BMED- pharm anxiety/depression/OCD

What does SSRI stand for?

Selective serotonin reuptake inhibitor

What are SSRIs first-line for?

Anxiety disorders, depression, and OCD

What other conditions can SSRIs be used for?

PMDD, eating disorders, etc.

What are common SSRI side effects?

Sexual dysfunction, GI issues, headache

How long do SSRIs take to start working fully?

Several weeks

Can SSRIs be taken long term and then stopped?

Yes, can be weaned slowly; relapse possible

Are SSRIs habit-forming?

No (non-habit forming)

Name some important SSRI drug interactions.

Tramadol, warfarin, MAOIs, NSAIDs

What mood complication can SSRIs cause in bipolar patients?

Induce mania

Name common examples of SSRIs.

Paroxetine, fluvoxamine, escitalopram, citalopram, sertraline, fluoxetine

What specific cardiac risk is associated with citalopram?

QTc prolongation; few drug interactions

What specific risks are associated with escitalopram?

QTc prolongation; few drug interactions; S-isomer of citalopram

What are key characteristics of paroxetine?

More drug interactions, least activating, CR has less GI SEs, more weight gain, greater withdrawal, pregnancy category D

What are key characteristics of fluoxetine?

More drug interactions, most activating SSRI, no taper needed

What is a notable side effect of sertraline?

Diarrhea; few drug interactions

What are key characteristics of fluvoxamine?

More drug interactions; not indicated for MDD

What does SNRI stand for?

Serotonin/norepinephrine reuptake inhibitor

What are SNRIs used for?

Anxiety disorders, depression, etc.

Which SNRI is FDA approved for fibromyalgia?

Duloxetine

When are SNRIs often used in therapy order?

After failure of an SSRI

Name common SNRI side effects.

Increased BP, GI upset, sexual dysfunction, dizziness, sweating

How long do SNRIs take to fully work?

Several weeks

Can SNRIs be used long term then tapered?

Yes; slow taper recommended, relapse possible

Name important SNRI interactions.

Warfarin, NSAIDs, MAOIs, etc.

What eye condition is a contraindication for SNRIs?

Uncontrolled angle-closure glaucoma

What is important counseling for venlafaxine dosing?

Don't miss doses; unpleasant withdrawal

Name common SNRIs.

Venlafaxine, desvenlafaxine, duloxetine

What is special about desvenlafaxine?

Active form of venlafaxine; fewer drug interactions

What should be avoided with duloxetine?

Substantial alcohol use

How can venlafaxine GI side effects be reduced?

Take with food; XR formulation has less GI upset

What is mirtazapine's mechanism of action?

Alpha-2 antagonist increasing serotonin and norepinephrine release

What is mirtazapine FDA approved for?

Major Depressive Disorder

How is mirtazapine commonly used in practice?

Anxiety disorders and depression

What are mirtazapine's main contraindications?

Use of MAOI within 14 days; concurrent linezolid or IV methylene blue

What are common side effects of mirtazapine?

Increased appetite/weight gain, sedation (more at low doses), dizziness, abnormal dreams, constipation, dry mouth

What are rare hematologic side effects of mirtazapine?

Agranulocytosis, neutropenia

How fast do mirtazapine's insomnia/anxiety effects start?

Shortly after starting

How long may mirtazapine take to help depression?

Several weeks

Can mirtazapine be used long term and then tapered?

Yes, can be weaned slowly; relapse possible

When should mirtazapine usually be given?

At bedtime

Which type of patient is mirtazapine especially useful for?

Depressed patients with insomnia, anxiety, weight loss/low appetite, agitation, elderly

How is mirtazapine often used with SSRIs or venlafaxine?

To augment antidepressant response or counteract serotonergic side effects (anxiety, insomnia, anorexia)

What is the combo of venlafaxine + mirtazapine nicknamed?

"California rocket fuel"

What is buspirone's mechanism of action?

5-HT1A partial agonist; high affinity for 5-HT1A and 5-HT2 receptors

What is buspirone FDA indicated for?

Generalized Anxiety Disorder

What off-label condition is buspirone used for?

Depression

What are major contraindications for buspirone?

Hypersensitivity, MAOI use within 14 days, concurrent linezolid or IV methylene blue

What are common side effects of buspirone?

Headache, nausea, dizziness

What key side effects does buspirone NOT cause?

Sexual dysfunction or weight gain

How may buspirone affect SSRI-induced sexual dysfunction?

May help sexual dysfunction

How long does buspirone take to work?

About 2-4 weeks (no immediate effect)

Does buspirone cause withdrawal symptoms?

No

Is buspirone effective for acute anxiety attacks?

No

Why is buspirone a good option for people with substance abuse history?

Non-addictive; alternative anxiolytic

Can buspirone be used long term?

Yes

How is buspirone typically dosed?

Multiple times per day (BID or TID)

How is buspirone often used with antidepressants?

As augmentation

What is hydroxyzine's class and mechanism?

Antihistamine with activity at muscarinic, serotonergic (5-HT2), and dopaminergic receptors

How is hydroxyzine used in anxiety treatment?

As monotherapy or adjunct for anxiety

Why is hydroxyzine useful in patients with substance abuse history?

Non-addictive alternative

How fast does hydroxyzine work?

About 15-20 minutes

For what duration/use is hydroxyzine best?

Short-term or PRN use

What are the main side effects of hydroxyzine?

Dry mouth, sedation

What are hydroxyzine contraindications?

Early pregnancy, prolonged QT interval

What is gabapentin's mechanism?

Blocks voltage-gated Ca²⁺ channels; modulates glutamate; structurally related to GABA but does not bind GABA receptors

What are primary indications for gabapentin?

Neuropathic pain, restless legs; off-label for anxiety

What is a contraindication to gabapentin?

Proven allergy to gabapentin or pregabalin

Can gabapentin be used short or long term for anxiety?

Both short term and long term

How long does gabapentin take to impact anxiety?

May reduce anxiety over a few weeks

What are common side effects of gabapentin?

Sedation, dizziness, dry mouth

What is propranolol's mechanism?

Nonselective beta-1 and beta-2 receptor antagonist

Name propranolol's indications relevant to psychiatry.

Performance anxiety, lithium-induced tremor, aggressive behavior control, neuroleptic-induced akathisia (plus CV uses)

Name major contraindications for propranolol.

Uncompensated heart failure, cardiogenic shock, severe bradycardia or heart block > 1st degree, asthma or severe COPD

How does propranolol reduce anxiety?

Blunts peripheral autonomic symptoms (HR, sweating, blushing, tremor)

How should propranolol be used for performance anxiety?

Take 1 hour before performance as needed

What is important before first public use of propranolol?

Test dose at home to ensure adequate effect and no adverse events

Name common propranolol side effects.

Bradycardia, hypotension, depression, fatigue, bronchospasm

Why must propranolol not be abruptly discontinued?

Risk of rebound and CV complications

How do propranolol doses for anxiety compare to HTN doses?

Typically lower than HTN doses

What mood concern exists with propranolol?

Be careful in depressed patients

What is clonidine's mechanism?

Centrally acting alpha-2 agonist

Name psychiatric therapeutic uses of clonidine.

PTSD, social anxiety, ADHD, opioid/alcohol withdrawal, Tourette's (not first-line)

When is clonidine contraindicated?

BP < 90/60, cardiac arrhythmias

Name common clonidine side effects.

Dry mouth, fatigue, sedation, dizziness, nausea, hypotension, constipation, sexual dysfunction

How can clonidine help neurodiverse patients?

Helps with disruptive behaviors when prescribed daily

How quickly is clonidine absorbed orally?

Well absorbed; peak plasma in 1-3 hours

What is clonidine's half-life?

About 6-20 hours

What is the mechanism of benzodiazepines?

GABA positive allosteric modulators that enhance inhibitory GABA and inhibit neuronal activity

Which brain circuits are targeted by benzodiazepines for anxiety relief?

Amygdala-centered fear circuits

Name indications for benzodiazepines.

Insomnia, acute anxiety, panic disorder, agitation, alcohol withdrawal, anesthesia, anticonvulsant, muscle relaxant

Name major benzodiazepine contraindications.

Acute narrow-angle glaucoma, myasthenia gravis, severe respiratory insufficiency, sleep apnea

Name common benzodiazepine side effects.

Sedation, dizziness, ataxia, confusion, blurred vision, cognitive dysfunction, anterograde amnesia, depression

Which benzodiazepines are preferred in elderly or hepatic dysfunction?

Lorazepam, oxazepam, temazepam

Which benzodiazepines have rapid, intermediate, and slow onset?

Rapid: diazepam; slow: oxazepam, temazepam; most others intermediate

What risk exists if benzodiazepines are taken in overdose with alcohol?

Can be fatal

Why must benzodiazepines be tapered?

To avoid withdrawal and prevent seizures

To which benzodiazepine effects does tolerance develop?

Sedative, muscle relaxant, and anticonvulsant properties

What are first-line drugs for GAD?

SSRIs (paroxetine, escitalopram, sertraline) and SNRIs (duloxetine, venlafaxine)

What are second-line or alternative drugs for GAD?

Benzos, buspirone, imipramine, pregabalin, hydroxyzine, quetiapine

What are first-line drugs for Panic Disorder?

SSRIs and venlafaxine XR