Antidepressants Study Notes

Depression Overview

  • Symptoms: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor activity, Suicide (SIGECAPS)

  • Major Criteria: Depressed mood & loss of interest most days for 2+ weeks.

Treatment Approaches

Pharmacologic Treatment

  • Goal: Increase neurotransmitter levels (serotonin, norepinephrine, dopamine).

Nonpharmacologic Therapy

  • Psychotherapy: Cognitive Behavioral Therapy (CBT), Interpersonal therapy.

  • Somatic therapies: Electroconvulsive therapy, Transcranial Magnetic Stimulation.

Neurotransmitters

  • Inhibitory: GABA, Acetylcholine

  • Excitatory: Serotonin, Dopamine, Norepinephrine, Glutamate

Mechanism of Action (MOA) of Antidepressants

  • Prevent reuptake of neurotransmitters to increase CNS synapse levels.

  • MAOIs inhibit monoamine oxidase, raising neurotransmitter availability.

General Concepts

  • Initial responses typically 1-3 weeks; maximize in 12 weeks.

  • Boxed Warning: Increased risk of suicide, especially in younger adults.

Classes of Antidepressants

  1. MAOIs - e.g., Phenelzine, Tranylcypromine.

    • AE: Drug interactions, hypertensive crisis with tyramine-rich foods.

  2. TCAs - e.g., Amitriptyline.

    • AE: Sedation, orthostatic hypotension, overdose risk.

  3. SSRIs - e.g., Fluoxetine, Sertraline.

    • AE: Sexual dysfunction, nausea, discontinuation syndrome.

  4. SNRIs - e.g., Venlafaxine.

    • AE: Hypertension, withdrawal symptoms.

  5. Atypical Antidepressants - e.g., Bupropion, Trazodone.

    • Effects: Varies, bupropion aids in sexual dysfunction and is weight-neutral.

Key Points on SSRIs

  • Advantages: Used for a variety of disorders, fewer cardiac issues.

  • Disadvantages: May not aid in pain, risk of drug interactions.

  • Discontinuation requires tapering to avoid withdrawal symptoms.

  • Monitor for risk of serotonin syndrome and suicidal ideation.