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What would appear with SSRI discontiuation?
- After 1 to 3 days would experience:
- Dizziness, Nausea, Headache, Anxiety/agitation
- Sensory disturbances
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Name the Serotonin Norepinephrine reuptake inhibitors (SNRI)
- venlafaxine
- desvenlafaxine
- duloxetine
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What is Venlafaxine?
What else does it do?
What are its indications?
- It is a SNRI
- It is a weak inhibitor of DA reuptake
- Has NO AFFINITY FOR
- Muscarinic, H1 or Alpha adrenergic receptors.
Indications: Depression, GAD, Social Anxiety disorder
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What are some Velafaxine Adverse effects?
Short half-life
Abrupt discontinuation may lead to SSRI discontinuation syndrome
Extended release formulation reduces this somewhat
*at low doses it have more Adrenergic affects, at high doses it has more seritonin effects
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What are some Venlafaxine interactions?
- -Do NOT combine with MAOI
- -Wait 2 weeks after MAOI is stopped before giving starting this drug
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What is Devenlafaxine?
- -It is a SNRI
- -It is the major active metabolite of Venlafaxine
- -Not broken down by cyt P450
- -Side effects are similar to Venlafaxine
- -Does not undergo extensive hepatic metabolism
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What is Duloxetine?
What is it indicated in?
What is an adverse effect?
It is a SNRI
- -Depression
- -GAD
- -Neurologic pain management
- -Management of chronic musculoskeletal pain
Potential interaction with MAOI, as with other antidepressants.
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Name some other Antidepressents
- Dupropion
- Mirtazapine
- Trazodone
- Nefazodone
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Bupropion
It is an antidepressent with Dual monoamine reuptake inhibitor
- NE>DA (not as effective for seratonin)
- -Aid to smoking cessation
- -Can be used in treatment of ADHD
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Bupropion has the Absence of.......
and compared to other Antidepressents, Bupropion has...
- Absence of:
- Sedation, Cardio effects (mild increased BP), sexual dysfunction, Anticholinergic effects.
- Carparativly:
- -Reduced risk for “switching” to mania/hypomania
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What are the adverse effects of Bupropion???
What are some interactions that can occure?
- -Activation (insomnia, agitation)
- -Decrease in Appetite
- -Lowers seizure threshold (remember that the Seizures are dose related)
- Interactions with:
- -MAOI
- -Antiparkinson drugs (increase dopamine)
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What is Mirtazapine?
-It is an antidepressent that is NOT a reuptake inhibitor.
- -It is a potent Alpha 2 antagonist( blocks 5-HT2/3)
- -Therea are minimum effects on Monoamine reuptake
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What is Mirtazapines mech of action?
What does it have Low/ High effinity for?
- Blockade of presynaptic alpha-2 Autoreceptors ➨ ⇧NE release
- -Blockade of alpha-2 heteroreceptors on 5-HT neurons ➨ ⇧ 5-HT releas
- - Low affinity for Muscarinic Cholinergic and Dopamine recepters
- -High affinity for H1 (Sedation at low dose, Increase NE at higher dose)
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What is Trazodone?
What is its mech of action?
It is a weak 5-HT reuptake inhibition
The active metabolite, m-chlorophenyl piperazine (m-CPP) is a 5-HT agonist
- -Weak blocker of presynaptic alpha-2 receptors
- -Potent post-synaptic alpha-1 antagonist
- Causes Orthostatic hypotension
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What are the Drug interations of Trazodone?
- -Potentiates other CNS depressants
- -Potentiates antihypertensives
- -Potentiates other serotoninergic drugs
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What was Nefazodone withdrawn for?
Due to increased risk of Hepatic failure
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-What are the Antipsychotic drugs approved as adjunctive treatment?
-Fluoxetine + Olanzapine are fixed combinations that are approved for?
- 1. Quetiapine
- 2. Aripiprazole
- ___________________
- 1. Treatment resistant depression
- 2. Bipolar Depression
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Children and Antidepressants, what are they at increased risk for?
What are the ones approved for childrens use?
-Increased risk of Suicidal thinking and behavior
- Fluoxetine and Escitalopram
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TREATMENT OF BIPOLAR DISORDER
- Mood stablizers
- -llithium
- -lvalproic acid
- -lcarbamazepine
- -llamotrigine
- Antidepressant drugs
- Antipsychotic drugs
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Depression treatment (both acute and prophylaxis)
Mania treatment (noth acute and prophylaxis)
Depression: Antidepressents Mood Stablizers
Mania: Mood stablizers(and antipsycotic drugs) mood stablizers
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