Podcast
Questions and Answers
Which SSRI is noted for potentially suppressing nitric oxide synthase at higher doses?
Which SSRI is noted for potentially suppressing nitric oxide synthase at higher doses?
- Fluoxetine
- Paroxetine (correct)
- Sertraline
- Vortioxetine
Which formulation of paroxetine is designed to minimize gastrointestinal side effects?
Which formulation of paroxetine is designed to minimize gastrointestinal side effects?
- Oral Concentrate Solution
- Controlled Release (CR) (correct)
- Immediate Release
- Suspension
A patient reports experiencing nausea and diarrhea after starting an SSRI. Which of the following medications is MOST likely the cause, based solely on its common side effects?
A patient reports experiencing nausea and diarrhea after starting an SSRI. Which of the following medications is MOST likely the cause, based solely on its common side effects?
- Sertraline (correct)
- Lithium
- Amitriptyline
- Haloperidol
Which SSRI is also available as an oral concentrate solution?
Which SSRI is also available as an oral concentrate solution?
A clinician is considering prescribing an antidepressant that acts as an SSRI and also has agonist activity at the 5-HT1A receptor. Which of the following medications fits this profile?
A clinician is considering prescribing an antidepressant that acts as an SSRI and also has agonist activity at the 5-HT1A receptor. Which of the following medications fits this profile?
Which medication's multimodal mechanism of action is thought to confer potential cognitive benefits for some patients?
Which medication's multimodal mechanism of action is thought to confer potential cognitive benefits for some patients?
Which of the following is a contraindication for venlafaxine?
Which of the following is a contraindication for venlafaxine?
At lower doses, venlafaxine primarily affects which neurotransmitter system?
At lower doses, venlafaxine primarily affects which neurotransmitter system?
Which of the following side effects is most closely associated with higher doses of venlafaxine, differentiating it from typical SSRI side effect profiles?
Which of the following side effects is most closely associated with higher doses of venlafaxine, differentiating it from typical SSRI side effect profiles?
A patient taking an antidepressant is experiencing significant nausea, sexual dysfunction, and insomnia. If sertraline and vortioxetine are known to have these side effects, what differentiates them based on their mechanisms of action?
A patient taking an antidepressant is experiencing significant nausea, sexual dysfunction, and insomnia. If sertraline and vortioxetine are known to have these side effects, what differentiates them based on their mechanisms of action?
Which of the following best describes the primary mechanism of action shared by all listed SSRIs?
Which of the following best describes the primary mechanism of action shared by all listed SSRIs?
A patient reports experiencing dry mouth and constipation after starting an SSRI. Which of the following is the MOST likely cause?
A patient reports experiencing dry mouth and constipation after starting an SSRI. Which of the following is the MOST likely cause?
Which SSRI has a once-weekly formulation?
Which SSRI has a once-weekly formulation?
A patient is being switched from fluoxetine to a monoamine oxidase inhibitor (MAOI). What is the recommended minimum washout period before starting the MAOI?
A patient is being switched from fluoxetine to a monoamine oxidase inhibitor (MAOI). What is the recommended minimum washout period before starting the MAOI?
Which of the following SSRIs is MOST commonly used for obsessive-compulsive disorder (OCD) and social anxiety disorder?
Which of the following SSRIs is MOST commonly used for obsessive-compulsive disorder (OCD) and social anxiety disorder?
Which SSRI is available under the brand name Serafem?
Which SSRI is available under the brand name Serafem?
Which SSRI is associated with QTc prolongation at higher doses, necessitating caution and a maximum recommended daily dose?
Which SSRI is associated with QTc prolongation at higher doses, necessitating caution and a maximum recommended daily dose?
Which SSRI is considered the most 'activating,' potentially leading to insomnia in some patients?
Which SSRI is considered the most 'activating,' potentially leading to insomnia in some patients?
A patient abruptly discontinues paroxetine after several months of treatment. Which of the following is the MOST likely reason for experiencing significant withdrawal symptoms compared to other SSRIs?
A patient abruptly discontinues paroxetine after several months of treatment. Which of the following is the MOST likely reason for experiencing significant withdrawal symptoms compared to other SSRIs?
Which of the following statements about enantiomers of SSRIs is true?
Which of the following statements about enantiomers of SSRIs is true?
Which of the following SSRIs is available in a controlled-release formulation?
Which of the following SSRIs is available in a controlled-release formulation?
A patient with PMDD may be prescribed which brand name of fluoxetine?
A patient with PMDD may be prescribed which brand name of fluoxetine?
Which SSRI is most likely to cause significant withdrawal symptoms upon abrupt discontinuation due to its short half-life?
Which SSRI is most likely to cause significant withdrawal symptoms upon abrupt discontinuation due to its short half-life?
Which SSRI is primarily used for obsessive-compulsive disorder (OCD) and social anxiety disorder, and is not typically used for major depressive disorder (MDD) in the U.S.?
Which SSRI is primarily used for obsessive-compulsive disorder (OCD) and social anxiety disorder, and is not typically used for major depressive disorder (MDD) in the U.S.?
Which of the following side effects is most associated with paroxetine compared to other SSRIs?
Which of the following side effects is most associated with paroxetine compared to other SSRIs?
Which SSRI requires a 5-week washout period when switching to or from a monoamine oxidase inhibitor (MAOI)?
Which SSRI requires a 5-week washout period when switching to or from a monoamine oxidase inhibitor (MAOI)?
Which SSRI, when administered at doses exceeding 40 mg/day, poses an elevated risk of QTc prolongation?
Which SSRI, when administered at doses exceeding 40 mg/day, poses an elevated risk of QTc prolongation?
How does the mechanism of action of escitalopram differ from that of citalopram?
How does the mechanism of action of escitalopram differ from that of citalopram?
Which statement accurately describes the relative likelihood of insomnia as a side effect among the listed SSRIs?
Which statement accurately describes the relative likelihood of insomnia as a side effect among the listed SSRIs?
A cytochrome P450 (CYP450) inhibition profile for an SSRI reveals significant inhibition of CYP2D6. This characteristic would be most relevant when considering potential drug interactions with which of the following?
A cytochrome P450 (CYP450) inhibition profile for an SSRI reveals significant inhibition of CYP2D6. This characteristic would be most relevant when considering potential drug interactions with which of the following?
Which of the following SSRIs is known for its relatively high anticholinergic activity?
Which of the following SSRIs is known for its relatively high anticholinergic activity?
Which of the following is an important consideration when prescribing venlafaxine, particularly at higher dosages?
Which of the following is an important consideration when prescribing venlafaxine, particularly at higher dosages?
A patient experiences significant nausea and diarrhea after starting an antidepressant. If sertraline and vortioxetine are known to cause these side effects, which of the following differentiates them based on their mechanisms of action?
A patient experiences significant nausea and diarrhea after starting an antidepressant. If sertraline and vortioxetine are known to cause these side effects, which of the following differentiates them based on their mechanisms of action?
Which antidepressant has a mechanism of action that includes both serotonin reuptake inhibition and direct agonism of the 5-HT1A receptor?
Which antidepressant has a mechanism of action that includes both serotonin reuptake inhibition and direct agonism of the 5-HT1A receptor?
What is a key consideration to keep in mind while prescribing sertraline?
What is a key consideration to keep in mind while prescribing sertraline?
Which of the following antidepressants is LEAST likely to cause a significant increase in blood pressure, even at higher doses?
Which of the following antidepressants is LEAST likely to cause a significant increase in blood pressure, even at higher doses?
Which antidepressant is most likely to be considered as a first-line treatment option because of its balanced side effect profile?
Which antidepressant is most likely to be considered as a first-line treatment option because of its balanced side effect profile?
Which of the following side effects is most associated with venlafaxine?
Which of the following side effects is most associated with venlafaxine?
Which antidepressant's prescribing information specifically advises caution in patients with uncontrolled hypertension due to its potential to increase blood pressure?
Which antidepressant's prescribing information specifically advises caution in patients with uncontrolled hypertension due to its potential to increase blood pressure?
A patient on venlafaxine develops a blood pressure of 160/100 mmHg. What is the MOST appropriate initial step?
A patient on venlafaxine develops a blood pressure of 160/100 mmHg. What is the MOST appropriate initial step?
Which of the following antidepressants is available in both immediate-release and extended-release formulations, potentially affecting its dosing schedule and side effect profile?
Which of the following antidepressants is available in both immediate-release and extended-release formulations, potentially affecting its dosing schedule and side effect profile?
A patient is currently taking an antidepressant that inhibits both serotonin and norepinephrine reuptake. To what class of medications does this antidepressant belong?
A patient is currently taking an antidepressant that inhibits both serotonin and norepinephrine reuptake. To what class of medications does this antidepressant belong?
Considering the listed medications, which of the following requires monitoring of blood pressure, especially at higher doses, due to its pharmacological action?
Considering the listed medications, which of the following requires monitoring of blood pressure, especially at higher doses, due to its pharmacological action?
A clinician is looking for an antidepressant option that has a multimodal mechanism including 5-HT modulation but is NOT classified as either an SSRI or SNRI. Which of the following would be the MOST appropriate choice?
A clinician is looking for an antidepressant option that has a multimodal mechanism including 5-HT modulation but is NOT classified as either an SSRI or SNRI. Which of the following would be the MOST appropriate choice?
Which of the following medications comes in a transdermal form?
Which of the following medications comes in a transdermal form?
A patient who is CYP2D6 poor metabolizer is prescribed a moderate dose of desvenlafaxine. Which of the following outcomes is MOST likely?
A patient who is CYP2D6 poor metabolizer is prescribed a moderate dose of desvenlafaxine. Which of the following outcomes is MOST likely?
A patient on tranylcypromine starts taking an herbal supplement containing tyramine. Which of the following physiological responses is MOST likely to occur?
A patient on tranylcypromine starts taking an herbal supplement containing tyramine. Which of the following physiological responses is MOST likely to occur?
Which of the following strategies is MOST appropriate to mitigate the risk of serotonin syndrome when switching from fluoxetine to tranylcypromine?
Which of the following strategies is MOST appropriate to mitigate the risk of serotonin syndrome when switching from fluoxetine to tranylcypromine?
A patient is started on phenelzine for treatment-resistant depression. What dietary modification is MOST crucial to educate the patient about?
A patient is started on phenelzine for treatment-resistant depression. What dietary modification is MOST crucial to educate the patient about?
A patient is being treated with levomilnacipran. Which of the following pre-existing conditions would warrant the MOST caution when prescribing this medication?
A patient is being treated with levomilnacipran. Which of the following pre-existing conditions would warrant the MOST caution when prescribing this medication?
A patient taking an antidepressant is scheduled for elective surgery requiring anesthesia. Which antidepressant poses the GREATEST risk of interaction with anesthetic agents, potentially leading to cardiovascular instability?
A patient taking an antidepressant is scheduled for elective surgery requiring anesthesia. Which antidepressant poses the GREATEST risk of interaction with anesthetic agents, potentially leading to cardiovascular instability?
Which of the following best explains why trazodone is often prescribed at lower doses for insomnia compared to its antidepressant dosages?
Which of the following best explains why trazodone is often prescribed at lower doses for insomnia compared to its antidepressant dosages?
A patient on mirtazapine reports significant weight gain and daytime sedation. Which of the following strategies is the MOST appropriate initial step?
A patient on mirtazapine reports significant weight gain and daytime sedation. Which of the following strategies is the MOST appropriate initial step?
A patient with depression and comorbid neuropathic pain might benefit MOST from which of the following antidepressants?
A patient with depression and comorbid neuropathic pain might benefit MOST from which of the following antidepressants?
A patient presents with depressive symptoms and significant fatigue. After ruling out medical causes, which antidepressant would be the LEAST likely choice due to its potential to exacerbate fatigue?
A patient presents with depressive symptoms and significant fatigue. After ruling out medical causes, which antidepressant would be the LEAST likely choice due to its potential to exacerbate fatigue?
Flashcards
SSRIs: Mechanism
SSRIs: Mechanism
Selectively inhibit presynaptic reuptake of serotonin (5-HT), increasing serotonin levels in the synaptic cleft.
Citalopram (Celexa®): Side Effects
Citalopram (Celexa®): Side Effects
Nausea, sexual dysfunction, potential sedation or insomnia, initial anxiety increase, QTc prolongation risk.
Escitalopram (Lexapro®)
Escitalopram (Lexapro®)
Selectively inhibits presynaptic serotonin reuptake; S-enantiomer only.
Escitalopram (Lexapro®): Side Effects
Escitalopram (Lexapro®): Side Effects
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Fluoxetine (Prozac®): Side Effects
Fluoxetine (Prozac®): Side Effects
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Fluoxetine (Prozac®): Half-life
Fluoxetine (Prozac®): Half-life
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Fluvoxamine (Luvox®): Side Effects
Fluvoxamine (Luvox®): Side Effects
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Fluvoxamine (Luvox®): Uses
Fluvoxamine (Luvox®): Uses
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Paroxetine (Paxil®): Side Effects
Paroxetine (Paxil®): Side Effects
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Paroxetine (Paxil®): Discontinuation
Paroxetine (Paxil®): Discontinuation
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Paroxetine's Key Traits
Paroxetine's Key Traits
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Sertraline's Action
Sertraline's Action
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Sertraline's Side Effects
Sertraline's Side Effects
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Vortioxetine's Mechanism
Vortioxetine's Mechanism
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Vortioxetine's Side Effects
Vortioxetine's Side Effects
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Venlafaxine's Action
Venlafaxine's Action
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Venlafaxine's Side Effects
Venlafaxine's Side Effects
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Venlafaxine Contraindication
Venlafaxine Contraindication
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Paroxetine CR benefit
Paroxetine CR benefit
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Sertraline's Usage
Sertraline's Usage
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Sertraline's (Zoloft®) Action
Sertraline's (Zoloft®) Action
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Vortioxetine (Trintellix®) Mechanism
Vortioxetine (Trintellix®) Mechanism
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Vortioxetine's Benefit
Vortioxetine's Benefit
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Venlafaxine's (Effexor®) Action
Venlafaxine's (Effexor®) Action
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Vortioxetine's (Trintellix®) Side Effects
Vortioxetine's (Trintellix®) Side Effects
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Sertraline Contraindication
Sertraline Contraindication
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Venlafaxine's (Effexor ®) Side Effects
Venlafaxine's (Effexor ®) Side Effects
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Vortioxetine Contraindication
Vortioxetine Contraindication
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Citalopram (Celexa®): Action
Citalopram (Celexa®): Action
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Venlafaxine Dosage Effect
Venlafaxine Dosage Effect
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Citalopram (Celexa®): Contraindication
Citalopram (Celexa®): Contraindication
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Escitalopram (Lexapro®): Action
Escitalopram (Lexapro®): Action
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Escitalopram (Lexapro®): Contraindication
Escitalopram (Lexapro®): Contraindication
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Fluoxetine (Prozac®): Action
Fluoxetine (Prozac®): Action
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Fluoxetine (Prozac®): Contraindication
Fluoxetine (Prozac®): Contraindication
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Fluvoxamine (Luvox®): Action
Fluvoxamine (Luvox®): Action
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Fluvoxamine (Luvox®): Contraindication
Fluvoxamine (Luvox®): Contraindication
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Paroxetine (Paxil®): Action
Paroxetine (Paxil®): Action
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Paroxetine (Paxil®): Contraindication
Paroxetine (Paxil®): Contraindication
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TCAs: Mechanism
TCAs: Mechanism
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MAOIs: Mechanism
MAOIs: Mechanism
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Bupropion: Class
Bupropion: Class
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Mirtazapine: Action
Mirtazapine: Action
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Venlafaxine (Effexor®)
Venlafaxine (Effexor®)
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Bupropion (Wellbutrin®)
Bupropion (Wellbutrin®)
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Mirtazapine (Remeron®)
Mirtazapine (Remeron®)
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Amitriptyline (Elavil®)
Amitriptyline (Elavil®)
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Nortriptyline (Pamelor®)
Nortriptyline (Pamelor®)
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Maprotiline (Ludiomil®)
Maprotiline (Ludiomil®)
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MAOIs: Dietary restriction
MAOIs: Dietary restriction
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Study Notes
- Selective Serotonin Reuptake Inhibitors (SSRIs) increase serotonin levels in the synaptic cleft by selectively inhibiting presynaptic reuptake of serotonin (5-HT).
Citalopram (Celexa®)
- Selectively inhibits presynaptic reuptake of serotonin (5-HT).
- Increases serotonin levels in the synaptic cleft.
- Key side effects include nausea, sexual dysfunction, potential sedation or insomnia, an initial increase in anxiety, and risk of QTc prolongation at doses greater than 40 mg/day.
- Should not be taken by individuals with known hypersensitivity.
- A maximum daily dose of 40 mg is advised to reduce QT prolongation risk.
- Typically, the maximum recommended daily dose is 40 mg/day to reduce QT prolongation risk.
Escitalopram (Lexapro®)
- Selectively inhibits presynaptic serotonin reuptake.
- Consists only of the S-enantiomer (enantiomerically pure).
- Key side effects are nausea, insomnia or sedation, headache, and sexual dysfunction.
- Should not be taken by individuals with known hypersensitivity.
- Thought to have a slightly better side effect profile than citalopram.
- Similar to citalopram but consists only of the S-enantiomer (making it enantiomerically pure).
Fluoxetine (Prozac®, Prozac Weekly®, Serafem®, Selfemra®)
- Selectively inhibits presynaptic serotonin reuptake.
- Key side effects include nausea, sexual dysfunction, and insomnia; can initially increase anxiety.
- Should not be taken by individuals with known hypersensitivity to fluoxetine; caution with concurrent MAOI use (requires a 5-week washout).
- The SSRI which is the most “activating".
- Has a long half-life, and its active metabolite, norfluoxetine, has an even longer half-life.
- Prozac Weekly® is for once-weekly usage.
- Serafem® is a brand name typically used for PMDD.
- Considered the most "activating" SSRI.
Fluvoxamine (Luvox®)
- Selectively inhibits presynaptic serotonin reuptake.
- Key side effects are nausea, sedation, sexual dysfunction, and GI upset.
- Should not be taken by individuals with known hypersensitivity to fluvoxamine.
- Primarily FDA-approved for obsessive–compulsive disorder (OCD) and social anxiety disorder.
- Not typically used for MDD in the U.S., though may be used off-label.
Paroxetine (Paxil®, Pexeva®, Paxil CR®)
- Selectively inhibits presynaptic serotonin reuptake.
- Key side effects include anticholinergic effects (e.g., dry mouth, constipation), sedation, weight gain, increased risk of sexual dysfunction, and significant withdrawal symptoms if abruptly discontinued because it has one of the shortest half‐lives in the SSRI class.
- Should not be taken by individuals with known hypersensitivity to paroxetine; caution with abrupt discontinuation.
- Considered the most anticholinergic SSRI.
- Higher dosages could reduce nitric oxide synthase, which could lead to erectile dysfunction.
- The CR formulation can help reduce GI side effects.
- May suppress nitric oxide synthase at higher doses, possibly contributing to erectile dysfunction.
Sertraline (Zoloft®)
- Selectively inhibits presynaptic serotonin reuptake.
- Key side effects are nausea, diarrhea, sexual dysfunction, insomnia or sedation (varies by patient).
- Should not be taken by individuals with known hypersensitivity to sertraline.
- Often a first-line SSRI is due to a balanced side effect profile.
- Also available as an oral concentrate solution.
Vortioxetine (Trintellix®)
- Functions as an SSRI plus additional receptor activity (agonist at 5-HT1A, antagonist at 5-HT3).
- Key side effects are nausea, diarrhea, dizziness, and possible sexual dysfunction.
- Should not be taken by individuals with known hypersensitivity to vortioxetine.
- The multimodal mechanism may offer cognitive benefits for some patients.
Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)
- SNRIs inhibit presynaptic reuptake of serotonin and norepinephrine.
Venlafaxine (Effexor®, Effexor XR®)
- Inhibits presynaptic reuptake of serotonin and norepinephrine.
- Key side effects are nausea, sexual dysfunction, dose-related increases in blood pressure (especially at higher doses), insomnia, and increased sweating.
- Should not be taken by individuals with known hypersensitivity; caution in uncontrolled hypertension.
- Has more of an SSRI effect at lower doses.
Desvenlafaxine – Pristiq®, Khedezla®
- Inhibits presynaptic reuptake of serotonin and norepinephrine.
Duloxetine – Cymbalta®
- Inhibits presynaptic reuptake of serotonin and norepinephrine.
Levomilnacipran – Fetzima®
- Inhibits presynaptic reuptake of serotonin and norepinephrine.
Tricyclic Antidepressants (TCAs)
Tertiary Amines
- Amitriptyline – Elavil®
- Clomipramine – Anafranil®
- Doxepin – Sinequan®, Silenor®
- Imipramine – Tofranil®, Tofranil-PM®
- Trimipramine – Surmontil®
Secondary Amines
- Desipramine – Norpramin®
- Nortriptyline – Pamelor®
- Protriptyline – Vivactil®
- Amoxapine – Asendin® (discontinued)
Tetracyclic (sometimes classed as “heterocyclic”)
- Maprotiline – Ludiomil®
Monoamine Oxidase Inhibitors (MAOIs)
- Isocarboxazid – Marplan®
- Phenelzine – Nardil®
- Selegiline (transdermal) – Emsam®
- Tranylcypromine – Parnate®
Other (Atypical) Antidepressants / Miscellaneous
- Bupropion hydrochloride – Wellbutrin®, Wellbutrin-SR®, Wellbutrin-XL®
- Bupropion hydrobromide – Aplenzin®
- Dextromethorphan / Bupropion – Auvelity®
- Mirtazapine – Remeron®, Remeron SolTab®
- Vilazodone – Viibryd®
- Trazodone – Oleptro®, Desyrel®
- Nefazodone – Serzone® (brand discontinued in many places)
- Ketamine / Esketamine – Spravato® (esketamine)
- Brexanolone – Zulresso®
- Zuranolone – Zurzuvae®
- Gepirone – Exxua®
- Note: Some of the brand names may be discontinued or less commonly used in certain regions, but they are listed here as they appear in the document.
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Description
This note discusses Selective Serotonin Reuptake Inhibitors (SSRIs) like Citalopram, Escitalopram, and Fluoxetine. It inhibits presynaptic reuptake of serotonin (5-HT), increasing serotonin levels in the synaptic cleft. The note also outlines key side effects and contraindications for each medication.
