Antidepressants

75%

About ___% of patients taking amitriptyline (elavil) will have significant xerostomia.

15%

About ___% of patients taking venlafaxine (effexor) (dual mechanism newer drug) will have significant xerostomia.

15%

About ____% of patients taking paroxetine (paxil) will have significant xerostomia.

USE VASOCONSTRICTOR WITH CAUTION BECAUSE OF CHANCE TO CAUSE HYPERTENSION

Describe the local anesthesia/vasoconstrictor precautions for patients taking amitriptyline (elavil) or other tricyclics/TCAs.

These agents are potent inhibitors of the reuptake of both norepinephrine and serotonin. Thus the clinical effectiveness of these compounds result from increased synaptic levels of both of the transmitters.

Describe the mechanism of action for dual-mechanism newer drugs that are antidepressants.

These agents vary in their mechanism of action. They may have some effects on inhibiting transmitter re-uptake particularly dopamine. However, this does not seem to fully explain the mechanism of these agents. Note that bupropion is also the drug used to promote smoking cessation.

Describe the mechanism of action for second-generation miscellaneous antidepressant drugs.

MAO inhibitors block the actions of the enzyme and decrease the amounts of norepinephrine and serotonin that are destroyed. As a result, MAO inhibitors cause the levels of norepinephrine and serotonin to increase. Clinical improvement of depression usually results.

Describe the mechanism of action of monoamine-oxidase inhibitors (MAOIs).

BOTH NOREPINEPHRINE AND SEROTONIN. Thus the clinical effectiveness of these compounds result from increased synaptic levels of both of the transmitters.

Dual-mechanism newer drugs that are antidepressants are potent inhibitors of the reuptake of _______________________.

Selective serotonin re-uptake inhibitors (SSRIs)

Fluoxetine (prozac), paroxetine (paxil) and sertraline (zoloft) are all part of which class of antidepressant drugs?

1. Selective serotonin re-uptake inhibitors (SSRIs) (Prozac family) 2. Tricyclics (TCAs) 3. Monoamine oxidase inhibitors (MAOIs) 4. Second-generation miscellaneous 5. Dual-mechanism newer drugs **think: Smelly Toes Make Some Depressed**

List the 5 categories used to classify antidepressant drugs.

1. Fluoxetine (Prozac) 2. Paroxetine (Paxil) 3. Sertraline (Zoloft)

List three examples of drugs that are part of the Selective serotonin re-uptake inhibitors (SSRIs) class of antidepressant drugs.

TRICYCLICS/TCAs (like amitriptyline - elavil)

Long-term treatment with _____________ such as amitriptyline increases the risk of caries by reducing salivation and salivary buffer capacity.

DOPAMINE

Second-generation miscellaneous agents vary in their mechanism of action. They may have some effects on inhibiting transmitter re-uptake particularly of ______________. However, this does not seem to fully explain the mechanism of these agents.

FALSE! In mental depression there appears to be an abnormal DECREASE in the brain levels of norepinephrine and serotonin. (MAO inhibitors block the actions of the enzyme and decrease the amounts of norepinephrine and serotonin that are destroyed. As a result, MAO inhibitors cause the levels of norepinephrine and serotonin to increase. Clinical improvement of depression usually results)

T or F? In mental depression there appears to be an abnormal increase in the brain levels of norepinephrine and serotonin.

FALSE! MAO inhibitors block the actions of the enzyme and DECREASE the amounts of norepinephrine and serotonin that are destroyed. As a result, MAO inhibitors cause the levels of norepinephrine and serotonin to increase. Clinical improvement of depression usually results.

T or F? MAO inhibitors block the actions of the enzyme and increase the amounts of norepinephrine and serotonin that are destroyed.

Preventing the re-uptake of serotonin into the nerves that release serotonin. Thus, larger quantities of transmitter are available to stimulate post-synaptic nerves. This usually results in improvement of mood and sleep.

The SSRIs (Prozac-like drugs) work by ___________________.

SEROTONIN (Thus, larger quantities of transmitter are available to stimulate post-synaptic nerves. This usually results in improvement of mood and sleep)

The SSRIs (Prozac-like drugs) work by preventing the re-uptake of ____________ into the nerves that release ____________.

Selective serotonin re-uptake inhibitors (SSRIs) (Prozac family) - Fluoxetine (Prozac); Paroxetine (Paxil); and Sertraline (Zoloft)

The _____________________ work by preventing the re-uptake of serotonin into the nerves that release serotonin. Thus, larger quantities of transmitter are available to stimulate post-synaptic nerves. This usually results in improvement of mood and sleep.

TRICYCLIC/TCAs - Amitriptyline (Elavil);Nortriptyline (Pamelor)

The discovery of the ______________ antidepressants in the 1950's revolutionized the treatment of depression.

Monoamine oxidase (MAO)

The enzyme __________________ prevents the buildup of excessive brain levels of norepinephrine and serotonin.

Anticholinergic actions causing: -Dry mouth -Sedation -Orthostatic hypotension In addition, it is generally known that the vasoconstrictor used in the local anesthetic injections can potentially interact with the tricyclic type and MAOIs of antidepressants to cause unwanted hypertension and tachycardia at the time of injection.

The family of antidepressant drugs can cause a variety of significant adverse effects which may influence the dental treatment of the patient. These effects include:

NOREPINEPHRINE AND SEROTONIN (this enzyme prevents the buildup of excessive brain levels of norepinephrine and serotonin.

The normal function of the enzyme monoamine oxidase (MAO) is to breakdown _____________ and _______________ into metabolites that are secreted by the kidney.

TRICYCLICS/TCAs - Amitriptyline (Elavil);Nortriptyline (Pamelor)

These antidepressant drugs are predominantly re-uptake inhibitors of norepinephrine with some minor effects on serotonin re-uptake inhibition. They are effective in improving depression symptoms.

-XEROSTOMIA AND CHANGES IN SALIVATION -ORTHOSTATIC HYPOTENSION -STOMATITIS -PARTICULAR TASTE -BLACK TONGUE -INCREASE RISK OF CARIES (due to lack of saliva and salivary buffer capacity)

What are the effects on dental treatment for amitriptyline (elavil)?

-XEROSTOMIA -ORTHOSTATIC HYPOTENSION

What are the effects on dental treatment for patients taking MAOIs (monoamine oxidase inhibitors)?

-SIGNIFICANT XEROSTOMIA -MAY CONTRIBUTE TO ORAL DISCOMFORT (esp in elderly) -TASTE PERVERSION -PROLONGED BLEEDING TIME

What are the effects on dental treatment for patients taking venlafaxine (effexor)/dual mechanism newer drug?

-XEROSTOMIA -TASTE PERVERSION -SSRI-INDUCED BRUXISM OR INVOLUNTARY MUSCLE MOVEMENT -PROLONGED BLEEDING TIME

What are the effects on dental treatment of fluoxetine (prozac)?

-XEROSTOMIA AND CHANGES IN SALIVATION -POSTURAL HYPOTENSION -ABNORMAL TASTE -SSRI-INDUCED BRUXISM OR INVOLUNTARY MUSCLE MOVEMENT -PROLONGED BLEEDING TIME

What are the effects on dental treatment of paroxetine (paxil)?

-XEROSTOMIA -PROLONGED BLEEDING TIME

What are the effects on dental treatment of sertraline (zoloft)?

1. Amitriptyline (Elavil) 2. Nortriptyline (Pamelor)

What are two examples of drugs that are part of the Tricyclics (TCAs) class of antidepressant drugs?

Bupropion (Wellbutrin)

What is one example of a drug that is part of the second-generation miscellaneous class of antidepressants?

Amitriptyline (elavil) - Tricyclic

What is the antidepressant that causes the most significant dry mouth amoung patients?

ELAVIL (a tricyclic/TCA antidepressant drug)

What is the brand name for amitriptyline?

WELLBUTRIN (a second-generation miscellaneous antidepressant drug)

What is the brand name for bupropoin?

PROZAC (a selective serotonin re-uptake inhibitor/SSRIs/Prozac family antidepressant drug)

What is the brand name for fluoxetine?

PAMELOR (a tricyclic/TCAs antidepressant drug)

What is the brand name for nortriptyline?

PAXIL (a selective serotonin re-uptake inhibitor/SSRIs/Prozac family antidepressant drug)

What is the brand name for paroxetine?

ZOLOFT (a selective serotonin re-uptake inhibitor/SSRIs/Prozac family antidepressant drug)

What is the brand name for sertraline?

BUPROPOIN (WELLBUTRIN)

____________ is a second-generation miscellaneous antidepressant drug that is also used to promote smoking cessation.

AMITRIPTYLINE (ELAVIL) - Tricyclic/TCAs

_______________ is the most anticholinergic and sedating of the antidepressants and has pronounced effects on the cardiovascular system.

Monoamine-oxidase inhibitors (MAOIs)

________________ were discovered more than 35 years ago and act by reducing the neurotransmitter breakdown within the neuron.

Monoamine oxidase (MAO)

___________________- is an enzyme found in most body cells but particularly in adrenergic nerve endings. The normal function of the enzyme is to breakdown norepinephrine and serotonin into metabolites that are secreted by the kidney. This enzyme prevents the buildup of excessive brain levels of norepinephrine and serotonin.