Types of Antidepressants
Which antidepressant's MoA is to block the reuptake of serotonin, leaving more in the synapse to activate receptors?
SSRI's (Selective Serotonin Reuptake Inhibitors)
What are some common CNS effects?
-sleepiness
-dizziness
-restlessness
-seizures
-headache
What is the common ending for SSRIs?
-oxetine
Treatment of depression generally requires two things - what are they?
medication and therapy
What is the most common herbal interaction with antidepressants?
St. John's Wort
Which antidepressant's MoA is to block the reuptake of serotonin and norepinephrine leaving more in the synapse to be used?
SNRI's (Serotonin/Norepinephrine Reuptake inhibitors)
What are common GI side effects?
-what action by the patient can be done to decrease GI side effects?
don't chew med; take with food
-N/V
-anorexia
-weight loss/ weight gain
-constipation/diarrhea
What is the common ending for SNRIs?
-faxine
What is the most important herbal supplement you need to know before giving your patient an antidepressant?
St. John's wort (has an effect on serotonin) (think SS!)
True or False: Atypical antidepressants can be an adjunct medication used with MAOIs
False
Which antidepressant's MoA is to block the reuptake of norepinephrine and dopamine; it also has an effect on serotonin.
Atypical Antidepressants
Describe anticholinergic effects. Which antidepressant drug classes have anticholinergic effects as some of their adverse effects?
MAOIs and TCAs
-dry mouth, blurred vision, constipation, urinary retention, confusion, tachycardia, sometime delirium
Which drug class is considered the First Line Drugs for depression?
SSRIs
What are some things you may tell your patient about SSRI's before prescribing them?
-wait time!! (4-6 weeks?)
-side effects (especially sexual dysfunction - think age)
-report s/s of serotonin syndrome
What are the contraindications for Phenelzine and why?
-cardiovascular/cerebrovascular disease
-hepatic/renal impairment
-pheochromocytoma (what's that?)
BONUS: which drug/food interaction do you need to watch for in MAOIs?
Which antidepressant's MoA is to block the reuptake of norepinephrine and serotonin; it also partially blocks muscarinic Acetylcholine and/or Histamine receptors which may cause sedation; it also blocks certain calcium channels (may lead to cardiac toxicity)
Tricyclic Antidepressants (TCA's)
Why are there more cardiovascular effects when taking SNRIs than SSRIs?
-more norepinephrine causing hypertension and tachycardia
What are the four indications for Bupropion?
Depression (when SSRIs and SNRIs are not well tolerated), seasonal attention disorder, attention deficit disorder; tobacco cessation
What would you say to your patient if they are experiencing dry mouth?
-sip water
-chewing gum
-hard candy
Which type of drug may have an interaction with a SNS stimulant, causing a hypertensive crisis? (what is the type, and which drug are we studying of that class?)
-also, give some examples of a SNS stimulant
MAOIs (phenelzine)
-amphetamines, cocaine, dopamine, Epi, NE, and several herbal remedies)
Which antidepressant's MoA is to block the breakdown of serotonin, dopamine, and norepinephrine?
Monoamine Oxidase Inhibitors (MAOIs)
-what is an Monoamine Oxidase and where does it work?
What are signs of toxicity when taking TCAs?
-cholinergic blockade
-dysrhythmias/hypotension
-seizures, coma, death
Describe Serotonin Syndrome
rapid onset, tremors, agitation, hyperreflexia, fever, confusion, usually resolves when med is discontinued
Your patient reports a history of seizures. Which class of medication would you questions the physician for prescribing and why?
TCAs (decreases seizure threshold)
also atypical antidepressants
What are the possible drug/drug interactions with Amitriptyline?
MAOIs and St. John's wort (causing SS)
Sympathomimetic (what does that mean??) drugs like Epi and Dopamine will increase the effects of Amitriptyline
Many drugs can add anticholinergic effects (why??)
Many drugs can add CNS depressing effects
Other calcium blockers - heart problems