NR546 Antidepressant and Mood Stabilizer Medication Table.

NR546 Antidepressant and Mood Stabilizer Medication Table. Antidepressant Medications Name Indication, starting dose, target symptoms, and affected neurotransmitters Half-life (T1/2) CYP450 enzyme Notes/Notable side effects/Precautions SSRIs Citalopram (Celexa) serotonin reuptake inhibitor (S-RI) Commonly Prescribed for Depression Premenstrual dysphoric disorder (PMDD) Obsessive-compulsive disorder (OCD) Panic disorder Generalized anxiety disorder (GAD) Posttraumatic stress disorder (PTSD) Social anxiety disorder (social phobia) The goal of treatment is complete remission of current symptoms as well as prevention of future relapses How to Dose Initial 20 mg/day; increase by 20 mg/day after 1 or more weeks; maximum 40 mg/day; single-dose administration, morning or evening Parent drug has 23–45 hour halflife Weak inhibitor of CYP450 2D6 Metabolized by CYP450 3A4 and 2C19 Notable Side Effects Sexual dysfunction (dose-dependent; men: delayed ejaculation, erectile, dysfunction; men and women: decreased sexual desire, anorgasmia) Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth) Mostly CNS (dose-dependent insomnia but also sedation, agitation, tremors, headache, dizziness) Activation (short-term; patients with diagnosed or undiagnosed bipolar or psychotic disorders may be more vulnerable to CNS-activating actions of SSRIs) Sweating (dose-dependent) Bruising and rare bleeding Rare hyponatremia (mostly in elderly patients and generally reversible on discontinuation of citalopram) SIADH (syndrome of inappropriate antidiuretic hormone secretion) Other Warnings/Precautions Use with caution in patients with history of seizures Use with caution in patients with bipolar disorder unless treated with concomitant mood-stabilizing agent When treating children, carefully weigh the risks and benefits of pharmacological treatment against the risks and benefits of nontreatment with antidepressants and make sure to document this in the patient’s chart. Whenever possible, warn patients and their caregivers about the possibility of activating side effects, and advise them to report such symptoms immediately. Monitor patients for activation of suicidal ideation, especially children and adolescents Escitalopram (Lexapro) SSRI (selective serotonin reuptake inhibitor Commonly Prescribed for Mean terminal half-life 27–32 hours Substrate for Notable Side Effects Sexual dysfunction (men: delayed ejaculation, erectile dysfunction; men and women: decreased sexual desire, anorgasmia) Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth) Mostly Major depressive disorder (ages 12 and older) Generalized anxiety disorder (GAD) Panic disorder Obsessive-compulsive disorder (OCD) Posttraumatic stress disorder (PTSD) Social anxiety disorder (social phobia) Premenstrual dysphoric disorder (PMDD Boosts neurotransmitter serotonin Blocks serotonin reuptake pump (serotonin transporter) Desensitizes serotonin receptors, especially serotonin 1A autoreceptors Treatment most often reduces or even eliminates symptoms, but not a cure since symptoms can recur after medicine stopped Initial 10 mg/day; increase to 20 mg/day if necessary; singledose administration, morning or evening CYP450 2C19 and 3A4 No significant actions on CYP450 enzymes central nervous system (insomnia but also sedation, agitation, tremors, headache, dizziness) Note: patients with diagnosed or undiagnosed bipolar or psychotic disorders may be more vulnerable to CNS-activating actions of SSRIs Autonomic (sweating). Bruising and rare bleeding Rare hyponatremia (mostly in elderly patients and generally reversible on discontinuation of escitalopram SIADH (syndrome of inappropriate antidiuretic hormone secretion) Other Warnings/Precautions Use with caution in patients with history of seizures Use with caution in patients with bipolar disorder unless treated with concomitant mood-stabilizing agent When treating children, carefully weigh the risks and benefits of pharmacological treatment against the risks and benefits of nontreatment with antidepressants and make sure to document this in the patient’s chart Whenever possible, warn patients and their caregivers about the possibility of activating side effects, and advise them to report such symptoms immediately Monitor patients for activation of suicidal ideation, especially children and adolescents Fluoxetine (Prozac) SSRI (selective serotonin reuptake inhibitor Commonly Prescribed for Major depressive disorder (ages 8 and older) ObsessiveActive metabolite (norfluoxetine) has 2 week halflife Parent drug has 2–3 day halfNotable Side Effects Sexual dysfunction (men: delayed ejaculation, erectile dysfunction; men and women: decreased sexual desire, anorgasmia) Gastrointestinal (decreased appetite, nausea, diarrhea, constipation, dry mouth) Mostly CNS (insomnia but also sedation, agitation, tremors, headache, dizziness). Note: patients with diagnosed or undiagnosed compulsive disorder (OCD) (ages 7 and older) Premenstrual dysphoric disorder (PMDD) Bulimia nervosa Panic disorder Bipolar depression [in combination with olanzapine (Symbyax)] Treatment-resistant depression [in combination with olanzapine (Symbyax)] Social anxiety disorder (social phobia) Posttraumatic stress disorder (PTSD) Boosts neurotransmitter serotonin Blocks serotonin reuptake pump (serotonin transporter) Desensitizes serotonin receptors, especially serotonin 1A receptors Treatment most often reduces or even eliminates symptoms, but not a cure since symptoms can recur after medicine stopped How to Dose Depression and OCD: initial dose 20 mg/day in morning, usually wait a few weeks to assess drug effects before increasing dose; maximum dose generally 80 mg/day Bulimia: initial dose 60 mg/day life Inhibits CYP450 2D6 Inhibits CYP450 3A4 bipolar or psychotic disorders may be more vulnerable to CNSactivating actions of SSRIs Autonomic (sweating) Bruising and rare bleeding SIADH (syndrome of inappropriate antidiuretic hormone secretion) Life-Threatening or Dangerous Side Effects Rare seizures Rare induction of mania Rare activation of suicidal ideation and behavior (suicidality) (short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo beyond age 24) Other Warnings/Precautions Add or initiate other antidepressants with caution for up to 5 weeks after discontinuing fluoxetine Use with caution in patients with history of seizure Use with caution in patients with bipolar disorder unless treated with concomitant mood-stabilizing agent When treating children, carefully weigh the risks and benefits of pharmacological treatment against the risks and benefits of nontreatment with antidepressants and make sure to document this in the patient’s chart Whenever possible, warn patients and their caregivers about the possibility of activating side effects, and advise them to report such symptoms immediately Monitor patients for activation of suicidal ideation, especially children and adolescents in morning; some patients may need to begin at lower dose and titrate over several days.