Psyche Meds

Antidepressants

SSRIs

Selective Seratonin Reuptake Inhibitors

  • Most commonly used antidepressants.
  • Overdose is unlikely to be serious
  • Fewer side effects than other classes
  • Also used for OCD – paroxetine is particularly good here.

Including:

  • Sertraline – probably best choice to start someone with acute major depression
  • Citalopram
  • Paroxetine
  • Fluoxetine
  • Fluvoxamine
  • Escitalopram

Sertraline is probably best choice for starting someone on.

Citalopram or sertaline is best if they have chronic health problems or other medical problems as those two have lower propensity for interactions.

SNRIs

Selective Seotonin and Noradrenaline Reuptake Inhibiotor

  • Designed to be more effective than SSRIs but unclear evidence
  • Some people get on better with SSRIs, some with SNRIs

Includes:

  • Venlafaxine
  • Duloxetine

Problems:

  • Can cause SIAH
  • Can cause Stevens-Johnson syndrome
  • Can cause arrhymias

Think of a lifeboat house (RNLI = SNRI) with dulux  (duloxetine) paint and velux (venlfaxine) windows

Tricyclic Antidepressants

  • They used to be first line, they’re not anymore
  • Dangerous in overdose (blocks sodium channels and also potassium channels causing life threatening dysarrhymias)
  • Side effects are also worse
  • They tend to be used now just for people who are resistant to other treatments
  • Block both noradrenaline and serotonin into the presynaptic neurone

Include:

  • Amitriptyline (75mg – 200mg a day in divided doses)
    • Sedating – so useful when sleep is a problem
    • Also works for chronic pain
    • Particularly useful in depression with anxiety
  • Clomipramine
  • Dosulepine
  • Imipramine
  • Lofepramine
  • Nortriptyline
  • Trazadone

(If it has tri in the name best guess is it’s going to be a tricyclic – so that’s Amitriptyline, Nortriptylline, and Traz is two out of three – Trazodone. That leave Lofepramine, Imipramine, Dosulepine, Clomipramine. So the Pramines are tricyclics – think three pramines Imipramine, clomipramine and Lofepramine and it’s lofepramine with Lofe or Loaf in the name gives you the last one which is Dough – dough makes loafs so dosulepine. Yep I’m that good.)

NASSAs

Noradrenaline and Specific Serotonergic Antidepressants

  • Mirtazepine is the one we use

Supposed to be similar to SSRIs but they cause less sexual problems,

But may cause drowsiness to start with

 

MAOIs

Monoamine Oxidase Inhibitor

  • Pretty old now and not really used much
  • Only used when other newer antidepressants are not working/are problematic
  • The problem is you can’t be on certain foods on them: you have to avoid:
    • Alcohol
    • tyramine containing foods:
      • cheese
      • liver
      • yoghurt
      • marmite
      • oxo
      • bovril
      • broad bean pods
      • food that has femented or aged
      • large amounts of chocolate
      • some cold and cough remidies
  • Tyronine containing foods can lead to hypertensive crisis
  • They have to carry a card identifying themselves as taking a MAOI

Include:

  • Phenelezine
  • Isocarboxazid
  • Tranylcypromine
  • Moclobemide – newer one less problems
  • Selegline

(mneumonic is to think of them as slightly camp – the Trany – tranylcypromine – tansvestite, Isocarboxazid – think of someone saying IS Soooo Carbox a zid – in a slightly camp way, Mo-clo is your big gay guy with a big mo, Phenelezine sounds like a party drug, Selegline is a sweedish guy with a mo and a mullet, Ma-O mayo don’t eat yoghurt or it will turn you camp,)

Antipsychotics

Neuroleptics

Dopamine D2 receptor antagonists

For example:

  • Amisulpride
  • Metoclopromide (a benzamide)
  • Haliperidol (a butyrophenone)
  • Clozapine
  • Olanzepine (an atypical or newer antipsychotic) – works of the D2 receptor, but also strongly block the 5HT receptor
  • Pirozide (a diphenylbutylpiperidine)
  • Phenothiazines
    • Chlorpromazine
    • Promazine
  • Quetiapine
  • Risperidone