Antidepressants

**Antidepressant Drugs** Antidepressant drugs are primarily used in the treatment of major depressive illness, anxiety disorders, the depressed phase of bipolar disorder, and psychotic depression. Off-label uses of antidepressants include the treatment of chronic pain, migraine headaches, peripheral and diabetic neuropathies, sleep apnea, dermatologic disorders, panic disorders, and eating disorders. Although the mechanism of action is not completely understood, antidepressants somehow interact with two neurotransmitters, norepinephrine and serotonin, that regulate mood, arousal, attention, sensory processing, and appetite.

Antidepressants are divided into four groups:

1. Tricyclic and the related cyclic antidepressants 2. Selective serotonin reuptake inhibitors (SSRIs) 3. Monoamine oxidase inhibitors (MAOIs) 4. Other Antidepressants such as venlafaxine (Effexor), bupropion (Wellbutrin), trazodone (Desyrel), and nefazodone (Serzone)


 * Indications**
 * Major depressive illness**

Psychiatric disorder showing symptoms such as persistent feelings of hopelessness, dejection, poor concentration, lack of energy, inability to sleep, and, sometimes, suicidal tendencies

A psychiatric disorder causing feelings of persistent anxiety, e.g. panic disorder or post-traumatic stress disorder
 * Anxiety Disorders **

An emotional disorder that manifests itself in an irrational craving for, or avoidance of, food, e.g. bulimia
 * Eating Disorders**

Psychiatric disorder characterized by extreme mood swings, ranging between episodes of acute euphoria mania and severe depression
 * Bipolar Disorders **


 * Drugs **

** Brand Name: ** Paxil, Paxil CR, Pexeva · **CNS:** //Somnolence, dizziness, insomnia, tremor, nervousness, headache,// anxiety, paresthesia, blurred vision · **CV:** Palpitations, vasodilation, orthostatic hypotension, hypertension · **Dermatologic:** //Sweating,// rash, redness · **GI:** //Nausea, dry mouth, constipation, diarrhea,// anorexia, flatulence, vomiting · **GU:** //Ejaculatory disorders, male genital disorders,// urinary frequency · **Respiratory:** Yawns, pharyngitis, cough · **Other:** //Headache, asthenia// Tablets—10, 20, 30, 40 mg; CR tablets, 12.5, 25, 37.5 mg; suspension—10 mg/5 mL · Contraindicated with MAOI use. · Use cautiously in the elderly, with renal or hepatic impairment, pregnancy, lactation, suicidal patients.
 * Generic Name: Paroxetine hydrochloride**
 * Drug class:** Antidepressant
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category C**

· **CNS:** //Headache, nervousness, drowsiness, anxiety, tremor, dizziness, insomnia,// light- headedness, agitation, //sedation,// abnormal gait, seizures, //vision changes, fatigue// · **CV:** Hot flashes, palpitations, chest pain · **Dermatologic:** //Sweating,// rash, pruritus, acne, contact dermatitis · **GI:** //Nausea,// vomiting, //diarrhea, dry mouth,// anorexia, dyspepsia, constipation, taste changes, flatulence, gastroenteritis, dysphagia, gingivitis · **GU:** //Painful menstruation,// sexual dysfunction, frequency, cystitis, impotence, urgency, vaginitis · **Respiratory:** URIs, pharyngitis, cough, dyspnea , bronchitis, //rhinitis// · **Other:** Hot flashes, fever, back pain, thirst Tablets—25, 50, 100 mg; oral concentrate—20 mg/ mL · Contraindicated with hypersensitivity to sertraline. · Use cautiously with impaired hepatic or renal function, lactation, pregnancy; in children and adolescents with major depressive disorder.
 * Generic Name: Sertraline hydrochloride**
 * Brand Name: **Zoloft, Lustral
 * Drug classes:** Antidepressant, SSRI
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category C**

**Brand Name:** Celexa, Citrol, Cipramil · **CNS:** //Somnolence, dizziness, insomnia, tremor,// nervousness, headache, anxiety, paresthesia, blurred vision · **CV:** Palpitations, vasodilation, orthostatic hypotension, hypertension · **Dermatologic:** //Sweating,// rash, redness · **GI:** //Nausea, dry mouth,// constipation, diarrhea, anorexia, flatulence, vomiting · **GU:** //Ejaculatory disorders// · **Respiratory:** Sinusitis, URI, cough, rhinitis Tablets—10, 20, 40 mg; oral solution—2 mg/mL · Contraindicated with MAOI use; allergy to drug or any component of the drug or other SSRIs ; concomitant use of pimozide. · Use cautiously with renal or hepatic impairment, pregnancy, lactation, and in patients who are elderly or suicidal.
 * Generic Name: Citalopram hydrobromide **
 * Drug classes:** Antidepressant, SSRI
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category C**

**Brand Name:** Lexapro, Cipralex · **CNS:** //Somnolence, dizziness//, insomnia, fatigue · **Dermatologic:** Sweating · **GI:** //Nausea//, dry mouth//,// constipation, diarrhea, indigestion, abdominal pain**, **decreased appetite · **GU:** //Ejaculatory disorders,// impotence, anorgasmia in females, decreased libido · **Respiratory:** Rhinitis, sinusitis, flulike symptoms Tablets—5, 10, 20 mg; oral solution—5 mg/5 mL · Contraindicated with MAOI use; with allergy to drug or to citalopram or any component of the drug. · Use cautiously in the elderly, and with renal or hepatic impairment, illnesses of metabolism or hemodynamic response, pregnancy, lactation, suicidal patients, patients with mania or seizure disorders.
 * Generic Name: Escitalopram oxalate**
 * Drug classes:** Antidepressant, SSRI
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category C**

**Brand Name:** Apo-Trazodone, Desyrel , Desyrel Dividose , Nu-Trazodone · **CNS:** //Anger, hostility, agitation, nightmares or vivid dreams, hallucinations, delusions, hypomania, confusion, disorientation, decreased concentration, impaired memory, impaired speech, dizziness, incoordination, drowsiness, fatigue,// excitement, insomnia, nervousness, paresthesia , tremors, akathisia , headache, grand mal seizures, tinnitus, blurred vision, red eyes, nasal or sinus congestion, //malaise// · **CV:** //Hypertension, hypotension, shortness of breath, syncope, tachycardia, palpitations,// chest pain, **MI,** ventricular ectopic activity, occasional sinus bradycardia with long-term use · **GI:** //Abdominal or gastric disorder, decreased or increased appetite, bad taste in mouth, dry mouth, hypersalivation, nausea, vomiting, diarrhea, flatulence, constipation// · **GU:** //Decreased libido,// impotence, priapism, retrograde ejaculation, early menses, missed periods, hematuria , delayed urine flow, increased urinary frequency · **Hematologic** **:** Anemia, neutropenia, leukopenia , liver enzyme alterations · **Hypersensitivity:** //Allergic skin conditions, edema,// rash · **Musculoskeletal:** Musculoskeletal aches and pains, muscle twitches · **Other:** Sweating, clamminess Tablets—50, 100, 150, 300 mg · Contraindicated with hypersensitivity to trazodone, recent MI. · Use cautiously with preexisting cardiac disease (arrhythmias, including ventricular tachycardia, may be more likely), lactation, pregnancy.
 * Generic Name: Trazodone hydrochloride**
 * Drug Classes: ** Antidepressant
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category C**

**Brand Name:** Effexor, Effexor XR, Venlafaxine · **CNS:** //Somnolence, dizziness, insomnia, nervousness,// anxiety, tremor, dreams · **CV:** Vasodilation, hypertension, tachycardia · **Dermatologic:** //Sweating,// rash, pruritus · **GI:** //Nausea, constipation, anorexia,// diarrhea, vomiting, dyspepsia, //dry mouth,// flatulence · **GU:** //Abnormal ejaculation,// impotence, urinary frequency · **Other:** //Headache, asthenia,// infection, chills, chest pain Tablets—25, 37.5, 50, 75, 100 mg; ER capsules—37.5, 75, 150 mg · Contraindicated with allergy to venlafaxine, use of MAOIs within last 14 days. · Use cautiously with pregnancy, lactation, patients whose underlying medical condition might be compromised by increased heart rate (hyperthyroidism, CHF, recent MI).
 * Generic Name: Venlafaxine hydrochloride**
 * Drug class:** Antidepressant, Anxiolytic
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category C**

**Brand Name:** Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyba · **CNS:** //Agitation, insomnia, headache, migraine, tremor,// ataxia, incoordination, seizures, mania, increased libido, hallucinations, visual disturbances · **CV:** //Dizziness, tachycardia,// edema, ECG abnormalities, chest pain, shortness of breath · **Dermatologic:** Rash, alopecia, dry skin · **GI:** //Dry mouth, constipation,// nausea, vomiting, stomatitis · **GU:** Nocturia, vaginal irritation, testicular swelling · **Other:** //Weight loss,// flulike symptoms Tablets—75, 100 mg; SR tablets—100, 150, 200 mg; ER tablets—150, 300 mg · Contraindicated with hypersensitivity to bupropion ; history of seizure disorder, bulimia or anorexia, head trauma, CNS tumor (increased risk of seizures); treatment with MAOIs ; lactation. · Use cautiously with renal or liver disease; heart disease, history of MI, pregnancy.
 * Generic Name: Bupropion hydrochloride**
 * Drug classes:** Antidepressant, Smoking deterrent
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category B**

**Brand Name:** Remeron, Remeron SolTab, Mirtazipine · **CNS:** //Sedation and anticholinergic (atropine-like) effects; confusion// (especially in elderly), //disturbed concentration,// hallucinations, disorientation, decreased memory, feelings of unreality, delusions, anxiety, nervousness, restlessness, agitation, panic, insomnia, nightmares, hypomania, mania, exacerbation of psychosis, drowsiness, weakness, fatigue, headache, numbness, agitation (less likely with this drug than with other antidepressants) · **CV:** Orthostatic hypotension, hypertension, syncope, tachycardia, palpitations, **MI,** arrhythmias, **heart block,** precipitation of CHF, stroke · **Endocrine:** Elevated or depressed blood sugar; elevated prolactin levels; inappropriate ADH secretion · **GI:** //Dry mouth, constipation,// paralytic ileus, //nausea// (less likely with this drug than with other antidepressants), //increased appetite, weight gain,// vomiting, anorexia, epigastric distress, diarrhea, flatulence, dysphagia , peculiar taste, increased salivation, stomatitis , glossitis , parotid swelling, abdominal cramps, black tongue, liver enzyme elevations · **GU:** Urinary retention, delayed micturition, dilation of urinary tract, gynecomastia , testicular swelling in men; breast enlargement, menstrual irregularity, galactorrhea in women; increased or decreased libido; impotence · **Hematologic** **: Agranulocytosis ,** //neutropenia// · **Hypersensitivity:** Rash, pruritus, vasculitis , petechiae , photosensitization, edema Tablets—7.5, 15, 30, 45 mg; orally disintegrating tablet—15, 30, 45 mg · Contraindicated with hypersensitivity to any tricyclic or tetracyclic drug; concomitant therapy with an MAOI; recent MI; myelography · Use cautiously with ECT; preexisting CV disorders (eg, severe coronary heart disease, progressive heart failure, angina pectoris, paroxysmal tachycardia [possible increased risk of serious CVS toxicity with TCAs]); angle-closure glaucoma, increased IOP, urinary retention, ureteral or urethral spasm; seizure disorders ( TCAs lower the seizure threshold); hyperthyroidism (predisposes to CVS toxicity, including cardiac arrhythmias); impaired hepatic, renal function; psychiatric patients (schizophrenic or paranoid patients may exhibit a worsening of psychosis with TCAs ); manic-depressive disorder (may shift to hypomanic or manic phase); elective surgery ( TCAs should be discontinued as long as possible before surgery)
 * Generic Name: Mirtazapine **
 * Drug class:** Antidepressant ( tetracyclic )
 * Adverse effects:**
 * Available forms:**
 * Contraindications and cautions:**
 * Pregnancy Category C**


 * Note:** Adverse effects in //Italic// are most common; those in **Bold** are life-threatening.

Rufino, Robert Moses M. Simeon, Melisa R. Simtanching, Klayne Tamayo, Joannabel
 * Group Members:**

09:30-10:30 MWF A-206

**95/100 = VERY GOOD! =)** 