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Depression Overview
- mood disorder
- Lack of 5HT, Nepi, Epi, DA, Ach
- persistent feelings of hopelessness, worr, lack of energy, insomnia, poor conc'n
- gentic
- biological- treat
- environmental
- rule out bipolar to avoid rapid cycling
- 2 weeks to feel energized
- 4-6 weeks to feel happy
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Depression Diagnosis
- Must have 5 (x); including 1 of the 1st two
- depressed mood
- marked diminished interest/pleasure
- insomnia/hypersomnia
- agitation
- fatigue/lack of energy
- feelings of worthlessness
- diminished ability to concentrate
- recurrent suicide thoughts
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SSRIs (selective serotonin reuptake inhibitors)
- MOA: Blocks the reuptake of serotonin leading to 5HT levels
- USE: depression
- S/E: weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness
- C/I: MAOIs
- *Do NOT stop abruptly
- fluoxetine - prozac; sarafem
- paroxetine - paxil; paxil CR
- fluvoxamine - luvox
- sertaline - zoloft
- vilazodone - viibyrrd
- citalopram - celexa
- escitalopram - lexapro
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FLUOXETINE
- SSRI
- PROZAC
- SARAFEM - tx PMDD
- T1/2 = 7 days
- Give in the AM
- C/I: MAOIs
- *Do NOT stop abruptly
- *5 week washout period b/t MAOIs
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PAROXETINE
- PAXIL; PAXIL CR - SSRI
- S/E: sexual dysf(x); weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness
- C/I: MAOIs
- *Do NOT stop abruptly
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FLUVOXAMINE
- LUVOX - SSRI
- S/E: sexual dysf(x); weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness
- C/I: MAOIs
- * Do NOT stop abruptly
- * only used for depression
- * many DDIs
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SERTALINE
- ZOLOFT - SSRI
- S/E: sexual dysf(x); weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness
- C/I: MAOIs
- *Do NOT stop abruptly
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CITALOPRAM
- CELEXA - SSRI
- S/E: sexual dysf(x); weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness
- C/I: MAOIs
- *Do NOT stop abruptly
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ESCITALOPRAM
- LEXAPRO - SSRI
- S/E: sexual dys(fx); weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness
- C/I: MAOIs
- *Do NOT stop abruptly
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VILAZODONE
- VIIBRYD - SSRI
- take with food
- S/E: les sexual dysf(x); weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness
- C/I: MAOIs
- *Do NOT stop abruptly
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SNRIs (serotonin and norepinephrine reuptake inhibitors)
- MOA: block the reuptake of serotonin and Nepi
- USE: depression
- S/E: sexual dysf(x); weight gain; risk of bleeding when given with anticoagulants; risk of falls when taken with CNS stimulants; N/V/D; HA; SIADH; restless leg syndrome; restlessness; dry mouth; tachycardia; pupil dilation; excessive sweating; constipation; increase BP
- C/I: MAOIs (2week wash out period b/t)
- Venlafaxine - effexor
- desvenlafaxine - pristiq
- duloxetine - cymbalta ( treats pain too)
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VENLAFAXINE
- EFFEXOR - SNRI
- USE: depression; GAD
- S/E: N/V/; sexual dysf(x); dry mouth; tachycardia; pupil dilation; excessive sweating; constipation; increase BP
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DESVENLAFAXINE ER
- PRISTIQ - SNRI
- Use: depression
- S/E: N/V/; sexual dysf(x); dry mouth; tachycardia; pupil dilation; excessive sweating; constipation; increase BP
- *may see shell in stool, dont be alarmed
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DULOXETINE
- CYMBALTA - SNRI
- Use: depression; fibromyalgia; pain
- S/E: N/V/; sexual dysf(x); dry mouth; tachycardia; pupil dilation; excessive sweating; constipation; increase BP
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