FINALS DRUGS

• TCAs (Tricyclic Antidepressants)


  • Iminodibenzyl Ring
  • First class antidepressants
• TCA Drugs


  • AMITRYPTILINE
  • NORTRYPTILINE
  • PROTRYPTILINE
  • DESIPRAMINE
  • IMIPRAMINE
  • CLOMIPRAMINE
  • LOFEPRAMINE
  • DOXEPIN
• TCA MOA


  • Block neuronal reuptake of NE and 5HT
  • All are equally effective in relieving depression, although some patients respond better to on drug than another
• TCA Side Effects


  • Antihistamine
  • Alpha-1 adrenoceptor blocker
  • Antimuscarinic
  • Acute poisoning (manifest as suicidal ideation)
  • Cardiac Arrhythmias
  • Weight Gain (most common)
  • Confusion, impaired memory and cognition
  • Lower the seizure threshold
• TeCAs (Tetracyclic Antidepressants) MOA


  • Block neuronal reuptake of NE and 5HT
  • Alternative for patients who are unresponsive to other antidepressants
• TeCAs Drugs


  • AMOXAPINE
  • QUETIAPINE
  • MIANSERIN
  • MIRTAZAPINE
• Mianserin


  • First 2nd generation
  • Lacks cardiotoxic and anticholinergic S/E
  • Sedative, postural hypotension, weight gain
  • Caused blood dyscrasias
• Mirtazapine


  Derivative of Mianserin that lacks blood dyscrasias as adverse effect
• NaSSA Drugs


  • MAPROTILINE
  • SETIPTILINE
• SSRIs (Selective Serotonin Reuptake Inhibitors)


  • Most widely used drugs for depression and certain anxiety disorder
  • As effective as TCAs (fewer autonomic side effects, and less sedation)
  • Safer than TCAs (less likely to cause arrhythmia and seizures)
• SSRI Drugs


  • FLUOXETINE
  • PAROXETINE
  • FLUVOXAMINE
  • SERTRALINE
  • CITALOPRAM
  • ESCITALOPRAM
  • VILAZODONE
  • VORTIOXETINE
• SSRI MOA


  Selectively block the neuronal reuptake of serotonin and have much less effect on the reuptake of NE
• SSRI Side Effects


  • N&V
  • Diarrhea/constipation
  • Tremor
  • Dizziness
  • Sexual Dysfunction
  • HA
• SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors) MOA


  • Block the neuronal reuptake of serotonin and norepinephrine
  • SNRIs tend to be favored over the TCAs in the treatment of MDD
• SNRI Drugs


  • DULOXETINE
  • VENLAFAXINE
  • DESVENLAFAXINE
  • MILNACIPRAN
• NaRIs (Norepinephrine Reuptake Inhibitors) MOA


  • Block the neuronal reuptake of Norepinephrine
  • Also indicated for ADHD
• NaRI Drugs


  • REBOXETINE
  • ATOMOXETINE
  • VILOXAZINE
• Unicyclic Antidepressants MOA


  • Block neuronal reuptake of NE & DA
  • Adjunct therapy for patients who are attempting to quit smoking cigarettes
• Unicyclic Antidepressant Drugs


  • BUPROPION
• MAOIs (Monoamine Oxidase Inhibitors) MOA


  • Inhibits MAO, thereby increasing biogenic amines
  • Have potentially serious interaction with other drugs and food, they are not considered DOC for the treatment of MDD (used as an alternative)
• MAOI Interactions


  • MAOIs + Tyramine – rich food
  • MAOIs + Adrenergic Drugs
  • MAOIs + Serotonergic Drugs
• MAO Substrates


  • MAO-A: NE, Epi, 5HT
  • MAO-B: DA, Tyramine
• MAOI Drugs


  • MOCLOBEMIDE (RIMA)
  • SELEGILINE (Parkinson Disease)
  • RASAFILINE (Irreversible Inhibitors of MAO-B)
  • TRANYLCYPROMINE, ISOCARBOXAZID, PHENELZINE (Non-selective MAOIs)
• 5HT RECEPTOR MODULATORS MOA


  • Mild inhibition of serotonin reuptake
  • Neither drug is effective for severely depressed people
  • Trazodone is strong sedative which can improve sleep of depressed patients
• 5HT Receptor Modulator Drugs


  • TRAZODONE
  • NEFAZODONE
• St. John's Wort


  • Isolated from Hypericum officinalis/perforatum
  • Contains HYPERICIN and FLAVONES
  • MOA: Inhibit MAO
  • Block neuronal reuptake of 5HT
  • Have fewer side effects than other antidepressants but are not as effective as prescription antidepressants
• Some potential adverse effects are common to all antidepressants, most of their adverse effects are specific to subclass of agents and to their pharmacodynamic effects
• FDA warning applied to all antidepressants is the risk of increased suicidality in patients younger than 25. Association with suicidal ideation and gestures but not completed suicide
• Antidepressants are CATEGORY C OR D (PREGNANCY)
• Indications of Antidepressants


  • MDD (SSRIs and SNRIs are preferred, other drug classes often are used as alternative and adjunct, may not achieve their maximum benefit for 1-2 months (8-12 weeks of therapy), Goal: Remission of all symptoms)
  • Anxiety Disorders (PTSD, OCD, Social Anxiety, GAD, PD) (SSRIs and SNRIs)
  • Pain Disorders (Neuralgia, Nerve Pain, Neuropathic) (TCAs)
  • PMDD (SSRIs) (Pre-menstrual Dysphoric Disorder)
  • Smoking Cessation (Bupropion)
  • Eating Disorders (Bulimia nervosa: Fluoxetine, Anorexia nervosa: reduced food intake morbid fear of gaining weight)