Questions and Answers
Name the groups of antidepressants?
What is the mode of action of antidepressants?
Generally, they inhibit the reuptake of neurotransmitters such as serotonin, norepinephrine, and dopamine.
What do SSRIs inhibit?
SERT
Can you die from an overdose of SSRIs?
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Who is at high risk when using SSRIs?
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Which of the following are SSRIs?
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What is the drug of choice for teens with anorexia/bulimia within the SSRI group?
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What is the mechanism of action of SNRIs?
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Which drug is in the NDRI group?
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What are common side effects of NARI?
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What kind of antidepressant is Trazodone?
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What is the mechanism of action for Agomelatine?
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Which class of antidepressants does iMAO belong to?
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What is Esketamine used for?
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Study Notes
Groups of Antidepressants
- SSRI: Selective Serotonin Reuptake Inhibitors
- SNRI: Serotonin-Norepinephrine Reuptake Inhibitors
- NDRI: Norepinephrine-Dopamine Reuptake Inhibitors
- NARI: Norepinephrine Reuptake Inhibitors
- SARI: Serotonin Antagonist and Reuptake Inhibitors
- NASSA: Noradrenergic and Specific Serotonergic Antidepressants
- SMS: Serotonin Modulator and Stimulator
- TCA: Tricyclic Antidepressants
- iMAO: Irreversible Monoamine Oxidase Inhibitors
Mode of Action of Antidepressants
- Varies by class, generally involves modulation of neurotransmitters such as serotonin, norepinephrine, and dopamine
SSRIs Key Points
- Primarily inhibit SERT (serotonin transporter), with some action on NAT (norepinephrine transporter)
- Generally safe, overdose can be fatal but lower risk
- No significant interaction with alcohol
- Weight gain can occur, but not widespread
- High risk of suicidal thoughts in teenagers
- Possible drug-drug interactions with CYP2D6 and 3A4
- Adverse effects include gastrointestinal irritation, sexual dysfunction, and anhedonia
Common SSRIs
- Sertraline
- Fluoxetine
- Fluvoxamine
- Paroxetine
- Citalopram
- Escitalopram
Fluoxetine Details
- Antagonist of 5-HT2A and inhibits CYP2D6
- Weakest SERT inhibitor compared to other SSRIs
- Muscarinic effects lead to sedation
- Noted for its potential drug-drug interactions
Drug of Choice for Teens with Anorexia/Bulimia
- Fluoxetine is preferred due to its efficacy and safety profile
SNRIs Overview
- Mechanism includes 5-HT and norepinephrine blockage
- Side effects include insomnia, sexual impairment, appetite changes, and hypertension
- Common drugs in this group: Venlafaxine, desvenlafaxine, Duloxetine (also indicated for neuropathic pain)
NDRI Characteristics
- Minimal effect on serotonin systems
- Suitable for smoking cessation
- Associated risk of seizures, especially in anorexic patients
- Main mechanism increases serotonin leading to potential initial insomnia/anxiety
- Bupropion is the only drug in this category
NARI Insights
- Drugs include Reboxetine and Atomoxetine (used for ADHD)
- Mechanism blocks NAT with a ratio of SERT to NAT at 20:1
- Side effects encompass sexual dysfunction, constipation, insomnia, anxiety, and restlessness
Trazodone Profile
- Classified as SARI
- Inhibits SERT, agonizes 5-HT1A, and antagonizes H1, alpha-1 receptors
- Major side effects include hypotension and sedation
- Affected by CYP2D6 and CYP3A4 enzymes
- Indicated for various conditions including sexual disorders and insomnia
Mirazapine Overview
- Classified as NASSA
- Agonizes alpha-2, 5-HT2A/C, and 5-HT3 receptors
- Promotes weight gain and increased appetite
Vortioxetine Information
- Mechanism involves SERT inhibition, 5-HT1A agonism, and 5-HT3 antagonism
- Side effects include pruritus, nausea, and vivid dreams
- Substrate for CYP2D6, recommended for patients with depression and insomnia
- Enhances cognitive function without affecting sexual dysfunction
Agomelatine Details
- Mechanism involves MT1 and MT2 agonism and 5-HT2C antagonism
- Resynchronizes circadian rhythms by increasing melatonin release
- Substrate for CYP1A2, monitor for hepatotoxicity
- Single bedtime dose, unsuitable for alcoholics due to liver risk
TCA Mechanism and Effects
- Inhibits reuptake of serotonin, norepinephrine, and dopamine
- Clomipramine particularly affects serotonergic receptors
- Imipramine and desipramine impact adrenergic receptors
- Amitriptyline and Nortriptyline affect both serotonin and norepinephrine pathways
iMAO Characteristics
- Irreversible inhibition of monoamine oxidase enzymes
- Moclobemide specifically inhibits MAO-A
- Effects on neurotransmitters rank as 5-HT > NA > D
- Positive effects on cognition; caution with side effects including weight gain, hypotension, and CNS stimulation
- Antidote for hypertensive crisis is Phentolamine
Esketamine Overview
- NMDA antagonist that inhibits GABA interneurons
- Increases glutamate release, indicated for resistant depression in combination with other antidepressants
- Administered intranasally under supervision; careful monitoring of blood pressure is required
- Treatment phases include induction, optimization, and maintenance
Tianeptine Profile
- Functions as a reuptake enhancer
- Exhibits anti-craving effects in alcoholics
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Description
This quiz covers various groups of antidepressants, including SSRIs, SNRIs, and TCAs. It also explores their modes of action and key points, such as safety profiles and potential side effects. Test your knowledge about how these drugs interact with neurotransmitters and their implications for treatment.
