6.3 - Anti-depressants Cont. & Bipolar disorder

What are adverse effects of tricyclic anti-depressants?

• Sedations

• Anticholinergic effects

• CV problems

• Seizures

• Increased risk of fatal overdose

What are adverse effects of MAO inhibitors anti-depressants?

• CNS excitation

• Increased BP

  • Esp with other drugs and food that increase catecholamine release

What are adverse effects of SSRIs and SNRIs anti-depressants?

• Generally better tolerated

• May increase seizures

• More GI problems

What is serotonin syndrome?

• Possibility with all anti-depressants because they all affect the neurotransmitter to some extent

• Occurs when CNS serotonin receptors are overstimulated

• Usually reversible, but can be fatal if unchecked, make sure to report if symptoms are noticed

What are symptoms of serotonin syndrome?

• Increase HR and BP

• Confusion and hallucinations

• Agitation

• Sweating or shivering

• Dystonia’s

• Dyskinesia

• Muscle pain

• GI problems

When are the effects of antidepressants felt by patients?

• Often a delay before symptoms begin to improve and reach their peak

  • 1-2 weeks before taking effect

  • May take 6-8 weeks to reach max effect

• Chance depression can get worse during start of drug therapy

What should you do as a provider for those taking anti-depressants in the latency phase?

• Educate and acknowledge treatment may worsen at start of treatment

• May need to bring to attention to a member of the healthcare team

What is ketamine?

• Used to initiate/maintain anesthesia in certain situations causing a dissociative effect

• Blocks NMDA receptors decreasing excitatory amino acids

• Metabolites may also affect many other receptors

How does ketamine relate to depression?

• Sub-anesthetic doses may cause a decrease in depression in severe and resistant case that have not responded to other treatments

• Effects are rapid in comparison to anti-depressants, sometimes with hours of first dose

• Can be given by a single slow IV infusion and repeated as need and as a nasal spray 1-2 times per week

• Still being carefully followed due to its non-traditional nature

What are potential problems of ketamine use?

• High abuse potential and side effects limit widespread use

• Research ongoing on ketamine and its derivatives on its use in depression

What have anti-depressants been prescribed for off-label?

• Specific drugs use for chronic pain

  • Fibromyalgia

  • Neuropathic pain

  • Headache

  • Low back pain

  • Raynaud’s phenomenom

What is the treatment of bipolar syndrome?

• Classic treatment uses lithium

• Works as a mood stabilizer by preventing the manic episode

• Unclear mechanism, but thought to stabilize neurons, may be neuro-protective, and other theories

What are additional characteristics of the lithium drug?

• An element and not degraded by body

• Eliminated solely by the kidneys

• Accumulates rapidly if there is any problem with kidney function

  • Can lead to lithium toxicity

  • Small margin of error, not a large difference between therapeutic and toxic levels

What are other bipolar treatments?

• Cariprazine

  • Partial agonist and antagonist

    • Partial stimulation

  • Anti-manic effects

    • Anti-seizure, gabapentin, lamotrigine

  • Anti-psychotics