Antidepressant Flash Card Supplement

Which of the following drugs are classified as SSRIs?

Which of the following drugs are classified as SNRIs?

Which of the following drugs are classified as TCAs?

Which of the following drugs are classified as MAO-Is?

Which of the following drugs are classified as Atypical?

[blank_start]Amine[blank_end] Hypothesis  Abnormally low levels of norepinephrine and/or [blank_start]serotonin[blank_end] underlie [blank_start]depression[blank_end] Evidence for this hypothesis includes:  Reserpine, an (old) antihypertensive drug depletes pre-synaptic stores of [blank_start]norepinephrine[blank_end] (NE) and is associated with depressive symptoms.  Autopsy studies of the brains of depressed suicide victims indicate a [blank_start]low[blank_end] level of NE and/or serotonin (5-HT) metabolism in most brain regions  Drugs found to be beneficial act to enhance NE or 5-HT levels. A major weakness to this hypothesis is the therapeutic lag – effects of drugs on NE or 5-HT levels are observed [blank_start]immediately[blank_end] yet therapeutic benefit takes a minimum of 1 to 4 [blank_start]weeks[blank_end] to occur

[blank_start]Neuroendocrine[blank_end] Hypothesis  Depression is associated with elevated [blank_start]cortisol[blank_end] levels  [blank_start]HPA[blank_end] axis is dysregulated  Abnormal (low) [blank_start]thyroid[blank_end] function is common in depression

[blank_start]Neurotrophin[blank_end] Hypothesis  Laboratory research indicates that antidepressants [blank_start]increase[blank_end] BDNF production in [blank_start]hippocampus[blank_end]  This requires [blank_start]long[blank_end] term (weeks) not [blank_start]short[blank_end] term (days) treatment  BDNF increases neurogenesis and [blank_start]synaptic[blank_end] connectivity  Stress, pain and depression can [blank_start]reduce[blank_end] BDNF  Imaging studies indicate reduced hippocampal volume (size) in [blank_start]depression[blank_end]

Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for children?

Which Serotonin Selective Reuptake Inhibitors (SSRIs) are approved for adolescents?

Which of the following are uses for Serotonin Selective Reuptake Inhibitors (SSRIs)?

Which of the following are true about SSRIs?

Which seven of the following are the adverse effects of SSRIs?

Which of the following are uses of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?

Which of the following are true about SNRIs?

Which of the following are the adverse effects of SNRIs?

Which of the following are the uses for Tricyclic antidepressants (TCAs)?

Which of the following are true about TCAs?

Which of the following are the adverse effects of TCAs?

Which of the following are true about Trazodone?

Which of the following are the adverse effects of Trazodone?

Which of the following are true about Bupropion?

Which of the following are adverse effects of Bupropion?

Which of the following are true about Mirtazapine?

Which of the following are adverse effects of Mirtazapine?

Which of the following are true about Monoamine oxidase inhibitors (MAOIs)?

Which of the following are adverse effects of MOAIs?

[blank_start]Serotonin[blank_end] [blank_start]Syndrome[blank_end]  [blank_start]Cognitive[blank_end] (delirium), [blank_start]autonomic[blank_end] (hypertension, tachycardia, sweating) and [blank_start]somatic[blank_end] (tremor), also [blank_start]fever[blank_end], shivering  [blank_start]Discontinue[blank_end] serotonergic [blank_start]antidepressants[blank_end] at least [blank_start]2 weeks[blank_end] before starting MAOI; [blank_start]fluoxetine[blank_end] requires 5 weeks  Discontinue MAOI for 2 weeks [blank_start]before[blank_end] starting a serotonergic agent  Linezolid (antimicrobial), dextromethorphan, sumatriptan, tramadol, [blank_start]methadone[blank_end], St. John’s wart can cause serotonin syndrome in the presence of [blank_start]SSRI[blank_end] or MAOI

Therapeutic use of antidepressants: [blank_start]Depression[blank_end] Requires [blank_start]1-2 months[blank_end] for benefit [blank_start]Trial period[blank_end] is [blank_start]4-12 weeks[blank_end], if inadequate response then switch or [blank_start]add[blank_end] another agent ~[blank_start]30%[blank_end] respond to [blank_start]initial[blank_end] agent ~[blank_start]70%[blank_end] respond if treatment is [blank_start]optimized[blank_end] e.g. SSRI + bupropion/atypical antipsychotic Many patients continue [blank_start]maintenance[blank_end] doses for year

Therapeutic uses of [blank_start]antidepressants[blank_end]:  Depression  [blank_start]Anxiety[blank_end] - SSRIs and SNRIs are approved for PTSD, OCD, social anxiety, GAD and panic disorder - Slower onset of benefit than [blank_start]benzodiazepines[blank_end]  [blank_start]Pain[blank_end] - Effects on pain are [blank_start]independent[blank_end] of antidepressant effects - [blank_start]TCAs[blank_end], SNRIs are more effective than others  [blank_start]Premenstrual Dysphoric Disorder[blank_end] - [blank_start]Fluoxetine[blank_end] and sertraline are approved therapies  [blank_start]Smoking Cessation[blank_end] - [blank_start]Bupropion[blank_end] - As effective as nicotine patches  [blank_start]Eating Disorders[blank_end] - More success with [blank_start]bulimia[blank_end] than [blank_start]anorexia[blank_end] - [blank_start]Mirtazapine[blank_end] stimulates appetite and used in anorexia  [blank_start]Premature ejaculation[blank_end] - [blank_start]SSRIs[blank_end] - Most antidepressants (except bupropion, [blank_start]mirtazapine[blank_end]) have sexual side effects  [blank_start]Menopausal “hot flashes”[blank_end] - SSRIs and SNRIs show benefit

Choosing an antidepressant  At the population level, [blank_start]efficacy[blank_end] is [blank_start]similar[blank_end] for all drugs  SSRIs and [blank_start]SNRIs[blank_end] are first line therapies  choice is often based on [blank_start]adverse effects[blank_end], potential drug interactions, patient [blank_start]history[blank_end]  [blank_start]Bupropion[blank_end]

Antidepressants: Mechanisms of action  [blank_start]SERT inhibition[blank_end] (SSRIs)  NET and SERT inhibition ([blank_start]venlafaxine[blank_end], TCAs)  5-HT2C agonist ([blank_start]trazodone[blank_end])  α2 antagonist ([blank_start]mirtazapine[blank_end])  [blank_start]5-HT2A, 2C, 3 antagonist[blank_end] (mirtazapine)  MAO inhibition ([blank_start]MAOIs[blank_end])  [blank_start]NE and DA potentiating[blank_end] ([blank_start]bupropion[blank_end])

Adverse effects  Mirtazapine has [blank_start]high[blank_end] affinity for [blank_start]H1[blank_end]  Antagonism of M, H1 and α1 is characteristic of [blank_start]TCAs[blank_end] - Dry mouth, sedation, [blank_start]orthostatic hypotension[blank_end] - Cardiotoxicity  [blank_start]SSRIs[blank_end] - Weight gain, sexual dysfunction, drug interactions (plasma protein binding, drug metabolism), nausea, [blank_start]insomnia[blank_end]