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Pharmacotherapy (Antidepressants (Information about Antidepressants…

- - - - blocks the enzyme monoamine oxidase
        
        breaks down serotonin and norephinephrine in the brain
    - - nausea, diarrhea, constipation, weight gain
      - dry mouth, headache, dizziness, muscle cramps
      - sedation, insomnia, parathesias, hypotension
  - - - block the reuptake of serotonin and norephinephrine
    - - constipation, dry mouth, sexual dysfunction
      - blurred vision, tachycardia and cardiotoxicity
      - sedation, weight gain, tremor
      - dizziness, confusion in the elderly
      - beneficacious, but the side effect profile limits tolerability
  - - - currently the most widely prescribed antidepressant, and also first-line treatment for anxiety disorders, including GAD, panic disorder, OCD, social anxiety, PTSD
      - E.g. Prozac, Zoloft, Paxil, Celexa, Lexapro, Luvox
    - - blocks the reuptake of serotonin
    - - GI upset, weight gain, sexual dysfunction, increased body temperature
      - apathy, agitation, sedation, insomnia
    - - Mechanism of Action
        
        blocks the reuptake of both serotonin and norephinephrine but with fewer side effects than TCAs
      - Common side effects
        
        agitation, hypertension, insomnia
        
        increased body temperature, sweating, dizziness, nausea
      - SNRI's good for patients whose depressive symptoms of symptoms of inertia, low energy, low motivation
        not helpful when high anxiety present
  - - - wellbutrin is potentially helpful to reduce dysfunction, potentially useful in ADHD, contraindicated in patients with epilepsy and seizures
      - only antidepressant considered safe in patients with bipolar disorder
      - norephinephrine and dopamine reuptake inhibitor
      - Side Effects:
        
        agitation, anxiety, HTN, increase risk of seizure
    - - Side Effects:
        
        sedation, increased appetite and weight gain, constipation, dry mouth
      - antagonist of adrenergic and serotonin receptors, antihistiminergic
    - - acts as a serotonin antagonist and reuptake inhibitor
      - Side effects:
        
        prolonged QT interval, sedation, orthostatic hypotension, used mostly for insomnia
      - good choice for daytime agitation/sundowning in elderly/dementia
    - - acts as serotonin reuptake inhibitor AND 5-HT1A agonist
      - Side effects:
        
        nausea, dry mouth, dizziness, insomnia, headachers
      - most be taken with food for adequate absorption and bioavailability
      - minimal sexual dysfunction compare to most other antidepressants
    - - inhibits serotonin reuptake, antagonizes HT3 receptors, agonized 5HT1A receptors
      - Side effects:
        
        nausea, diarrhea, dry mouth, constipation, dizziness, sexual dysfunction
      - may be very efficacious but due to its affinity for multiple serotonin receptors there may may be risk of serotonin syndrome
- - - - Reduces excitatory dopamine and glutamate transmission
      - increases inhibitory GABA transmission
      - appears to increase the volume of brain structures involved in emotional regulation including the pre-frontal cortex, hippocampus, and amygdala
    - - hand tremor, N/V, weight gain, hair loss, hypothyroidism
    - - N/V/D, ataxia, muscle weakness
      - polyuria/polydipsia, tremor, drowsiness
      - confusion, blurred vision, seizure, coma
    - - gold standard of rx in Bipolar disorder, beneficial for suicidal thoughts
      - requires on-going monitoring of serum lithium level (therapeutic range 0.6-1.2 mEq/L),
      - patients should have a baseline EKG before initiating treatment
  - - - have been found to be effective in regulation of mood seen in bipolar disorder
      - used when patients cannot tolerate Lithium and/or its side effects
      - make nerve cells in the brain less excitable
    - - requires serum monitoring (therapeutic level 50-100 mEq/L)
      - good for acute mania, less efficacious for depressed mood in bipolar disorder
      - Side effects: sedation, weight gain, GI upset
    - - good for bipolar depression; starter packs for "starting low and going slow"
      - well tolerated but takes 5 weeks to reach therapeutic level
    - - many off-label uses including mood regulation, anxiety, sleep and fibromyalgia
      - potential for cognitive impairment
  - - - Mechanisms of action: post-synpatic blockage of brain dopamine D2 receptors in cortical and striatal areas
      - Dvided into:
        
        High potency
        
        Trilafon, Haldol, Stelazine
        
        less sedation, weight gain and anticholinergic effects but higher risk of EPS
        
        Low Potency
        
        Thorazine, Mellaril
        
        more sedation, weight gain, and anticholinergic effects but lower risk of EPS
      - Side effects: dry mouth, weight gain, pancreatitis, QTC prolongation, risk of cardiac event
    - - serotonin-dopamine antagonists
      - fewer neuromuscular side effects, treat both positive and negative symptoms
      - E.g. abilify, seroquel, Zyprexa, Clozapine
        
        Abilify and Clozapine have improved fuctional capacity for many chronically patients with improvement in cognition, energy, and a reduction in negative sx
- - - - CIWA-B scale