antidepressants

Question 1

treatment principles for antidepressants

Answer 1

• establish diagnosis
• assess for suicide risk
• counseling or psychotherapy
• non-pharmacologic tx: relaxation, exercise, sleep hygiene, nutrition
• pharmacological tx: acute treatment phase, augmentation for partial responders, continuation phase, maintenance phase
• educate about concurrent herbal use: brewers yeast, st. johns wart, gingko

Question 2

SSRI

Answer 2

• fluoxetine HCL (Prozac)
• used for anxiety and antidepressant
• good for young adults, and pediatrics, and geriatrics
• Celexa not good for CV-QT prolongation
• blks synaptic cleft from the serotonin transporter returning serotonin to presynaptic cell
• contraindications: no MAOI within 14 days, severe hepatic/renal impairment, 1st and 3rd trimester of pregnancy,
• adrs: seratonin syndrome
• drug interactions: no MAOI or TCA, CNS depression with ETOH, antihistamines, opoids, St. Johns wart may cause seratonin syndrome

Question 3

antidepressant drugs

Answer 3

• SSRI- most common
• SNRI (serotonin/norepinephrine reuptake inhibitors): venlafaxine (Effexor) duloxetine (Cymbalta II)
• NDRI (norepi/dopamine reuptake inhibitor): buproprion (Wellbutrin)
• TCA: nortriptyline (Parnate)
• noradrenergic agonist: mirtazapine (Remeron)
• SARI/SSRI: trazadone (Desyrel); nefazodone (Serzone)
• MAOI: phenelzine (Nardil); tranylcpromine (Parnate)

Question 4

SNRI

Answer 4

• venlafaxine(Effexor)
• blocks both seratonin and norepi reuptake
• potential for increased suicidal ideation especially early in initial therapy
• may exacerbate glaucoma
• preg. class C
• adrs: abnormal ejaculation, HTN2
• 2nd line for antidepressants; can be used for chronic pn and for pts

Question 5

NDRIs

Answer 5

• buproprion (Wellbutrin)
• increases norepi and dopamine
• don’t stop suddenly-must wean
• off MAOIs 14 days prior b/4 startint

Question 6

nonadrenergic antagonists/mixed serotonin blkers

Answer 6

• blks histamine leads to weight gain
• mirtazapine (Remeron)
• good for insomnia and aggitation