K REDDY
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
, Antidepressant Medications
Kristin Reddy NR 456 September 2022
Indication (FDA approved = bold), starting dose, Half-life (T1/2) Notes/Notable side effects/Precautions
Drug Name target symptoms, and affected neurotransmitters CYP450
enzyme
SSRIs
Citalopram Indication: Half-life: Notable side effects:
(Celexa) ◗ Depression Parent drug ◗ Sexual dysfunction (dose-dependent; men:
◗ Premenstrual dysphoric disorder (PMDD) - 23–45 delayed ejaculation, erectile dysfunction; men and
◗ Obsessive-compulsive disorder (OCD) hours women: decreased sexual desire, anorgasmia)
◗ Panic disorder ◗ Gastrointestinal (decreased appetite, nausea,
◗ Generalized anxiety disorder (GAD) Metabolized by diarrhea, constipation, dry mouth)
◗ Posttraumatic stress disorder (PTSD) CYP450 - 3A4 ◗ Mostly CNS (dose-dependent insomnia but also
◗ Social anxiety disorder (social and 2C19 sedation, agitation, tremors, headache,
phobia) Starting dose: dizziness)
◗ 20 mg/day; increase by 20 mg/day after 1 or (Weak inhibitor ◗ Activation (short-term; patients with diagnosed or
more weeks; maximum 40 mg/day; single-dose of 2D6) undiagnosed bipolar or psychotic disorders may be
administration, morning or evening more vulnerable to CNS activating actions of SSRIs)
Target Symptoms: ◗ Sweating (dose-dependent)
◗ Depressed mood ◗ Bruising and rare bleeding
◗ Anxiety ◗ Rare hyponatremia (mostly in elderly patients and
◗ Panic attacks, avoidant behavior, generally reversible on discontinuation of
reexperiencing, hyperarousal citalopram)
◗ Sleep disturbance, both insomnia ◗ SIADH (syndrome of inappropriate antidiuretic
and hypersomnia hormone secretion)
Affected neurotransmitters: Side effect pathways:
◗ Boosts neurotransmitter serotonin ✓ Theoretically due to increases in serotonin
◗ Blocks serotonin reuptake pump concentrations at serotonin receptors in parts of the
(serotonin transporter) brain and body other than those that cause therapeutic
◗ Desensitizes serotonin receptors, actions (e.g., unwanted actions of serotonin in sleep
especially serotonin 1A autoreceptors centers causing insomnia, unwanted actions of
◗ Presumably increases serotonin in the gut causing diarrhea, etc.)
serotonergic neurotransmission ✓ Increasing serotonin can cause diminished
◗ Citalopram also has mild antagonist actions at dopamine release and might contribute to
H1 histamine receptors emotional flattening, cognitive slowing, and apathy
◗ Citalopram’s inactive R enantiomer may in some patients
interfere with the therapeutic actions of the ✓ Most side effects are immediate but often go away
active S enantiomer at serotonin reuptake with time, in contrast to most therapeutic effects
pumps which are delayed and are enhanced over time
✓ Citalopram’s unique mild antihistamine properties
may contribute to sedation and fatigue in some
, patients
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
➢ Distribute the brochures provided by the FDA and
the drug companies
➢ 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 Indication: Half-life: 27– Notable side effects:
(Lexapro) ◗ Major depressive disorder (ages 12 and older) 32 hours ✓ Sexual dysfunction (men: delayed ejaculation, erectile
◗ Generalized anxiety disorder (GAD) dysfunction; men and women: decreased sexual
◗ Panic disorder Substrate for desire, anorgasmia)
◗ Obsessive-compulsive disorder (OCD) CYP450 2C19 ✓ Gastrointestinal (decreased appetite, nausea,
◗ Posttraumatic stress disorder (PTSD) and 3A4 diarrhea, constipation, dry mouth)
◗ Social anxiety disorder (social phobia) ✓ Mostly central nervous system (insomnia but
◗ Premenstrual dysphoric disorder No significant also sedation, agitation, tremors, headache,
(PMDD) Starting dose: actions on dizziness)
◗ Initial 10 mg/day; increase to 20 mg/day if CYP450 ✓ Autonomic (sweating)
necessary; single-dose administration, morning enzymes ✓ Bruising and rare bleeding
or evening ✓ Rare hyponatremia (mostly in elderly patients and
◗ Given once *Food does not generally reversible on discontinuation of
Target Symptoms: affect escitalopram
◗ Depressed mood absorption ✓ SIADH (syndrome of inappropriate antidiuretic
◗ Anxiety hormone secretion)
◗ Panic attacks, avoidant behavior, Side effect pathways:
reexperiencing, hyperarousal ✓ Theoretically due to increases in serotonin
◗ Sleep disturbance, both insomnia concentrations at serotonin receptors in parts of the
and hypersomnia brain and body other than those that cause therapeutic
Affected neurotransmitters: actions (e.g., unwanted actions of serotonin in sleep
◗ Boosts neurotransmitter serotonin centers causing insomnia, unwanted actions of
◗ Blocks serotonin reuptake pump serotonin in the gut causing diarrhea, etc.)
(serotonin transporter) ✓ Increasing serotonin can cause diminished
◗ Desensitizes serotonin receptors, especially dopamine release and might contribute to
serotonin 1A autoreceptors emotional flattening, cognitive slowing, and apathy
in some patients
[Document subtitle]
[DATE]
[COMPANY NAME]
[Company address]
, Antidepressant Medications
Kristin Reddy NR 456 September 2022
Indication (FDA approved = bold), starting dose, Half-life (T1/2) Notes/Notable side effects/Precautions
Drug Name target symptoms, and affected neurotransmitters CYP450
enzyme
SSRIs
Citalopram Indication: Half-life: Notable side effects:
(Celexa) ◗ Depression Parent drug ◗ Sexual dysfunction (dose-dependent; men:
◗ Premenstrual dysphoric disorder (PMDD) - 23–45 delayed ejaculation, erectile dysfunction; men and
◗ Obsessive-compulsive disorder (OCD) hours women: decreased sexual desire, anorgasmia)
◗ Panic disorder ◗ Gastrointestinal (decreased appetite, nausea,
◗ Generalized anxiety disorder (GAD) Metabolized by diarrhea, constipation, dry mouth)
◗ Posttraumatic stress disorder (PTSD) CYP450 - 3A4 ◗ Mostly CNS (dose-dependent insomnia but also
◗ Social anxiety disorder (social and 2C19 sedation, agitation, tremors, headache,
phobia) Starting dose: dizziness)
◗ 20 mg/day; increase by 20 mg/day after 1 or (Weak inhibitor ◗ Activation (short-term; patients with diagnosed or
more weeks; maximum 40 mg/day; single-dose of 2D6) undiagnosed bipolar or psychotic disorders may be
administration, morning or evening more vulnerable to CNS activating actions of SSRIs)
Target Symptoms: ◗ Sweating (dose-dependent)
◗ Depressed mood ◗ Bruising and rare bleeding
◗ Anxiety ◗ Rare hyponatremia (mostly in elderly patients and
◗ Panic attacks, avoidant behavior, generally reversible on discontinuation of
reexperiencing, hyperarousal citalopram)
◗ Sleep disturbance, both insomnia ◗ SIADH (syndrome of inappropriate antidiuretic
and hypersomnia hormone secretion)
Affected neurotransmitters: Side effect pathways:
◗ Boosts neurotransmitter serotonin ✓ Theoretically due to increases in serotonin
◗ Blocks serotonin reuptake pump concentrations at serotonin receptors in parts of the
(serotonin transporter) brain and body other than those that cause therapeutic
◗ Desensitizes serotonin receptors, actions (e.g., unwanted actions of serotonin in sleep
especially serotonin 1A autoreceptors centers causing insomnia, unwanted actions of
◗ Presumably increases serotonin in the gut causing diarrhea, etc.)
serotonergic neurotransmission ✓ Increasing serotonin can cause diminished
◗ Citalopram also has mild antagonist actions at dopamine release and might contribute to
H1 histamine receptors emotional flattening, cognitive slowing, and apathy
◗ Citalopram’s inactive R enantiomer may in some patients
interfere with the therapeutic actions of the ✓ Most side effects are immediate but often go away
active S enantiomer at serotonin reuptake with time, in contrast to most therapeutic effects
pumps which are delayed and are enhanced over time
✓ Citalopram’s unique mild antihistamine properties
may contribute to sedation and fatigue in some
, patients
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
➢ Distribute the brochures provided by the FDA and
the drug companies
➢ 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 Indication: Half-life: 27– Notable side effects:
(Lexapro) ◗ Major depressive disorder (ages 12 and older) 32 hours ✓ Sexual dysfunction (men: delayed ejaculation, erectile
◗ Generalized anxiety disorder (GAD) dysfunction; men and women: decreased sexual
◗ Panic disorder Substrate for desire, anorgasmia)
◗ Obsessive-compulsive disorder (OCD) CYP450 2C19 ✓ Gastrointestinal (decreased appetite, nausea,
◗ Posttraumatic stress disorder (PTSD) and 3A4 diarrhea, constipation, dry mouth)
◗ Social anxiety disorder (social phobia) ✓ Mostly central nervous system (insomnia but
◗ Premenstrual dysphoric disorder No significant also sedation, agitation, tremors, headache,
(PMDD) Starting dose: actions on dizziness)
◗ Initial 10 mg/day; increase to 20 mg/day if CYP450 ✓ Autonomic (sweating)
necessary; single-dose administration, morning enzymes ✓ Bruising and rare bleeding
or evening ✓ Rare hyponatremia (mostly in elderly patients and
◗ Given once *Food does not generally reversible on discontinuation of
Target Symptoms: affect escitalopram
◗ Depressed mood absorption ✓ SIADH (syndrome of inappropriate antidiuretic
◗ Anxiety hormone secretion)
◗ Panic attacks, avoidant behavior, Side effect pathways:
reexperiencing, hyperarousal ✓ Theoretically due to increases in serotonin
◗ Sleep disturbance, both insomnia concentrations at serotonin receptors in parts of the
and hypersomnia brain and body other than those that cause therapeutic
Affected neurotransmitters: actions (e.g., unwanted actions of serotonin in sleep
◗ Boosts neurotransmitter serotonin centers causing insomnia, unwanted actions of
◗ Blocks serotonin reuptake pump serotonin in the gut causing diarrhea, etc.)
(serotonin transporter) ✓ Increasing serotonin can cause diminished
◗ Desensitizes serotonin receptors, especially dopamine release and might contribute to
serotonin 1A autoreceptors emotional flattening, cognitive slowing, and apathy
in some patients
