CNS Drugs: Mood Disorders, Depression

Brand and generic, black box warnings, major counseling points. also topics regarding depression

Symptoms of depression

• low mood

• changes in appetite

• sleep disturbances

• agitation

• fatigue

• difficulty concentrating

Major neurotransmitters involved in depression

1. norepinephrine

2. serotonin

3. dopamine

all antidepressants are taken by which route

PO; by mouth

What does SSRI stand for

Selective serotonin reuptake inhibitor

Which antidepressants are SSRI

• citalopram

• escitalopram

• fluoxetine

• paroxetine

• sertraline

What does SNRI stand for

Serotonin-norepinephrine reuptake inhibitor

Which antidepressants are SNRIs

• venlafaxine

• desvenlafaxine

• duloxetine

What does TCA stand for

Tricyclic antidepressant (Serotonin/Norepinephrine/dopamine/many)

Which drugs are TCAs

• amitriptyline

• nortriptyline

drug class for Vilazodone

SSRI/Serotonin-1a receptor partial agonist

drug class for Bupropion

Norepinephrine-dopamine reuptake inhibitor

drug class for Mirtazapine

Norepinephrine/histamine antidepressant

Major counseling points for most antidepressants

• may take 2-4 weeks to start seeing the efficacy effects, and full effects in 4-6 weeks

• risk of QTc prolongation- increased risk of arrythmia (heart racing, pounding for not physical reasons)

• Risk of HYPONATREMIA (headache, weakness, confusion) (***NOT INCLUDING BUPROPION AND MIRTAZAPINE***)

• DO NOT STOP THE DRUG ABRUPTLY; taper the dose!!

Bupropion and Mirtazapine have one exception to the major counseling points. Which is…

Also, while other antidepressants all have _______ activities these two are an exception as they target other neurotransmitters

risk of hyponatremia; serotonin

Blackbox warning for all antidepressants

• increased risk of suicide in children, adolescents and young adults

Celexa

generic or brand? Give counseling point. give adverse drug reactions

Brand.

Generic: citalopram

Reactions: sleep disturbances (somnolence, insomnia), anxiety, nausea, dry mouth, DIARRHEA, sexual dysfunction; hyponatremia, increased risk of bleeding

Counseling: -may increase risk of bleeding, especially if taking other blood thinners. -sexual dysfunction

Lexapro

generic or brand? Give counseling point. give adverse drug reactions

Brand.

Generic: escitalopram

Reactions: sleep disturbances (somnolence, insomnia), anxiety, nausea, dry mouth, DIARRHEA, sexual dysfunction; hyponatremia, increased risk of bleeding

Counseling: -may increase risk of bleeding, especially if taking other blood thinners. -sexual dysfunction

Fluoxetine

generic or brand? Give counseling point. give adverse drug reactions

Generic

Brand: Prozac, Sarafem

Reactions: sleep disturbances (somnolence, insomnia), anxiety, nausea, dry mouth, DIARRHEA, sexual dysfunction; hyponatremia, increased risk of bleeding

Counseling: -may increase risk of bleeding, especially if taking other blood thinners. -sexual dysfunction

Paroxetine

generic or brand? Give counseling point. give adverse drug reactions

Generic

Brand: Paxil

Reactions: sleep disturbances (somnolence, insomnia), anxiety, nausea, dry mouth, DIARRHEA, sexual dysfunction; hyponatremia, increased risk of bleeding

Counseling: -may increase risk of bleeding, especially if taking other blood thinners. -sexual dysfunction

Sertraline

generic or brand? Give counseling point. give adverse drug reactions

Generic

Brand: Zoloft

Reactions: sleep disturbances (somnolence, insomnia), anxiety, nausea, dry mouth, DIARRHEA, sexual dysfunction; hyponatremia, increased risk of bleeding

Counseling: -may increase risk of bleeding, especially if taking other blood thinners. -sexual dysfunction

Venlafaxine

generic or brand? Give counseling point. give adverse drug reactions

Generic

Brand: Effexor (tablet), Effexor XR (capsule)

Reactions: Nausea, dry mouth, constipation, HYPERTENSION, sexual dysfunction; hyponatremia

Counseling: may increase blood pressure (and heart rate)

Pristiq

generic or brand? Give counseling point. give adverse drug reactions

Brand

Generic: desvenlafaxine

Reactions: Nausea, dry mouth, constipation, HYPERTENSION, sexual dysfunction; hyponatremia

Counseling: may increase blood pressure (and heart rate)

Cymbalta

generic or brand? Give counseling point. give adverse drug reactions

Brand

Generic: duloxetine

Reactions: Nausea, dry mouth, constipation, HYPERTENSION, sexual dysfunction; hyponatremia

Counseling: may increase blood pressure (and heart rate)

Elavil

generic or brand? Give counseling point. give adverse drug reactions

Brand

Generic: amitriptyline

Reactions: may experience ANTICHOLINERGIC side effects: dry mouth, blurred vison, CONSTIPATION and/or URINARY RETENTION (trouble goin potty), drowsiness, hyponatremia, weight gain

Counseling: -may experience ANTICHOLINERGIC side effects: dry mouth, blurred vison, CONSTIPATION and/or URINARY RETENTION -drowsiness

Nortriptyline

generic or brand? Give counseling point. give adverse drug reactions

Generic

Brand: Pamelor

Reactions: may experience ANTICHOLINERGIC side effects: dry mouth, blurred vison, CONSTIPATION and/or URINARY RETENTION (trouble goin potty), drowsiness, hyponatremia, weight gain

Counseling: -may experience ANTICHOLINERGIC side effects: dry mouth, blurred vison, CONSTIPATION and/or URINARY RETENTION -drowsiness

Vilazodone

generic or brand? Give counseling point. give adverse drug reactions

Generic

Brand: Viibryd

Reactions: Increased risk of bleeding; nausea/vomiting, hyponatremia, sexual dysfunction

Counseling: May increase the risk of bleeding, especially if taking with other blood thinners; sexual dysfunction TAKE WITH FOOD

Bupropion

generic or brand? Give counseling point. give adverse drug reactions

Generic

Brand: Wellbutrin, Zyban

Reactions: SEIZURES, INSOMNIA, dry mouth, tremors, headache

Counseling: -Carries the risk of SEIZURES: DO NOT TAKE if the patient has history of seizures; the max dose per day is 450mg. -if taking for smoking cessation (Zyban), start the drug ONE week before quit day

Remeron

generic or brand? Give counseling point. give adverse drug reactions

Brand

Generic: Mirtazapine

Reaction DROWSINESS, SOMNOLENCE, increase appetite = WEIGHT GAIN, dry mouth, constipation

Counseling: it is SEDATING so —> take at bedtime. Risk of QTc prolongation- increase risk of arrythmia (heart racing, pounding for not physical reasons)