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antidepressants and mood stabilizers (antidepressant mechanism (MAOIs…
antidepressants and mood stabilizers
depression
characterized by intense feelings of sadness and despair
some patients become depressed for no apparent reason
neurochemical balance may play a role, want to ensure there is the "right" mix of NTs, key corner stone of pharmacological theory
antidepressant mechanism
MAOIs
most dangerous, rarely used
phenelzine
monoamine oxidase is an enzyme that helps remove released transmitters through enzymatic destruction
inhibiting this enzyme means more NTs in the synapse
last line drug therapy
can have deadly interaction with food containing tyramine which leads to excessive build up of Epi and Norepi NT
TCAs
more side effects due to lack of selectivity
amitriptyline, nortriptyline
older drug class
less specific, more side effects than SSRI/SNRI, lots of sedation,anticholinergic side effects,can cause fatal arrhythmias in cases of overdose
SSRI and SNRI
selective serotonin reuptake inhibitors
less sedative less potential for cardiovascular effects and less anticholinergic effects
watch for sweating, restless, rapid HR, shivering
very rare: can be fatal
first line therapy, well tolerated
fluoxetine,citalopram,
serotonin-norepinephrine reuptake inhibitors
similar side effects as SSRIs
some patient don't notice a difference between agents, others finally get effect after a switch
duloxetine,venlafaxine
other antidepressants
bupropion
dopamine, NorEpi and Epi reuptake inhibitor
smoking cessation
trazodone
blocks serotonin receptors and inhibits reuptake
often used for sleep
bipolar disorder
cycling between depression and mania
cornerstone mood stabilizer is lituim
lithium is a cation
thought to "help prevent neuronal degeneration and sustain neuronal function
lithium toxicity
it is not metabolized, it can build up in the body , especially when renal function is decreased, patients taking lithium generally have blood monitoring to ensure safe effective doses
minor
fine hand tremor, weakness, nausea, polyuria,polydipsia
major
confusion, seizures, vomiting, diarrhea,syncope,bradycardia,renal damage
some patients may also be on atypical antipsychotics or anticonvulsants
remember to ask why they are taking a drug