may occur iniitally but usually lessen or stope in first several weeks.

anxiety, nervousnes, headach

insomnina, drowsiness, fatigue

tremore, diaphorisis, dizziness,

 nausea, diahreea,

skin rash hives.

SSRI:

Prototype

SSRI

Mechanism, Use,

Blockes reuptake of 5ht at axon for better seritonin transmission

major use: most pop tx of depression, also treat OCD

All have low anicholi and sedative effects

fluoxetine (prozac)

sertaline (zoloft)

Paroxetine (Paxil)

citalopram (Celexa)

escitalopram (Lexapro)

act on variety of NT inc norepi, serotonin reuptake

effective as ssri's more se's and more lethal potential

most given once daily single dose

causes sedation should be given at bedtime

tertiary tca's

amytriptyline (Elavil) imipramine (Tofranil)

Block reuptake of NE or 5HT by the axon correcting defficit

amoxapine (Asendin)

nortriptyline (Pamelor)

desipramine (Norpramin)

imipramine (Tofranil)

doxepin (Sinequan)

maprotiline (Ludiomil)

amitryptilene (Elavil)

clomipramine (Anafranil)

anticholi effects

Sedation, drowziness, ortho hypo,

dizziness, weight gain

Impotence ejaculatory dysfucntion, Decreased libido, vag dryness, tremors, GI dist (N/V/D)

MAOIs

Prototype

phenelzine (Nardil)

tranylcypromine (Parnate)

MAOI's

Action

Issues

MAOIs

Adverse Effects

anticholenergic, hypertensive crises (can cause intracranial bleeding)

severe HA, stiff neck, NV

Avoined thymine

Atypical Antideps

Action/Name

trazodone (Dysyrel)

Selectively block reputake of seri, fewer anticholi effects than SSRI's

sedation, weight gain, N/V/C, dizziness, fatiguw

incoordination, tremor

Serotonin-NOrepi reuptake Inhibitors

SNRI's

 Low dose: inhib serotonin uptake

Mod to HIgh: inhib norepi

Higher dose: Dopamine is added

venlafaxine (Effexor)

duloxetine (Cymbalta)

nefazodone (Serzone

disipramine (Norpramin)

SE's: sim to SSRI, risk for inc BP

Norepi-Dopamine Reuptake Inhbitors

NDRI

bupropion (Wellbutrin, Zyban)

Inhibigs norepi and Dopamine

SE: agitation, anxiety, insomnia, app suppresion, psychosis, inc risk for seizures

mirtazapine (Remeron): lower se profile, antagonizes seri receptors and other complex actions)

Maprotoline Hydrochloride (blocks norepi reuptake

Most Common

antimania: Lithium carbonate, Lithium

Anticonvulsant: valproic acid (Depakote)

Cheap $7/day

used sicne 70's fist line tx for BPd

treat mania

Long term therapy, entire life

Usual dose 300-600 mg tid

Onset 5-7 days andmay take 2 weeks

.5-1.5 (ideal 0.8-1.0)

toxic levels 1.5-4.0

Reprot flu like symptoms

No dose if 2 hours post, wait and take next

Draw 12 hrs after last dose for levels

Reduce repetitive firing of action potentials in nerves.

Pharmacokenetics

peak serum levels in 1-4 hrs

educate pts, aobut potential drug interactions

Anti convulsants

carbamazepine (Tegretol)

Effectiv in pts no resp to lit or pts with secondary mania

)therapudic range 4-12 mg (ideal 8-9

More se's than depakote, dizziness, confusion, drowsiness GI Blurred vis, double vision, photosnesitivity, hepatotox

agranulocytosis =weekly WBC's

2 week washout after MAOIs

DC gradually seizures/status epilep

Anticonvulsants:

valproic acid (Depakote)

broader spec of efficacy, longer periods of mood stab

fewest SE's most expensive $400/month

se:

gi distress, change in appitite, sedation, weight gain, hair loss, increased risk of bleeding.

Ther level ;

50-125 (80 ideal)

L

T

D

Litiium =0.8meq/l (.5-1.5) 1.0 ideal

Tegratol=8.0-9 mcg/ml ideal(4-12)

Depakote =80 mcg ideal (50-120)