EPPP Antidepressant Rx
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What are the (traditional) classes of anti-depressant drugs?
Tricyclics, SSRIs (selective serotonin reuptake inhibitors) and MAOIs (monoamine oxidase inhibitors).
What are the newer classes of anti-depressant drugs?
Norepinephrine dopamine reuptake inhibitors, selective serotonin norepinephrine reuptake inhibitor, serotonin-2 antagonists / reuptake inhibitors.
Name the Tricyclics.
Amitriptyline, doxepin, imipramine, clomipramine.
TCAs are most effective for depressions involving what kinds of symptoms?
The vegetative, somatic symptoms, including: early morning waking and other sleep disturbances, decreased appetite and weight loss, psychomotor retardation, and anhedonia.
How long does it take for Tricyclics to have their effect? What is the treatment implication of this timing?
Two to four weeks. Other treatments (they mention ECT) are sometimes preferred for patients with severe depression and high suicide risk.
Other than depression, what are Tricyclics also used to treat?
Panic Disorder, Agoraphobia, OCD (especially clomipramine) and enuresis in children and adolescents (especially imipramine).
What are the TCA's mode of action?
They block the reuptake of norepinephrine, serotonin, and / or dopamine at the nerve synapses.
What hypothesis does the TCA's mode of action support?
The catecholamine hypothesis, which proposes that depression is a result of catecholamine deficiency.
What is the most serious adverse effect of TCAs?
Cardiotoxicity; produces tachycardia, palpitations, hypertension, severe hypotension, and arrhythmia.
What precautions should be taken to avoid serious side effets with TCAs?
Use with caution with persons suffering from heart disease (or high-risk populations such as the elderly); use lower dose with high risk populations. Prescribe in small quantities with suicidal patients because overdose can be letal.
What are symptoms of TCA overdose?
Ataxia, impaired concentration, agitation, severe hypotension, fever, cardiac arrhythmia, delirium, seizures, and coma.
What are the possible adverse effects associated with TCA drugs?
Cardiovascular syptoms; anticholinergic effects (e.g., dry mouth, blurred vision, urinary retention, constipation, sexual dysfunction); confusion; drowsiness; fatigue; weight gain; fine tremor; paresthesia; blood dyscrasia
Name the SSRIs.
Fluoxetine, fluvoxamine, paroxetine, and sertraline.
SSRIs are most effective for treating what kind of depressions?
Other than Depression, what are SSRIs also used to treat?
OCD, Bulimia, Panic Disorder, and PTSD.
What are the SSRI's mode of action?
They block the reuptake of serotonin.
What are the adverse effects associated with SSRIs?
Gastorintestinal disturbances (e.g., nausea, appetite loss, constipation, or diarrhea); anorexia; frequent urination; sexual dysfunction; insomnia; anxiety; tremor; headache; dizziness.
What are the advantages of SSRIs over TCAs?
Less cardiotoxic, safer in overdose, less likely to produce cognitive impairment, have a more rapid onset.
What is Serotonin Syndrome? How is it caused?
Syndrome brought on by use of SSRI in tadem with AOI or other serotonergic agent. Can cause neurological effects (headache, nystagmus, tremor, dizziness, unsteady gait), changes in mental state (irritability, confusion, delirium), and cardiac arrhythmiaand ca progress to coma and death.
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