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Antidepressants

Antidepressants. Amanda Kelly, Pharm. D. St. Luke’s Pharmacy Practice Resident. Classifications. Selective serotonin reuptake inhibitors Serotonin and norepinephrine reuptake inhibitors Bupropion Tricyclics Mirtazapine Monoamine oxidase inhibitors Trazodone. SSRIs - Drugs.

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Antidepressants

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  1. Antidepressants Amanda Kelly, Pharm. D. St. Luke’s Pharmacy Practice Resident

  2. Classifications • Selective serotonin reuptake inhibitors • Serotonin and norepinephrine reuptake inhibitors • Bupropion • Tricyclics • Mirtazapine • Monoamine oxidase inhibitors • Trazodone

  3. SSRIs - Drugs • Prozac (fluoxetine) • Paxil (paroxetine) • Zoloft (sertraline) • Celexa (citalopram) • Lexapro (escitalopram) • Luvox (fluvoxamine)

  4. SSRIs - Other indications • PTSD • OCD • PMDD • Eating disorders • Anxiety • Alcoholism • IBS • Stuttering • Diabetic neuropathy • Hot flashes • Migraine prophylaxis

  5. SNRIs - Drugs • Pristiq (desvenlafaxine) • Effexor (venlafaxine) • Cymbalta (duloxitine) 

  6. SNRIs – Other Indications • Pain • Fibromyalgia  • Neuropathy • Hot flashes • Anxiety

  7. SSRI and SNRI Adverse Effects • Dizziness • Headache • Insomnia • Somnolence • Increased sweating • Dry mouth • Shortness of breath • Diarrhea • Nausea

  8. Bupropion • Wellbutrin • Mechanism not well understood • Smoking cessation  • Avoid in seizures and with alcohol • Headache, insomnia, dry mouth, nausea

  9. Tricyclics • Amitriptyline • Desipramine • Doxepin • Imipramine • Nortriptyline • Protriptyline • Trimipramine

  10. Tricyclics • Fibromyalgias • Many off-label indications • Reuptake inhibition • Seizures, sexual dysfunction, dry mouth, urinary retention, sleepiness, weight gain, photosensitivity, arrhythmias

  11. Mirtazapine • Remeron • Potentiates neurotransmitters • Sedative • Increased appetite/weight gain

  12. Trazodone • Desyrel • Insomnia • Potentiate 5-HT • QTc prolongation • Dizziness, sleepiness, confusion, blood pressure, nervousness, dry mouth

  13. MAOIs • Isocarboxazid • Phenelzine • Tranylcypromine

  14. MAOIs • Not first choice • Interactions • MAO • 2 weeks • HTN crisis

  15. Serotonin Syndrome • Interaction:  • SSRIs, SNRIs, triptans, MAOIs, meperidine, dextromethorphan, linezolid • Requires medical attention

  16. Serotonin Syndrome Signs/Symptoms • Fever/chills • Palpitations • Mental changes • Diarrhea • Nausea/vomiting • Spasms/tremors • Seizures

  17. Serotonin Syndrome - Treatment • Benzodiazepines • Cyproheptadine • IV fluids • Stop offending drug

  18. Antidepressant Withdrawal • Irritability • Anxiety • Insomnia • Headaches • Dizziness • Fatigue • Nausea • Return of depression symptoms

  19. Antidepressants • Suicide black box • Serotonin syndrome • Withdrawals • Slow to work

  20. Questions?

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