Study Depressive Disorders & Antidepressants Flash Cards

 
Pile Management Card
Depressive Disorders & Antidepressants

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Atypical Antidepressants: Uses & Side Effects
>>E.g. For a list of drugs used for anxiety, pick the ones not used for it<<

Buproprion (Wellbutrin) - adrenergic effect, can cause anxiety and insomnia; augment effects of SSRIs; energizing, less side effects; don't use for anxiety.

Buspirone (Buspar) - also used for anxiety.

Nefazodone (Serzone)

(L2-4, P10) & (L4-5, P1)
Tricyclics: Side Effects
>>Know types of effects & 5-6 side effects<<

1. Anticholinergic Effect
Dry skin, dry mouth, blurred vision, constipation, intestine paralysis, & death.

2. Adrenergic Effect
Sweating, orthostatic hypotension, & sexual dysfunction.

3. Antihistaminic Effect
Weight gain & sedation.

4. Other Effects
Reduce seizure threshold, anxiety, elevated heart rate, rashes, palpitations, hepatitis, arrhythmias, & agranulocytosis.

(L2-4, P8)
SSRIs: Definitions
>>Know definition with drugs<<

[Flowers Please Every Valentine Sounds Cool - PPLLZC]

Fluoxetine (Prozac) - energizing, long half-life

Paroxetine (Paxil) - good anti-anxiety benefits.

Escitalopram (Lexapro) - minimal sedation, minimal interaction with other drugs.

Voxamine (Luvox)

Sertraline (Zoloft) - low sedation, little anxiety

Citalopram (Celexa) - minimal sedation, minimal interaction with other drugs.

(L4-5, P1)
SNRIs: Examples
>>Know<<

[MVD - REC (i.e. MVP's reck stuff)]

Mirtazapine (Remeron)
Venalfaxine (Effexor)
Duloxetine (Cymbalta)

Used in severe depression.

(L2-4, P9) & (L4-5, P1)
SSRIs: Examples
>>Know<<

[Flowers Please, Every Valentine Sounds Cool - PPLLZC (i.e. "please")]

Fluoxetine (Prozac)
Paroxetine (Paxil)
Escitalopram (Lexapro)
Voxamine (Luvox)
Sertraline (Zoloft)
Citalopram (Celexa)

(L2-4, P9)
Selective Serotonin Reuptake Inhibitors (SSRIs): "Clean" & Side Effects
>>If they're "clean" drugs, they're an SSRI<<

Relatively less side effects, mostly to serotoninergic synapses.

Side effects due to serotonin (SE) increase.

Side effects: nausea, sweating, anxiety, insomnia, headache, restlessness, sexual dysfunction, GI upset, [anorgasmia (i.e. delayed ejaculation), some anticholinergic effect]

[Used for major depressive, eating, and anxiety disorders.]

(L2-4, P9)
Cyclic Antidepressants: Examples
>>Know names & it's a cyclic antidepressant<<

[ADDIT - ENSTD]

Amitriptyline (Elavil)
Desipramine (Norparmin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Trazodone (Desyrel)

(L2-4, P8)
Clinical Depression: Symptoms
>>Know 4-5 symptoms (short-answer)<<

Mood changes (e.g. sadness, despair, emptiness)
Low self-esteem
Apathy, low motivation, social withdrawal
Negativity, pessimistic thinking
Irritability
Suicidal ideation
(Anhedonia)
(Excessive emotional sensitivity)

(L2-4, P5)
Depression v. Clinical Depression
>>Know depression v. clinical depression (matching)<<

Depression is a chronic episodic, remitting, and relapsing disease. If untreated, relapse will be more frequent and more severe.

Clinical depression: intensity, duration, and impact of symptoms in normal functioning. Suffering months to years with severely affected daily life.

(L2-4, P4)
DSM-IV TR
>>Know what's in every axis (short-answer)<<

Axis I: Mental Disorders
Axis II: Personality Disorders (PD) & Mental Retardation (MR)
Axis III: Physical Conditions & Disorders
Axis IV: Psychological & Environmental Problems
Axis V: Global Assessment of Functioning (GAF)

(L2-4, P1)
Side Effects: 5 Problems
1. Activation - acute onset/after a few hours of start or when dose is increased.
Side effects: Nervousness, anxiety, insomnia.
Solution: 3 weeks of low dose tranquilizer, and then phased out.

2. Sexual dysfunction, inorgasmia - use Buproprion (Wellbutrin) or Viagra

3. Genital anesthesia & ejaculation with no pleasure - rare.

4. Weight gain - may be metabolic effect.

5. Switching - IP goes into manic state after several weeks into treatment.

(L2-4, P13)
Contest Side Effects: Optimization, Substitution, & Antidote Strategies
Optimization:
1. Wait habituation
2. Adjust the dose and administration (i.e. reducing the dosage)
3. Drug Holiday (only works if have short half-life)

Substitution:
(Be careful due to other side effects or relapse)

Antidote strategies:
Bupropion (Wellbutrin) is used most due to low risk in sexual dysfunction (i.e. sometimes counteract SSRI's sexual side effects)
Natural drugs, antihistaminic, & Sidenafil (Viagra) [i.e. for sexual side effects or erectile dysfunction (ED)]

(L2-4, P12)
Stimulants: Examples
[Ay Matey - Don't Run]

Amphetamine (Dexedrine)
Methylphenidate (Ritalin)

[Not an antidepressant medication.]

(L2-4, P10)
Stimulants: Uses & Side Effects
Used to augment the effect of antidepressants. [Can be used with antidepressants.]

Side Effects: insomnia, agitation, anxiety, & appetite suppression.

Amphetamine (Dexedrine) - causes shaky, dryness; more adrenaline release.

(L2-4, P11)
MonoAmino Oxidase Inhibitors (MAOIs): Examples
[TSP of sugar - Please Enjoy Now]

Tranylcipromine (Parnate)
Selegiline (Ensam)
Phenelzine (Nardil)

(L2-4, P10)
MAOIs: Uses & Side Effects
Only used in MDD & Panic Disorder, when other medications fail.

Dangerous hypertensive reaction when taken with food containing tyramine (e.g. wine, cheese).

[Can't be taken with medications (e.g. SSRIs).]

Side Effects: sedation, insomnia, agitation, confusion, orthostatic hypotension, & edema.

Tranylcipromine (Parnate) - most common

Selegiline (Ensam) - transdermal patch, reduced risk of hypertensive reaction.

(L2-4, P10)
Atypical Antidepressants: Examples
[Billy's Back Now - Welcome Back Son]

Bupropion (Wellbutrin)
Buspirone (Buspar)
Nefazodone (Serzone)

(L2-4, P10)
NRIs: Examples
[Ah Robot - Save Village!]

Atomoxetine (Strattera)
Reboxetine (Vestra)

(L2-4, P10)
Norepinephrine Reuptake Inhibitors (NRIs): Uses, Effects, & Side Effects
Atomoxetine (Strattera) - selective blocker of NE reuptake; only approved for ADHD use, despite antidepressant effect.

Reboxetine (Vestra) - improve energy, cognition, anxiety, less appetite, little sexual side effects, paradoxical sedation (i.e. suppose to stimulate); in Europe only.

(L2-4, P10)
Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs): Uses
Have dual action.

Blocks reuptake of NE & SE (i.e. 5-HT) neurotransmitters.

Mirtazapine (Remeron) - Alpha 2 adreno receptor blocker, increases SE & NE activity.

[Sometimes SSRIs may not work, so may need SNRIs.]

(L2-4, P9)
Cyclic Antidepressants: Drugs & Their Side Effects
Most side effects: Amitripyiline (Elavil) & Doxepin (Sinequan).
Anticholinergic hypotension & sedation.

Trazodone (Desyrel).
No anticholinergic effect, mild sedation and hypotension.
[Mainly used for sedation/sleep, not as an antidepressant.]

Lowest side effects: Imipramine (Tofranil) & Desipramin (Norpramin).
Almost no sedation.

(L2-4, P8)
Tricyclics: "Dirty"
Called "Dirty" because of the reaction with several receptors causing side effects.

[Cause a lot of side effects, dangerous - can be lethal and kill you.]

(L2-4, P8)
Antidepressant Classifications
1. Cyclic Antidepressants; Tricyclics (TCAs)
2. Selective Serotonin Reuptake Inhibitors (SSRIs)
3. Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs)
4. Norepinephrine Reuptake Inhibitors (NRIs)
5. MonoAmino Oxidase Inhibitors (MAOIs)
6. Atypical Antidepressants

(L2-4, P8)
Grief or Uncomplicated Bereavement (Depressive Disorder)
Prolonged and even painful response to loss with emotional distress.

Can last 6-12 months, and can continue in a lesser degree.

Affects functioning, all depends on individual.

(L2-4, P4)
Reactive Dysphoria or Sadness (Depressive Disorder)
Low grade sadness & despair.

No interference with normal functioning.

Little impact in the social, interpersonal, occupational life.

(L2-4, P4)
Depressive Disorders: 3 Classifications
3 Classifications:
1. Reactive dysphoria or sadness
2. Grief or uncomplicated bereavement
3. Clinical Depression

(L2-4, P4)
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