Medications for depression - ANSWER SSRIs SNRIs SDRIs TCAs MAOIs
SSRIs - ANSWER -Action: inhibit 5-HT reuptake
-Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline
-Adverse effects:
• nausea • agitation • diarrhea • headache • weight gain • sexual side effects SNRIs - ANSWER -inhibit 5-HT reuptake -inhibit NE reuptake (↑ energy, focus) -increase DA in prefrontal cortex (↑ cognition)
-Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine
-Adverse effects:
• elevated blood pressure • nausea • sweating • tremors • anxiety • insomnia • constipation • anorexia • sexual dysfunction SDRIs - ANSWER -inhibit DA reuptake (↑alertness, motivation) -inhibit NE reuptake (↑energy)
-Adverse effects: 1 / 4
• agitation • headache • dry mouth • constipation • weight loss TCAs - ANSWER -Action: inhibits the reuptake of serotonin and norepinephrine; blocks norepinephrine, histamine, and acetylcholine receptors
-Examples: amitriptyline, clomipramine, desipramine, doxepin
-Common Side Effects:
• dry mouth • constipation • blurred vision • urinary retention • sedation • weight gain • hypotension • tachycardia • sexual dysfunction MAOIs - ANSWER -Action: increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it
-Examples: isocarboxazid, phenelzine, tranylcypromine
-Common Side Effects:
• sedation • dizziness • sexual dysfunction • hypertensive crisis
Prescribing pearls: citalopram (Celexa) - ANSWER mild
antihistamine effects 2 / 4
Prescribing pearls: escitalopram (Lexapro) - ANSWER no known drug interactions Prescribing pearls: fluoxetine (Prozac) - ANSWER longest half-life Prescribing pearls: paroxetine (Paxil) - ANSWER also treats social anxiety and insomnia Prescribing pearls: fluvoxamine (Luvox) - ANSWER treats anxious depression smokers require increased dose Prescribing pearls: sertraline (Zoloft) - ANSWER also treats social anxiety and hypersomnolence Prescribing pearls: bupropion (Wellbutrin) - ANSWER NDRI may improve energy, alertness, and motivation; not first line treatment for anxiety; contraindicated in clients with a history of seizures Prescribing pearls: duloxetine (Cymbalta) - ANSWER effective for atypical pain at higher doses; appropriate for clients who present with somatic symptoms of depression; effective for atypical pain, such as fibromyalgia and diabetic neuropathy Prescribing pearls: venlafaxine (Effexor) - ANSWER treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication 3 / 4
Prescribing pearls: desvenlafaxine (Pristiq) - ANSWER effective for perimenopausal vasomotor symptoms
considered when selecting a medication: - ANSWER -Client
preference -Prior treatment response -Anticipated adverse effects -Comorbidities -Half-life and interactions -Cost if a medication is not achieving efficacy: - ANSWER -Increase dose gradually -Switch to a different drug within the same class -Switch to drug in a different class -Add a second medication Use to protect against suicide - ANSWER lithium MDD and BPD genetics - ANSWER genetic factors contribute 31- 42% of the disease risk in MDD and 59-85% in BPD monoamine hypothesis of depression - ANSWER -posits that depression occurs as a result of a deficiency of one or all three monoamine transmitters • serotonin, norepinephrine, and dopamine -while mania may result from an excess
- / 4