NR 546 Week 5 Antidepressant and Mood Stabilizer Medication Table latest update 2024 GRADED A+

NR 546 Week 5 Antidepressant and Mood Stabilizer Medication Table latest update 2024 GRADED A+ 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) Selective serotonin reuptake inhibitor Commonly prescribed for depression, PMDD, OCD, panic disorder, GAD, PTSD, social anxiety disorder Starting dose: 20mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, presumably increases serotonergic neurotransmission Parent drug 23-45 hour half-life. Weak inhibitor of CYP450 2D6. Metabolized by CYP450 3A4 and 2C19 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: mild antihistamine properties may contribute to sedation and fatigue in some. Risks versus benefits in pregnancy and breast feeding. Escitalopram (Lexapro) Selective serotonin reuptake inhibitor Commonly prescribed for MDD, GAD, panic disorder, OCD, PTSD, social anxiety disorder, and PMDD Starting dose: 10mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, presumably increases serotonergic neurotransmission Mean terminal half life 27-32 hours. Substrate for CYP450 2C19 and 3A4 No significant actions of CYP450 enzymes Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: may be among the best tolerated antidepressants. Commonly used as an augmenting agent as it has least interactions with CYP450. Fluoxetine (Prozac) Selective serotonin reuptake inhibitor Commonly prescribed for: MDD, OCD, PMDD, bulimia nervosa, panic disorder, bipolar depression, treatment resistant depression in combination with olanzapine, social anxiety disorder, PTSD Starting dose: depression and OCD – initial dose 20mg/day Bulimia – 60mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, Active metabolite norfluoxetine has 2 week half life Parent drug has 2-3 day half life Inhibits CYP450 2D6 and 3A4 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents. Add or initiate other antidepressants with caution for up to 5 weeks after discontinuing fluoxetine. Notes:may be a first line choice for atypical depression. presumably increases serotonergic neurotransmission Fluvoxamine (Luvox) Selective serotonin reuptake inhibitor Commonly prescribed for: OCD, social anxiety disorder, depression, panic disorder, GAD, PTSD Starting dose: immediate release 50mg/day Controlled release 100mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, presumably increases serotonergic neurotransmission Parent drug has a half life 9-28 hours Inhibits CYP450 3A4, 1A2, and 2C9/2C19 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: sigma 1 agonist properties may contribute to fatigue and sedation. May have lower incidence of sexual dysfunction than other SSRIs. Paroxetine (Paxil) Selective serotonin reuptake inhibitor Commonly prescribed for: MDD, OCD, panic disorder, social anxiety disorder, PTSD, GAD, PMDD Starting dose: depression, social anxiety disorder, other anxiety disorders – initially 24 hour half life Inhibits CYP450 2D6 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: withdrawal can be more common and more severe than other SSRIs, weak antimuscarinic properties can cause constipation, dry mouth and sedation. 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) Selective serotonin reuptake inhibitor Commonly prescribed for depression, PMDD, OCD, panic disorder, GAD, PTSD, social anxiety disorder Starting dose: 20mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, presumably increases serotonergic neurotransmission Parent drug 23-45 hour half-life. Weak inhibitor of CYP450 2D6. Metabolized by CYP450 3A4 and 2C19 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: mild antihistamine properties may contribute to sedation and fatigue in some. Risks versus benefits in pregnancy and breast feeding. Escitalopram (Lexapro) Selective serotonin reuptake inhibitor Commonly prescribed for MDD, GAD, panic disorder, OCD, PTSD, social anxiety disorder, and PMDD Starting dose: 10mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, presumably increases serotonergic neurotransmission Mean terminal half life 27-32 hours. Substrate for CYP450 2C19 and 3A4 No significant actions of CYP450 enzymes Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: may be among the best tolerated antidepressants. Commonly used as an augmenting agent as it has least interactions with CYP450. Fluoxetine (Prozac) Selective serotonin reuptake inhibitor Commonly prescribed for: MDD, OCD, PMDD, bulimia nervosa, panic disorder, bipolar depression, treatment resistant depression in combination with olanzapine, social anxiety disorder, PTSD Starting dose: depression and OCD – initial dose 20mg/day Bulimia – 60mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, Active metabolite norfluoxetine has 2 week half life Parent drug has 2-3 day half life Inhibits CYP450 2D6 and 3A4 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents. Add or initiate other antidepressants with caution for up to 5 weeks after discontinuing fluoxetine. Notes:may be a first line choice for atypical depression. presumably increases serotonergic neurotransmission Fluvoxamine (Luvox) Selective serotonin reuptake inhibitor Commonly prescribed for: OCD, social anxiety disorder, depression, panic disorder, GAD, PTSD Starting dose: immediate release 50mg/day Controlled release 100mg/day Blocks serotonin and serotonin reuptake pump, desensitizes serotonin receptors, presumably increases serotonergic neurotransmission Parent drug has a half life 9-28 hours Inhibits CYP450 3A4, 1A2, and 2C9/2C19 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: sigma 1 agonist properties may contribute to fatigue and sedation. May have lower incidence of sexual dysfunction than other SSRIs. Paroxetine (Paxil) Selective serotonin reuptake inhibitor Commonly prescribed for: MDD, OCD, panic disorder, social anxiety disorder, PTSD, GAD, PMDD Starting dose: depression, social anxiety disorder, other anxiety disorders – initially 24 hour half life Inhibits CYP450 2D6 Notable side effects: sexual dysfunction, decreased appetite, N/V/D, constipation, dry mouth, dose-dependent insomnia, agitation, tremors, headache, dizziness, sweating, bruising and rare bleeding. Precautions: rare seizures, rare mania, rare activation of suicidal ideation, sedation. Caution with patients with seizure disorders, bipolar disorder, monitor for SI in children and adolescents Notes: withdrawal can be more common and more severe than other SSRIs, weak antimuscarinic properties can cause constipation, dry mouth and sedation.