Antidepressants & ECT II

Question 1

Fluoxetine (Prozac)

Answer 1

SSRI; half life 2-3 days

No serotonin discontinuation symptoms

Question 2

Sertraline (Zoloft)

Answer 2

SSRI; half life of 24 hrs, risk of discontinuation symptoms

Weak dopaminergic activity, useful after brain injury

Question 3

Paroxetine (Paxil)

Answer 3

SSRI; half life of 24 hrs, somewhat sedating, useful in anxiety disorders

• Significant 2D6 inhibition
• Anticholinergic side effects

Question 4

Citalopram (Celexa)

Answer 4

SSRI; half life of 24 hrs

Fewer drug interactions, useful if someone is on numerous meds

Question 5

What is the enantiomer of Citalopram (Celexa)?

Answer 5

Escitalopram (Lexapro)

Question 6

Fluvoxamine (Luvox)

Answer 6

SSRI

Approved for treatment of OCD, but used by some to treat depression

Question 7

fever, delirium, hypertension, hypotension, neuromuscular excitability occurring after taking a certain class of drugs

Answer 7

Serotonin Syndrome

Question 8

Buproprion (Wellbutrin)

Answer 8

• Dopamine and NE reuptake inhibition (most likely)
• Few side FX
• Electrolyte imbalance –> increased seizure risk
• Used in smoking cessation
• May be useful for ADHD

Question 9

What is Buproprion (Wellbutrin) contraindicated in?

Answer 9

Patients with history of seizures, patients with eating disorders or other metabolic disturbances

Question 10

What drug can be effective in decreases sexual side FX when given with an SSRI?

Answer 10

Buproprion (Wellbutrin)

Question 11

Venlaxafine (Effexor)

Answer 11

SNRI (serotonin-NE reuptake inhibition)

• Side FX similar to SSRIs
• Dose related increase in BP
• Useful in patients on numerous meds (very few drug interactions)
• Treatment of generalized anxiety disorder

Question 12

Desvenlafaxine (Pristiq)

Answer 12

• SNRI
• Relatively greater NE reuptake inhibition than venlaxafine, but more serotonergic than noradrenergic
• Plasma levels more consistent than venlaxafine
• More potent effect on NE may be helpful in pain conditions like fibromyalgia

Question 13

Duloxetine (Cymbalta)

Answer 13

• SNRI
• Less likely than Effexor to cause dose-related HTN
• Also indicated for depression and diabetic neuropathic pain

Question 14

Mirtazapine (Remeron)

Answer 14

• alpha-2 Antagonist at central presynaptic adrenergic autoreceptors
• very sedating
• Antihistaminic properties dramatically increase appetite and weight gain
• Useful for people w/ loss of appetite and poor sleep

Question 15

Trazodone

Answer 15

• Most common use is for insomnia in low doses

- Major concern is priapism, and failure to treat in time can lead to permanent erectile dysfunction

Question 16

TCA Side Fx

Answer 16

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

Question 17

TCAs cause prolongaiton of what cardiac EKG interval?

Answer 17

QT

Question 18

T or F. TCAs are not lethal in overdose.

Answer 18

F - very lethal

Question 19

MAOI’s (monoamine oxidase inhibitors)

Answer 19

• Inhibits enzyme that metabolizes NE, serotonin, dopamine, tyramine, resulting in increase in neurotransmitters in synapse
• Used for major depression, anxiety disorders, social phobia, treatment resistant depression
• Hypertensive crisis can occur as side effect when combined with certain drugs/foods

Question 20

Selegiline (EMSAM)

Answer 20

MAOI-B previously used for Parkinson’s, but was used off label for depression

Question 21

How long do you have to be off of an MAOI before a regular diet can be resumed or contraindicated meds started?

Answer 21

at least 2 weeks

Question 22

What drug can cause congenital cardiac abnormalities in first trimester?

Answer 22

Paroxetine (Paxil)

Question 23

When does postpartum depression occur?

Answer 23

Within four weeks of delivery

Question 24

What is normal postpartum sadness timeframe?

Answer 24

7-10 days

Question 25

What is drug of choice for postpartum depression? Why?

Answer 25

Sertraline b/c exposure through breast milk is lower than in utero

Question 26

What does ECT induce?

Answer 26

Bilateral, generalized tonic-clonic seizure for 30-90 seconds, often involving deeper brain structures like thalamus and also affecting every major neurotransmitter system

Question 27

What conditions is ECT used for?

Answer 27

- Major depressive disorder - Manic episodes - Schizophrenia

Question 28

What type of schizophrenia can be helped by ECT? Which is not helped by ECT?

Answer 28

Schizophrenia characterized by catatonic or mood symptoms most likely show a response. Chronic schizo does not.

Question 29

T or F. ECT can help with somatization disorders, personality disorder, OCD

Answer 29

False

Question 30

What medications are given to a patient prior to ECT?

Answer 30

Muscarinic anticholinergic agent for control of oral and respiratory secretions General anesthetic, usually short acting barbiturate Muscle relaxants to decrease bone fractures, succinylcholine

Question 31

What receptors are down regulated in ECT?

Answer 31

Post synaptic beta adrenergic receptors

Question 32

Common side FX of ECT

Answer 32

- headache, confusion, delirium, muscle soreness, some memory impairment

Question 33

What can be used as therapy for SAD (seasonal affective disorder) which occurs in winter months or in cloudy climates?

Answer 33

Light therapy

Question 34

What newly approved treatment for depression generates a magnetic field that induces an electrical current in undrlying areas of brain?

Answer 34

Transcranial magnetic stimulation

Question 35

What highly experimental treatment is a battery powered pulse generator implanted in chest with leads tunneled under scalp and guided into brain near the cingulate cortex?

Answer 35

Deep brain stimulation