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