence |
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Antidepressant discontinuation syndrome
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Caused by abrupt cessationof ADs,esp. paroxetine and venlafaxine
• Maylastupto1-2weeks |
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Antidepressant discontinuation syndrome
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Flu-like symptoms
– Dizzines – Sweating – Nausea – Headache |
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Antidepressant discontinuation syndrome
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Also increased anxiety & insomnia common Slowly taper medication dosage priorto discontinuation to minimize disc. symptoms
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