For Depression think <SIG E CAPS= and the phrase <2 blue weeks=
Suicidal thoughts
Interests decreased
Guilt
Energy decreased
Concentration decreased
Appetite Disturbance (increased or decreased)
Psychomotor Changes (Agitation or Retardation)
Sleep Disturbances (increased or decreased)
3 Main Neurotransmitters we will discuss for treating Depression:
Serotonin: Can help with depression, anxiety, obsessions and compulsions.
Norepinephrine: Can help with depression, alertness and energy (can increase anxiety)
Dopamine: Can help with depression, anxiety, attention, motivation, pleasure, reward
The Rule of Sixes (Main points: Antidepressants don’t work immediately, they generally need to be continued
for a period of 6+ months, and should not be stopped abruptly).
• 6 Weeks: Try a certain dose of a drug to see if there is a therapeutic effect.
• 6 Months: Once an effective dose is found, continue the treatment for at least 6 months.
• 6 Weeks: Taper off to avoid side effects (when switching medications) and withdrawal symptoms (when
discontinuing)
Antidepressant Medications
SSRIs- Prevent the reuptake of Serotonin
Side effects include the 3 S’s- Stomach upset, Sexual Dysfunction and Serotonin Syndrome (*medical
emergency*-Hyperthermia, Muscle rigidity, Diarrhea, Shivers, Seizures.)
-Fluoxetine (Prozac), Sertraline (Zoloft), Citalopram (Celexa), Escitalopram (Lexapro),
Paroxetine (Paxil)
SNRIs-Prevent the reuptake of Serotonin and Norepinephrine
-Same side effects as SSRIs, can also help with chronic pain syndromes (Ex. fibromyalgia)
-Duloxetine (Cymbalta), Venlafaxine (Effexor), Desvenlafaxine (Pristiq)
NDRIs- Prevent the reuptake of Norepinephrine and Dopamine
Wellbutrin- Can be energizing but can cause anxiety. Can increase seizure risk. Helps with focus.
TCAs- Work similar to SNRIs but with more side effects
-Overdose causes the 3 C’s: Convulsions, Cardiotoxicity, and Coma
-Imipramine( Tofranil), Amitriptyline (Elavil), Nortriptyline (Aventyl), Trimipramine (Surmontil)
MAOIs-Inhibit Monoamine Oxidase (which means it inhibits the breakdown of 5-HT, NE, DA)
-Rarely used. Avoid Tyramine Rich foods (Monoamine precursor) such as alcohol, aged cheese, liver.. these can
lead to Hypertensive Crisis.
-Phenelzine (Nardil), Isocarboxazid (Marplan), Tranylcypromine (Parnate), Selegline (Emsam)
Atypicals- Help with sleep-Desyrel (Trazodone) used almost exclusively as a sleep aid.
-Mirtazapine (Remeron) can help to increase appetite in addition to sleep.
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