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Antidepressants
This document summarizes different types of antidepressant medications, including SSRIs, TCAs, SNRIs, mirtazapine, and reversible MAO inhibitors. It describes their mechanisms of action, indications, administration notes, side effects, drug interactions, cautions and contraindications. The key classes covered are SSRIs, which specifically block serotonin reuptake; TCAs, which block norepinephrine and serotonin reuptake and have anticholinergic effects; and SNRIs, which block reuptake of serotonin and norepinephrine. Common side effects across drug classes include gastrointestinal issues, weight changes, and sexual dysfunction.
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Antidepressants
- 1. Antidepressants K. Kavindya M.Fernando JMJ 1
- 2. Contents • SSRI • TCA •SNRI • Mirtazapine • Reboxetine • Reversible MAO inhibitors JMJ 2
- 3. Specific Serotonin Reuptake Inhibitors Citalopram,escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline JMJ 3
- 4. Action • Specifically blocksserotonin reuptake pump JMJ 4
- 5. Indications • Depressive illness •Generalized anxiety disorder • Panic disorder • Obsessive compulsive disorder • Social phobia • Post traumatic stress disorder JMJ 5
- 6. Notes on administration •Administrated as a single daily dose • Given in the morning • Start with minimal effective dose • Action takes 2-3 weeks • If response is inadequate after 2-3 weeks, increase dose • If symptoms persist after tx with maximum dose for 6 weeks • Consider another antidepressants • Lower doses in panic disorder JMJ 6
- 7. Side effects • Gastrointestinaleffects • Nause, vomiting • Dyspepsia • Constipation, diarrhoeas • Weight loss, weight gain • Increase risk of GI bleeding JMJ 7
- 8. Side effects • Seriousadverse effects • Seizures, • Hyponatremia (syndrome of inappropriate ADH secretion) • Increase suicidal risk in children and adolescents • Hypomania • Mania JMJ 8
- 9. Side effects • Others •Insomnia • Sedation • Drowsiness • Agitation • Anxiety • Drymouth, urinary retension • Erectile dysfunction • Delayed ejaculation • Hypersensitivity & rash JMJ 9
- 10. Management of sideeffects • Hypernatremia • Antidepressant induced hyponatremia (SIADH) • Elderly people are at higher risk • If features present check serum electrolytes immediately (dizziness, lethargy, seizures) • Hyponatremia occurs- stop antidepressants JMJ 10
- 11. Management of sideeffects • Hypernatremia • Serum Na >125mmol/l • Stop antidepressant • Monitor Na levels daily • Fluid restriction • Seum Na <125 mmol/l • Stop antidepressant • Admit to hospital • Initiate management JMJ 11
- 12. Caution • Bipolar disorder •Epilepsy • Cardiac disease • Hepatic impairment • Renal impairment • Pregnancy • Brest feeding JMJ 12
- 13. Drug interaction • Candisplace highly protein bound wafarine and thereby • increase risk of bleeding, • Increase risk of GI bleeding with NSAIDs • Serotonine syndrome with concurrent MAOI, tricyclics or when several SSRIs used together JMJ 13
- 14. Tricyclic Antidepressents Amitriptiline, clomipramine, doxepin,imipramine, lofepramine, nortriptyline Tricyclic related antidepressant – trazadone JMJ 14
- 15. Action • Blocks reuptakeof noradrenalin & serotonin • Side effects caused by • Blockage of alpha 1 adrenergic receptors • H1 histamine receptors • Muscarinic cholinergic receptors JMJ 15
- 16. Indications • Depressive illness •OCD (clomipramine) • Panic disorder • Nocturnal enuresis in children • Neuropathic pain • Prophylaxis of migraine JMJ 16
- 17. Notes on administration •Amitriptaline, imipramine, clomipramine • Dose range 75 -225mg • Single daily dose • Dose should be titrated to minimize side effects • Start with 25mg • Increase gradually over a few days to 75mg • Minimum effective dose 75-150mg JMJ 17
- 18. Notes on administration •Action takes 2-3 weeks • If response is inadequate after 2-3 weeks • Increase the dose • If symptoms persist after tx with maximum effective dose for 6 weeks • Consider change to another rantidepressent JMJ 18
- 19. Side effects • Anticholinergiceffects • Dry mouth • Blurred vision • Urinary retention • Constipation • Antiadrenergic effects • Postural hypotension • Ejaculatory delay JMJ 19
- 20. Side effects • Cardiovascularside effects • Potural hypotension • Tachycardia • Arrhythmias • Sudden death • Others • Drowsiness, dizziness, seizure, • Tremors, weight gain, hyponatremia • Hypomania, mania JMJ 20
- 21.
- 22. Action • Blocks serotoninreuptake pump & norepinephrine reuptake pump • Unlike tricyclics, they do not block • alpha 1 adrenergic receptors, • H1 histamine receptors • Muscuranic cholinergic receptors JMJ 22
- 23. Indications • Depressive illness •Generalized anxiety disorder • Panic disorder • OCD • Duloxetine – used in diabetic neuropathy JMJ 23
- 24. Notes on administration •Venalaflexin • 75-225mg (extended release) • 75-375mg (normal relase) • Given as bd dose • Dosage over 300mg should be given under observation JMJ 24
- 25. Side effects • Gastrointestinaleffects • Nause, vomiting • Dyspepsia • Constipation, diarrhoeas • Cardiovascular • Hypertension • QT prolongation • Reports death sue to cardiotoxicity in overdose JMJ 25
- 26. Side effects • Seriousadverse effects • Hyponatremia (syndrome of inappropriate ADH secretion) • Increase suicidal risk in children and adolescents • Hypomania • Mania • Weight loss, weight gain JMJ 26
- 27. Side effects • Others •Drowsiness • Agitation • Anxiety • Drymouth, urinary retension • Sexual dysfunction • Seizure • Hypersensitivity & rash JMJ 27
- 28. Caution • Bipolar disorder •Epilepsy • Hypertension • Cardiac disease • Hepatic impairment • Renal impairment • Pregnancy • Breast feeding JMJ 28
- 29. Contraindication • Cardiac arrhythmias •Pregnancy JMJ 29
- 30. Drug interactions • Serotoninsyndrome with MAO inhibitors • Increased risk of bleeding with warfarin & NSAIDs JMJ 30
- 31.
- 32. Action • Noradrenergic andspecific serotonergic antidepressant JMJ 32
- 33. Indications • Depressive disorder •Generalized anxiety disorder • Panic disorder JMJ 33
- 34. Dosage and sideeffects • 15-45mg • Side effects similar to SSRI • Sexual dysfunction is rare JMJ 34
- 35.
- 36. Action • Reversibly blocksMAO-A • Indicated in depressive disorder JMJ 36
- 37. Precautions • Reversible MAOIinteract less with food containing thiamine • But patients should avoid • Cheese, • Yeast extract • Fermented soy bean products JMJ 37
- 38. Contraindications • Hepatic impairment •Pregnancy • Breast feeding JMJ 38
- 39.