Depression drugs

Fluoxetine

Longest half life

activating

Sertraline

Preferred for elderly/post MI

Escitalopram

MDD kids 12+

generally well tolerated

Citalopram

Qtc prolongation

Not for use in patients with hx of qtc prolongation

Fluvoxamine

Not approved for depression

paroxetine

Not approved for use in kids

Not for use in pregnancy

antocholinergic + s3xual side effects

venlafaxine

2d6 inhibitor

dose related HTN

desvenlafaxine

better for patients already on other antidepressants

Duloxetine

Dose related nausea

increase in liver function tests

levomilnacipran

highest norepinephrine reuptake inhibition

esketamine

nasal spray iwht quick reduction of symptoms

addiciton or abuse potential

Suicide risk

REMS

Tricyclics names

amitryptyline

desimpramine

nortriptyline

imipramine

Tricyclics effects

Associated with cardiotoxicity and seizures in overdose

Manyu drug interactions

MAOI inhibitors info

Many side effects

diet restrictions

bupropion

Not for use in pts with EDs or hx of seizure disorders

Positive sexual affects

mirtazapine

Low dose more sedating

weight gain/appetite increase

trazodone

sleep aid

aripiprazole

antipsychotic, adjunct

Response

50% decrease in sx

Remission

Reduction in Ham-D score to <7 or PHQ-9 <5

Relapse

Symptoms return before recovery

Recurrence

Symptoms return after 2 months of recovery

Risk of recurrence after 1 episode

50%

Risk of recurrence after 2 episodes

70%

Risk of recurrence after 3 episodes

90%

SIG E CAPS

Sleep

Interest changes

Guilt

Energy decrease

Concentration decrease

Appetite changes

Psychomotor retardation

Suicidal ideation

Clomipramine

OCD

Buspar/Buspirone

Must be scheduled, anxiety

Benzodiazepines

GABA agonists, PRN, last resort

How long should Benzodiazepines be prescribed?

2-4 weeks

Pregabalin

calm down overactive nerve signals by inhibiting NTs + decrease calcium at nerve terminals

Hydroxyzine

Antihistamine with sedating effects, prn, breakthrough anxiety.

Hydroxyzine side effects

anti-cholinergic

Anti-hypertensives (Propranolol)

Performance anxiety, beta blocker, off label

Prazosin

Off label, PTSD nightmares

Best GAD meds?

DEVP- duloxetine, escitalopram, venlafaxine, pregabalin

Best tx for Social anxiety?

Sertraline or escitalopram

Panic disorders 1st line TX

SSRI/SNRI

PTSD 1st line tx?

SSRI/SNRI

What is not recommended for PTSD?

Benzos, antipsychotics

OCT tx

High dose SSRIs

eszopiclone + zolpidem

z hypnotics, GABA agonist, sleep related behaviors

suvorexant

dual orexin receptor antagonist, blocks wake promoting signals

modafinil/armodafinil

inhibit dopamine reuptake