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SSRIs
- Fluvoxamine
- Paroxetine
- Fluoxetine
- Sertraline
- Citalopram
- Escitalopram
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Fluvoxamine
- Luvox
- FDA approved for OCD
- Strongly anticholinergic --> give at night
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Paroxetine
- Paxil
- Most serotonin specific of the SSRIs
- Most activating (stimulating)
- Half life of 6-12 hours --> good for drug holiday and quick withdrawal
- SE: sexual dysfunction, anticholinergic --> dry --> along with P450 interactions --> not good for elderly, weight gain (packs on pounds), sedating
- Good for PTSD and anxiety
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Fluoxetine
- Prozac
- Very effective for depression!
- Activating
- half life 13-15 days --> self tapers
- FDA approved for bulimia and premature ejaculation
- Lots of P450 interactions
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Sertraline
- Zoloft
- SE: platelet problems
- Can be activating (25%) or sedating (75%)
- Good for adolescents
- More effect on anxiety than depression
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Citalopram
- Celexa
- Cheap
- Few interactions --> Safe for geriatrics
- Need to use at least 60mg for anxiety
- BBW: >60mg --> increased QTC
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Escitalopram
- Lexapro
- Same as Celexa
- Expensive! --> no generic
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Dosing SSRIs
- 1. Start at low dose
- 2. Reassess at 4-6 weeks, if partial response -->
- 3. increase dose
- 4. Reassess at 4-6 weeks later, if partial response -->
- 5. increase dose
- 6. Try a different drug if no response after 2 adjustments --> after 2-3 SSRIs, try atypical
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SNRIs
- Duloxetine
- Venlafaxine
- Desvenlafaxine
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Duloxetine
- Cymbalta
- FDA approved for depression and pain (neuralgia)
- BID dosing
- Not dose dependent for the 1NE:4-5S effect
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Venlafaxine
- Effexor
- Dose dependent!
- - Up to 150mg, only getting S
- - Up to 225mg, getting 1NE:4-5S
- - Above 300mg, also getting DA
- Good for refractory depression and neuropathy
- SE: HTN, withdrawal after 1-3 missed doses (zapping pain, flulike sx), similar SE for SSRI
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Atypical antidepressants
- Buproprion
- Mirtazapine
- Trazodone
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Buproprion
- Wellbutryn
- Good for: smoking, SAD, adult ADHD
- Less sexual SE than SSRIs
- Serious SE: seizures! - careful in EtOH withdrawal or eating disorders, psychosis (high dose), similar SE to SSRIs
- Good to use in manics - won't cycle up the mood
- NE and DA reuptake inhibition
- Can be monotherapy or adjunct
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Mirtazapine
- Remeron
- a2 agonist --> also used for HTN
- SE: sedation, increased appetite, slowed metabolism, dizziness, tremor, agranulocytosis
- 7.5-15mg: good for sleep and appetite in geri pts --> can be used with more activating med in the AM
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Trazodone
- Desyrel
- Useful for refractory MDD, MD with anxiety and insomnia
- Need at least 300mg for antidepressant effects
- Non-addictive
- Easy to build up tolerance
- Vivid dreams --> don't use in PTSD!
- SE: sedation, N, dizziness, orthostasis, arrhythmias, priapism
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