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A young woman says that she has constant feelings of sadness and helplessness with trouble sleeping since her sister became ill. What may be the molecular causes of her depression?
depression is believed to be induced by the depletion of amine neurotransmitters caused by inhibition of storage of amine transmitters
How do fluoxetine and other antidepressants work?
- the overall immediate action is to increase the amounts of serotonin and/or NE at the synapse
- Fluoxetine specifically is a selective serotonin reuptake inhibitor that increases the amount of serotonin at the synapse
Your young female pt has been taking fluoxetine for two weeks for her symptoms of depression but is complaining that the medicine is not working. Why is there a delay in the onset of drug action?
- fluoxetine has a long half life so it takes longer to work but the withdrawal symptoms are not as bad
- (a little unsure about this one)
When you saw your pt for her symptoms of depression you asked her specifically if she has had any thoughts about suicide. Why did you ask her if she has had these thoughts?
you must use caution when prescribing fluoxetine because it has been shown to cause increased risk of suicide in children and adults
You prescribed fluoxetine for your pt that came to you for her symptoms of depression. What should she be observed for in the future?
- drug interactions--SSRIs can potentiate agents metabolized by CYP1A2 and some other cyto P450 enzymes (drugs affected include antipsychotics, antidepressants, barbs, benzos and carbamazepine)
- SSRI + TCA--serum [TCA] may rise to toxic levels
- SSRI + MAOI--dangerous interactions and serotonin syndrome
- increased risk of suicide
- may impair blood glucose regulation in diabetics
- may induce hyponatremia and elevated urine osmolarity by causing inapproproate ADH secretion (SIADH)
For your young patient with symptoms of depression following her sister's illness, why did you not prescribe a TCA or MAOI?
- -There are a lot of side effects with TCA use like blockade of AChR (blurred vision, dry mouth, urinary retention and constipation), cardiac overstimulation, orthostatic hypotension, sedation, sexual dysfunction, and weight gain
- -The side effects of MAOIs include acute hypertensive crisis with indirect acting sympathomimetics, severe headaches, and danger of intracranial bleed
- --> SSRIs are the drug of choice for depression