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Chapter 32: Antidepressants
Terms in this set (17)
What is depression?
-most common psychotic disorder
~15 million adults in US affected each year
-incidence is twice as high male as that in female
-risk of suicide is high with depression
-30% on antidepressants achieve full remission
-20-30% achieve > 50% decrease in symptoms severity
What are clinical features of depression?
-symptoms must be present most of the day, nearly every day for> 2 weeks:
-loss of pleasure or interest
-feeling guilt, worthlessness
What causes depression?
-sometimes out of the blue or stressful events can bring it on
What are treatments for depression?
-depression-specific psychotherapy: CBT
-Somatic therapies: ECT, light therapy
What are antidepressants?
USE: primarily to relieve symptoms of depression
-help pt with anxiety disorder
-Tricyclic antidepressants (TCA)
-selective serotonin reuptake inhibitors (SSRI)
-serotonin/NE reuptake inhibitors (SNRI)
-Monoamine oxidase inhibitors (MAOI)
What is drug therapy for depression?
1. Time course of response:
-symptoms resolve slowly
-initial responses develop in 1-3 weeks
-MAX responses may not be seen fo 12 weeks
2. Drug selection:
-Antidepressants have nearly equal efficacy
-based on tolerability and safety
-drug interactions and side effects
-pt preference, cost
What is the BBW with antidepressants?
-may increase suicide tendencies during EARLY treatment
-Pt should be observed for:
-change in behavior
-prescriptions should be written for smallest number of doses consistent with good pr management
-taper the dose over 1-4 weeks if it lasted for > 3 weeks and they want to discontinue
What are Tricyclic antidepressants (TCA)?
INDICATIONS: major depression disorder
-hypersensitive to amityoptyline
-coadministration with or within 14 days of MAOI
-substrate of 2D6 (major)
DOSE FORM: oral
-Blocks neuronal reuptake of NE, 5-HT
-also blocks histamine and muscarinic receptors
-depression, bipolar, ADHD, OCD
- in the past, TCA were first drug choice for depression
MOST COMMON adverse effects:
-sedation, ortho hypotension, anticholinergic'
MOST DANGEROUS adverse effects:
What are selective serotonin reuptake inhibitors (SSRIs)?
-produces inhibition of reuptake of serotonin (5-HT)
-produce CNS excitation rather than sedation like with TCA
-overdose does NOT cause cardiac toxicity like with TCA
FDA APPROVED INDICATIONS:
-Major depressive disorder (MDD)
OFF LABEL: use for PTSD
-insomina, HA, drowsiness, wt gain
-if used with aspirin, or NSAID(increased risk of bleeding)
~~if used with other seroteonergics (TCAs, 'triptans')
What is Serotonin Syndrome with use of SSRI?
-incoordination, hyperreflexia, excessive sweating, tremor, fever
-altered mental status
-resolves spontaneously after discontinuing the drug
-risk is increased by concurrent use of MAOIs and other serotonergic drugs
What are serotonin Norepinephrine Reuptake Inhibitors (SNRIs)?
-potent inhibitors of neuronal 5-HT and NE reuptake
-not block muscarinin, histamine, or alpha1
-major depressive disorder
-nausea, dry mouth, sweating, insomnia, blurred vision
--Pharmacologic effects similar to SSRIs but SSRI may be tolerated better
-Combined with use of MAOI will increase risk of serotonin syndrome
What are Monoamine Oxidase Inhibitors?
-First transdermal tx for depression
-decrease risk of HTN with transdermal vs oral (doesn't go through GI tract)
-converts monoamine NT to inactive products
MOA and MAOI:
-reversible: last 3-5 days
-Irreversible: lasts 2 weeks
~~all are irreversible in current use
-later choice for pt (as effective as TCA and SSRI but more hazardous)
~*drug of choice for atypical depression
-bulimia nervosa, ADHD, OCD
-antidepressaants: TCA, SSRI, SNRI
-dietary TYRAMINE interaction:
~~tyramine promotes release of NE from sympathetic neurons--> Hypertensive crisis
~~foods with tyramine: veggies, fruit, meat, fish
What is the atypical antidepressant, Bupropion?
-inhibit neuronal reuptake of DA and NE
-does not effect 5-HT, ACh, or histamine transmission
-less likely to cause wt gain or sexual dysfunction
-major depressive disorder
-marketed as aid for smoking cessation
-agitation, HA, dry mouth, constipation, wt loss
-increase risk for seizures
-MAOI increase toxicity
What is the atypical antidepressant, Trazodone and Mirtazapine?
MOA: inhibits neuronal reuptake of 5-HT
-CNS alpha2 antagonist; increase NE, 5-HT release
-antagonist at 5-HT2, 3, 1, and alpha 1 receptor
-sedation, seizure, wt gain
What are completmentary and alternative medications for depression?
-st john's wort--herbal:
-may equal efficacy of TCAs
-no evidence for pt with severe depression
-significant interaction withdraws through:
~~inducing CYP P450 enzyme
-poses risk for serotonin syndrome
What is the new drug, Esketamine?
-treatment-resistant depression (TRD) in adults, in conjunction with oral antidepressant
-sedation/dissociation abuse/misuse, REMS, suicidal thoughts
-N-methyl-D-aspartate receptor antagonist
-intranasal twice weekly x 5 weeks, then weekly
-increased BP, anxiety, n/v
What is the new drug, Brexanolone?
-postpartum depression in adults
-not fully understood but thought to be related to positive allosteric modulation of GABA-A receptors
-risk of excessive sedation or loss of consciousness, must be accompanied during interactions with their child
-60 hour continuous infusion
-presyncope, drowsiness, sedated state
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