Antidepressant
Desvenlafaxine (Pristiq)
-3rd SNRi approved by FDA in 2008 -50% of drug is excreted in urine -half life is 11 hours higher selectivity for serotonin reuptake inhibition compared with norepinephrine reuptake inhibition
Clomipramine
Anafranil
Monamine Oxidase Inhibitors (MAOIs)
Antidepressant agents used to increase serotonin, norepinephrine, and dopamine levels. Superior to TCA's. Treats 55-70% of depression
Vortioxetine
Brintellix SSRI
Duloxetine
Cymbalta
Doxepin
Sinequan
Sertraline
Zoloft
amygdala
activity in what part of the brain is high when a person is sad or clinically depressed? It even continues after recovery.
Bupropion (Wellbutrin)
atypical antidepressant with low side effects, particularly sexual -short half life so good for geriatric clients -seizure risk in bulimics
Brexpiprazole (Rexulti)
atypical antipsychotic used for mDD
zero order transformation
biotransformation drug metabolized at a specific rate regardless of the concentration or elimination is independent of the drugs concentration
tricyclic antidepressants
block reuptake of norepinephrine, metabolized by first-order, and concentrated in the heart and brain.
Neurochemical basis of depression
depression stems from deficiencies in bioamines
the neurotransmitter or receptor site
genetic predisposed depression has been found to have hypoactive functioning of either _____ or ____.
The Biogenic Amine Hypothesis
hypothesis that states depression is caused by a deficiency of monoamines, particular noradrenaline and serotonin (drugs that boost these are effective)
Atypical Antidepressants
miscellaneous group of drugs with antidepressant effects but only mild side effects
Biological model of depression
model of depression that states women get more depressed due to physiology (ie. mood issues and puberty)
phelezine
nardil
-cerebral cortex -hippocampus -thalamus -amygdala
parts of the brain affected by depression (4)
biological amine theory of depression
theory that depression can be caused by medications when norepinephrine and serotonin neurotransmitters are depleted
hypertension, occipital headache, clamy skin, sore neck
what happens in a noradrenergic crisis?
fever, abnormal muscle movement, even death
what happens in a serotonergic crisis
SSRI's & bupropion, mirtazapine, mocibemide, and venlafaxine
what meds are safe in geriatric depression?
Serotonergic Crisis
when you combine MAOI's and SSRI's you get a
GI tract
where are TCA's absorbed?
pre migraine vertigo visual distortion headache
withdrawal from SSRI's
flu like without fever sleep disturbance hypomanic symptoms
withdrawal from TCA's
Paroxetine (Paxil)
💊SSRI commonly causes somnolence -diarrhea less common -low mania induction in bipolar -anticholinergic effects common -approved for treatment of OCD, depression, panic disorder, GAD, PTSD, and social phobia
Sertraline (Zoloft)
💊SSRI with low side effects such as nervousness -lowest SSRI in anorexia -maximum absorption requires full stomach -creates dry mouth -low mania induction in bipolar
Fluoxetine (Prozac)
💊with long half life -missed dosage not a problem -activates energy quickly -decreases appetite -lethargy uncommon
Venlafaxine (Effexor)
-first SNRI to be marketed in the US in 1993 -low sexual side effects -effective in geriatric and melancholic depression
Levomilnacipran (Fetzima)
-once per day dosage greater potency for norepinephrine reuptake inhibition to serotonin reuptake inhibition
Duloxetine (Cymbalta)
-used to treated MDD and GAD -used to treat a chronic pain disorder called fibromyalgia and nerve damage in diabetics max dosage is 60 mg per day -side effects are dry mouth, sleepiness, constipation, decreased appetite, increased sweating
-inadequate dose -inadequate time allowed for functioing
2 major mistakes in prescribing TCA's
tricyclic antidepressants
Amitriptyline, nortriptyline, imipramine, desipramine, doxepin, protriptyline, trimipramine maleate
Selective Reuptake Inhibitors (SSRIs)
Antidepressant drugs which work by increasing the amount of neurotransmitter at the synaptic cleft by blocking the reuptake of neurotransmitters, especially serotonin. E.g. Prozac. These drugs have fewer side effects.
Tricyclic Antidepressants (TCAs)
Antidepressants that increase the action of neurotransimtters by blocking their removal (reuptake) from the synapses (spaces between nerve cells). (1)
Bupropion (Wellbutrin) nefazodone (serzone) clomipramine (anafranil) trazodone (desyrel) mirtazapine (remeron) brexpiprazole (rexulti)
Atypical antidepressants?
Citalopram
Celexa
Trazodone
Desyrel
Venlafaxine
Effexor
Amitryptyline
Elavil
Selegiline
Emsam
MDD OCD Moderate to severe bulimia Panic disorder recently OCD and depression if 7-17 year olds
FDA approves Prozac (Fluoxetine) for ? (6)
MDD, OCD, social anxiety disorder panic disorder PTSD PMDD
FDA approves Zoloft (sertraline) for ? (6)
12.5 mg
If Yolanda takes 100 mg dose of medication with a half-life of 15 minutes, how much of the drug will be in her body after 45 minutes?
escitalopram
Lexapro
Fluvoxamine
Luvox
Phenelzine (Nardil) Tranylcypromine (Parnate) isocarboxazid (marplan) Selegiline (emsam)
MAOI's
Desipramine
Norpramin
Nortriptyline
Pamelor, Aventyl
Tranylcypromine
Parnate
Paroxetine
Paxil
Monoamine Oxidase Inhibitors
Phenelzine Tranylcypromine isocarboxazid selegiline
Desvenlafaxine
Pristiq
fluoxetine
Prozac
Mirtazapine
Remeron
Brexpiprazole
Rexulti
venlafaxine (effexor) duloxetine (cymbalta) mirtazapine (remeron) desvenlafaxine (pristiq) levomilnacipran (fetzima)
SNRI's
Vilazodone hydrochloride (Viibryd)
SSRI 40 mg once daily treatment should be titrated (dosage increased slowly)
Escitalopram Oxalate (Lexapro)
SSRI that may take 4 weeks to act -10 mg daily dose -isomer of citalopram -treats MDD and GAD
fluoxetine (prozac) paroxetine (paxil) fluvoxamine (luvox) sertraline (zoloft) citalopram oxalate (lexapro) vortioxetine (brintellix) vilazodone hydrochloride (viibyrd)
SSRI's
Citalopram (Celexa)
SSRi arrived for MDD and depression -low side effect profile -minimal effect on norepinephrine and dopamine -low anticholinergic effects antidotal (not tolerated by anxious clients)
dual mechanism reuptake inhibitors
Selective Norepinephrine and Serotonin Reuptake Inhibitors (SNRIs)
Nefazodone
Serzone
Trimipramine
Surmontil
anticholinergic effects cardiac arrhythmia orthostatic hypertension hypertension sedation
TCA side effects
Trazodone (Desyrel)
TCA used also for insomnia may be prescribed for cocaine withdrawal
Clomipramine (Anafranil)
TCA with serotonin reuptake restriction used specifically for OCD side effects make it less desirable used with panic and phobias
Amitriptyline (Elavil) Desipramine (Norpramin) Doxepin (Sinequan) Impramine (Tofranil) Nortriptyline (Aventyl) Portriptyline (Vivactil) Trimipramine maleate (surmontil)
TCA's
Imipramine
Tofranil
Vilazodone Hydrochloride
Viibryd
Protriptyline
Vivactil
Bupropion
Wellbutrin
discontinuation syndrome
a condition that can occur following the interruption, dose reduction, or discontinuation of antidepressant drugs, including selective serotonin re-uptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs).
Selective Serotonin Reuptake Inhibitors (SSRIs)
a group of second-generation antidepressant drugs that increase serotonin activity specifically, without affecting other neurotransmitters
Monoamine Oxidase Inhibitors (MAOIs)
antidepressant medications that increase the amount of monoamine neurotransmitter in synapses
Selective Norepinephrine and Serotonin Reuptake Inhibitors (SNRIs)
antidepressant meds that increase the levels of both serotonin and norepinephrine by inhibiting their reuptake into brain cells
PDR warning
antidepressants increased the risk compared to placebo of suicidal thinking and behavior in children, teens, and adults
Nefazodone (Serzone)
atypical antidepressant almost no anxious, nervous or insomnia side effects bradycardia risk
Mirtazapine (Remeron)
atypical antidepressant associated with increased hunger and weight gain. also abnormal dreams but less likely to cause nausea, vomiting, and sexual dysfunction
MAOI's side effects
drowsiness constipation nausea diarrhea stomach upset fatigue dry mouth dizziness low blood pressure lightheadedness decreased urine output sleep disturbances muscle twitch weight gain blurred vision etc
First Order Biotransformation
drug elimination is proportional to its concentration or a percentage of the drug is eliminated each hour ex. antibiotics
amphetamine and cocaine
drugs that potentiate dopamine (2)
Noradrenergic Crisis
emerges from combining MAOI's with TCA's, tyramine food, and stimulates (ie. over the counter drugs)
the dose of the drug
half life is based on?
10-14 days full affect 6 weeks
how long cold it take TCA's to act?
10-14 days
how long does it take for symptoms to improve on SSRI's?
5
how many half-lives must pass before a single dose of chemical is eliminated?
25%
how much of the dose remains in the system after the 2nd half-life period?
12%
how much of the dose remains in the system after the 3rd half-life period?
isocarboxazid
marplan
fluvoxamine
most gastrointestinal upset SSRI
paroxetine
most sedative SSRI
fluoxetine
most short-term weight loss and activation (anxiety & agitation) SSRI
Hippocampus
people with recurrent depression have a significantly smaller ? this region is associated with forming new memories
drug metabolism (biotransformation)
process by which biochemical reactions alter drugs within the body
SSRIs and atypicals used for all of these
seasonal affective disorder uncomplicated bereavement chronic pain disorders premature ejaculation anorexia nervosa bulimia premenstrual dyspohric disorder smoking cessation OCD PTSD panic disorder cocaine withdrawal
Vortioxetine (Brintellix)
specifically indicated for MDD -come from a psychotropic class of chemical compounds -start at 10 mg and bumps to 20 when tolerable
drug half life
the time required for the elimination process to reduce the concentration of the drug to one half what it was at initial administration
aged cheese air-dried sausages sauerkraut tap beers red wine fava green beans pickled herring Chinese food concentrated yeast extracts
things to avoid if on MAOI's or if experiencing migraines:
biological half-life
time it takes for the body to eliminate half the dose of the active drug in circulation