| MOA of SSRI | Selectively inhibit reuptake of serotonin, may also desensitize presynaptic serotonin receptors in a negative feedback loop that normally inhibits serotonin release// abrupt stopping may result into rebound depression |
| MOA of TCA | Inhibit reuptake of NE and serotonin, basically a more potent inhibitor of NE |
| Common side effects of TCA | Anti cholinergic, increase IOP, difficulty urinating, dry mouth and constipation |
| Which antidepressant class do you have to monitor levels and caution should be used in patients with heart disease or seizures and may impact QT intervals | TCA |
| Which antidepressant have the BBW of increased risk of suicidal thought and behavior in children, adolescent , and young adults | TCA’s BBW |
| MOA of SNRI | inhibits reuptake NE and serotonin, more potent inhibitor of serotonin (similar to TCA but less anti cholinergic) |
| Which class of antidepressants should you monitor patients blood pressure, it may take several weeks to see improvements and a sudden stop will lead to sudden significant worsening of mood, DO NOT use with MAOi or within 14 days of taking MAOi | SNRI |
| Facts for Venlafaxine (Effexor) | Dose dependent effect on BP, substrate (major) 206 and 3A4 and weak inhibitor for 2B6, 2D6, 3A4 |
| Facts for Desvenlafaxine | Active metabolite of Venlafaxine and more than 50 mg can confer little benefit |
| Facts for duloxetine (Cymbalta) | Can also be used for diabetic neuropathy and fibromyalgia, N/V, use caution with patients with gastroparesis |
| Common ADRs with duloxetine (Cymbalta) | Initial changes in BP, lowers seizure threshold, N/V, HA, xerostoma. And sexual dysfunction |
| Fact for Citalopram (Celexa) | Max dose of 20mg, racemic mixture, NOT approved for children and caution for hepatic impairment due to conc dependent QT prolongation |
| Facts for Escitalopram (Lexapro) | S enantiomer, avoid within 2 weeks of MAOi |
| Facts of fluoxetine (Prozac, sarafem) | Metabolized to Norfluoxetine, stop MAOi for 14 WEEKS!, or start MAOi 5 weeks after stopping fluoxetine, also used for fibromyalgia, panic disorder, PTSD, Reynauds phenomena, and social anxiety disorder |
| Which antidepressant is contraindicated with Thioridazine or primozide | Fluoxetine (Prozac, sarafem) |
| Facts for Paroxetine (Paxil) | One of the most sedating and anti cholinergic SSRI, WEIGHT GAIN, limit dose in hepatic impairment |
| Facts for Sertraline (Zoloft) | Reduce dose for liver impairment, may cause FALSE POSITIVE FOR BENZOS, safe for 6 years, more useful in the elderly |
| Fact of vilazodone (Viibryd) | Unique mechanism- partial 5HT1A agonist |
| Least likely to interact with CYP450 | Citalopram and Escitalopram |
| Well known inhibitors of CYP2D6 (antidepressants) | Fluoxetine and paroxetine |
