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30 Cards in this Set
- Front
- Back
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4 types of antidepressants
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TCAs, MAOIs, SSRIs, Atypicals
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Off-label use of antidepressants: Enuresis
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TCAs
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Off-label use of antidepressants: Neuropathic pain
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TCAs
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Off-label use of antidepressants: Depressive phase of manic depression
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SSRIs, bupropion
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Off-label use of antidepressants: Insomnia
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Mirtazapine (NASA), TCAs, Trazodone (SARI)
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TCAs: General Info
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- Inhibit reuptake of NE and 5HT
- lethal in OD - Start with low dose - AEs= AntiHAM (esp widened QRS > 100ms- treat with IV NaHCO3) - 3Cs = Convulsions, Coma, Cardiotox |
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Imipramine
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- TCA (Tofranil)
- used for enuresis and ADHD |
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Amitriptyline
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- TCA (Elavil)
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Trimipramine
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- TCA (Surmontil)
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Nortriptyline
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- TCA (Pamelor)
- least likely to cause orthostatic hypotension |
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Desipramine
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- TCA (Norpramin)
- least sedating - least anti-chol AEs |
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Clomipramine
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- TCA (Anafranil)
- most seratonin specific - Used in tx of OCD |
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Doxepin
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-TCA (Sinequan)
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MAOIs: General Info
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- prevent inactivation of norepi, 5HT, dopamine, and tyramine
- IRREVERSIBLY inhibits MAO-A (more 5HT) and MAO-B (more norepi) - Not first-line, but very effective for refractory depression and panic d/o |
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MAOIs: Side effects
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Common- Orthostatic hypo, weight gain, sexual dysfx, sleep dysfx
Serious: Serotonin syndrome (esp w/ SSRI. Lethargy, restlessness, confusion, flusing, sweating, tremor --> hypertherm, hypertonic, rhabdo) and Hypertensive crisis (esp with tyramine-rich foods or sympathomimetics. Tx with phentolamine, 5HT2A antag, or IV nitro) |
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Phenelzine
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- MAOI (Nardil)
- daytime somnolence |
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Tranylcypromine
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- MAOI (Parnate)
- insomnia, agitation |
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Isocarboxazid
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- MAOI (Marplan)
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SSRIs: General Info
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- inhibit presynaptic seratonin pumps
- Lowest incidence of AEs (sexual dysfx in 25%, seratonin syndrom with MAOIs) - No food restrictions - Low OD potential - Also used for anxiety disorders, OCD, and PMDD |
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Fluoxetine
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- SSRI (Prozac)
- longest half-life - no need to taper - approved in peds |
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Sertraline
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- SSRI (Zoloft)
- highest risk of GI AEs |
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Paroxetine
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- SSRI (Paxil)
- most seratonin-specific - most stimulating - weight gain |
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Fluvoxamine
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- SSRI (Luvox)
- used for OCD |
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Citalopram
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- SSRI (Celexa)
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Escitalopram
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- SSRI (Lexapro)
- levo enantiomer of citalopram - fewer AEs (more expensive) |
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Sub-classes of Atypical Antidepressants
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- SNRIs: serotonin norepi reuptake inhibitors
- NDRIs- norepi dopamine reuptake inhibiors - SARIs- serotonin antagonist and reuptake inhibitors - NASAs- norepi and serotonin antagonists |
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Venlafaxine
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- SNRI (Effexor)
- used in refractory depression - may increase BP - flu-like withdrawal sx |
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Bupropion
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- NDRI (Wellbutrin)
- smoking cessation, seasonal affect d/o, adult ADHD - less sexual AEs than SSRIs - may exacerbate psychosis (dopaminergic) - CIs- anxiety, seizures, eating disorders, MAOIs |
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Nefazodone and trazodone
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- SARI (Serzone and Desyrel)
- Refractory MDD (w anxiety) and Insomnia - AEs- sedation, priapism |
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Mirtazapine
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- NASA (Remeron)
- Refractory MDD - AE - weight gain (can be advantate), and agranuloytosis - less sedating at higher doses (increases norepi uptake) |
