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Antidepressants
also Mood Stabilizers
- SSRIs
- Tricyclic antidepressants
- MAOIs(mono amine oxidase inhibitors)
- others
can take 2-3 wks for antidepressants to have an effect
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SSRIs
- Serotonin-specific reuptake inhibitors
- No effects on NE or dopamine
- most widely used antidepressants-fewer/less severe side effects
- Maybe used for tourette syndrome or OCD
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SSRI's ADR
- GI distress
- SEXUAL DYSFUNCTION
- Anorgasmia
- serotonin syndrome w/ MAOI: HTN, hyperthermia, muscle rigidity, CVS collapse
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SSRI drugs
- FLUOXETINE
- SERTRALINE
- PAROXETINE
- Citalopram
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TCAs
- Tricylic antidepressants
- blocks reuptake of both NE and serotonin
- used in depression
- can block the alpha-q adrenergic, histamine, and muscarinic receptors
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TCAs ADR
- Seuxal: impotence, anorgasmia
- Anticholinergic: tachycardia, UR
- CNS: sedation/drowsiness, insomnia, disorientation/confusion
- CVS: more common in the elderly, tachycardia, orthostatic hypotension
- TRI C's: convulsion, coma, cardiotoxicity(arrthymia)
- HAM= histamine-blocks it which leads to drowsiness, alpha trypsin-blocks bronchoconstriction, muscarinic-m1/m2/m3- dry mouth, eyes
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TCA drugs
- Imipramine: desipramine-strongly anticholinergic
- Amitripyline: nortripyline-strongly anticholinergic
- Clomipramine
- Doxepin
- Amoxapine
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Random uses
- Imipramine: Enuresis, which is bedwetting
- Amitriptyline: chronic pain
- imipramine also treats panic disorder
- fluoxetine, clomipramine: treats OCD
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Other considerations
- Not first line for pt's with resp diff's
- lower seizure threshold
- may impair driving
- avoid in first trimester
- withdrawal symptoms
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MAOIs
- inhibits the enzyme that metabolizes serotonin, epinephrine, and NE
- seleginine, phenelzine
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MAOI's ADR
- MAOI with TYRAMINE=hyptertensive crisis!!!
- occipital headaches, stiff neck, N/V, CP, dilated pupils, nosebleed, elevated BP
- stop the drug, give phentolamine(alpha blocker)
- fyi: tyramine is found in cheese and fish
- DO NOT GIVE MAOI WITH SSRIs
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Other Antidepressants
- BUPROPION
- TRAZODONE
- venlafaxine
- mertazipine
- maprotiline
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Bupropion
- aka Wellbutrin
- mech not well understood, NE
- used for smoking cessation
- NO SEXUAL SIDE EFFECTS
- toxicity: tachycardia, insomnia, headache, lowers seizure threshold
- DO NOT USE IN EATING DISORDERS OR ALCHOLICS
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Venlafaxine
- used also in generalized anxiety disorder
- inhibits catacholamine reuptake
- toxicity: stimulant effects, nausea, constipation, increase BP, impotence
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Mirtazapine
- Alpha 2 antagonist(increase the release of NE and serotonin)
- toxicity: sedation, increase appetite(good for depression in eating disorders)
- dry mouth
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Maprotiline
- Blocks NE reuptake
- ADR: sedation, orthostatic hypotension
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Trazodone
- Inhibits serotonin reuptake
- toxicity: sedation(can improve sleep quality), nausea, Priapism(contant boner), postural hypotension
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Mood Stabilizers
- Lithium
- Valproic acid
- Carbamazepine
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Lithium
- Mech is not well understood
- Long term control and Px of Bipolar disorder, migraine cluster headaches, chronic aggression, combined with tricyclics for resistant depression
- when you hear lithium think BIPOLAR!!
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Lithium ADR
- L: Lithium
- M: metalic taste in mouth or movement (tremor)
- N: Nephrogenic diabetes insipidus
- O: HypOthyroidism
- P: Teratogenic-epstein anomaly
- Note: narrow therapeutic window requiring close monitoring of serum levels
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Valproic Acid
- Acute mania, bipolar, seizures, rapid mood changes
- augments the GABA receptor in the CNS
- monitor blood levels
- hepatoxic (don't use if Liver fnc. test are impaired)
- TERATOGENIC-NTD
- agranulocytosis
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Carbamezepine
- Also an anitconvulsant: can be used to treat seizures as well.
- ADR: aplastic anemia, agranulocytosis
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