Ati Nervous System Meds (Depressive Disorders)

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SSRI

Back 1

prototype: fluoxetine

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citalopram (Celexa)

Back 2

SSRI

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escitalopram (Lexapro)

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SSRI

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paroxetine (Paxil)

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SSRI

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sertaline (Zoloft)

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SSRI

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vilazdone (Viibryd)

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SSRI

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SSRI MOA

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selectively block reuptake of the monoamine neurotransmitter serotonin in the synaptic space, thereby intensifying the effects of serotonin

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SSRI uses

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depression, OCD, bulimia, PMDD, panic disorders, PTSD

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SSRI adverse

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sexual dysfunction, CNS stimulation, weight loss, serotonin syndrome, withdrawal syndrome, hyponatremia, rash, sleepiness, faintness, lightheadedness, GI bleeding, Bruxism

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SSRI contraindications

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fluoxetine and paroxetine increase risk of birth defects,withdrawal symptoms and pulmonary hypertension in a newborn, MAOIs and TCAs
liver, renal dysfunction, cardiac disease, seizure disorders, diabetes, ulcers, history of GI bleed

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SSRI interactions

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MAOI, TCA, St. John's Wort- risk of serotonin syndrome, fluoxetine can displace warfarin from bound protein and result in increased warfarin levels, increase levels of TCAs and lithium, supresses platelet aggregation, thus increasing bleeding when used concurrently with NSAIDS and anticoagulants

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atypical antidepressants

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prototype: bupropion HCL (Wellbutrin)

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atypical antidepressants MOA

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inhibits dopamine uptake

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atypical antidepressants USE

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depression, alternative to SSRI, smoking cessation, seasonal pattern depression

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atypical antidepressant adverse

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headache, dry mouth, GI distress, constipation, increased HR, nausea, restlessness, insomnia
appetite suppressant, seizures

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atypical antidepressant contraindications

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MAOI, seizure disorders

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atypical antidepressant interactions

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MAOI increase risk of toxicity, should be discontinued 2 weeks prior to bupropion HCL

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venlafaxine (Effexor), duloxetine (Cymbalta)

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atypical antidepressant
inhibit serotonin and norepinepherine reuptake which increases the amount of these neurotransmitters available in the brain for impulse transmission
minimal amount of dopamine blockade

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mirtazapine (Remeron)

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atypical antidepressant
increases release of serotonin and norepinepherine

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trazodone (desyrel)

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moderate selective blockade of serotonin receptors, which allows more serotonin to be available for impulse transmission

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TCAs

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Prototype: amitriptaline (Elavil)

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imipramine (Torfranil)

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TCA

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doxepin (SInequan)

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TCA

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nortiptyline (Aventyl)

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TCA

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amoxapine (Asendin)

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TCA

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Trimipramine (Surmontil)

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TCA

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TCA MOA

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block reuptake of norepinepherine and serotonin in the synaptic space

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TCA USE

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depression, bipolar disorders, neuropathic pain, fibromyalgia, anxiety disorder, insomnia

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TCA adverse

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orthostatic hypotension,
anticholinergic effects: dry mouth, blurred vision, photophobia, urinary hesitancy or retention, constipation, tachycardia
sedation, toxicity resulting in cholinergic blockade and cardiac toxicity evidenced by dysrhythmias, decreased seizure theshold, excessive sweating

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TCA contraindications

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seizure disorders, CAD, DM, liver, kidney, respiratory disorders, urinary retention and obstruction, angle-closure glaucoma, benign prostatic hyperplasia, and hyperthyroidism

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TCA interactions

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MAOI or St. J's can cause serotonin syndrome
antihistamines and other anticholinergics have additive anticholinergic effects,
decrease effects of ephedrine, amphetamine
alcohol, benzodiazipines, opioids, and antihistamines cause additive CNS depression when used concurrently

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MAOIs

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Prototype: phenelzine (Nardil)

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isocarboxazid (Marplan)

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MAOI

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tranlcypromine (Parnate)

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MAOI

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selegiline (Emsam)

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transdermal MAOI

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MAOI MOA

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block MAO in the brain, thereby increase the amount of norepinepherine, dopamine, and serotonin available for transmission of impulses
intensifies response and relieves depression

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MAOI use

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depression
bulimia

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MAOI adverse

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CNS stimulation, orthostatic hypotension, hypertensive crisis resulting from tyramine, severe hypertension, headache, nausea, increased HR and BP, local rash

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MAOI contraindications

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SSRIs, phechromocytoma, HF, cardiovascular and cerebral vascular disease, severe renal insufficiency, seizure disorders, TCAs,
transdermal selegiline is contraindicated for carbamazepine (Tegretol) or oxacarbazepine,(Trileptal)- increases blood levels of MAOI

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MAOI interactions

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indirect-acting sympathomimetics, TCAs- hypertensive crisis
SSRI- serotonin syndrome
antihypertensives- hypotensive effect
meperidine (Demerol)- hyperpyrexia
tyramine-rich foods- hypertensive crisis
concurrent use of vasopresseors- hypertension

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MAOI adminstration

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avoid tyramine rich foods

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SSRI administration

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take med in morning to minimize sleep disturbance

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atypical antidepressant administration

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avoid use with MAOI

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TCA administration

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monitor for toxicity manifested by cardiac dysrhythmias,
take at bedtime due to sedation and risk for orthostatic hypotension

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atypical antidepressant effectivness

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improvement in mood,
ability to perform ADLs,
improved sleeping and eating habits,
increased interaction with peers