NR546 Week 5 Assignment Antidepressant and Mood Stabiliser medication table

Name 

Half-life (T1/2)

CYP450 enzyme

Notes/Notable side effects/Precautions

SSRIs 

Citalopram 

(Celexa) 

MDD; Start: 20 mg/day; Targets: mood, anxiety; ↑Serotonin (5-HT)

~35 hrs

CYP2C19, CYP3A4

Risk of QT prolongation; max 40 mg/day; caution with cardiac issues

Escitalopram (Lexapro) 

MDD, GAD; Start: 10 mg/day; Targets: anxiety, depression; ↑Serotonin

27–32 hrs

CYP2C19, CYP3A4

Well tolerated; minimal drug interactions; dose adjustment in liver issues

Fluoxetine

 (Prozac) 

MDD, OCD, bulimia, panic; Start: 20 mg/day; Targets: mood, appetite; ↑Serotonin

4–6 days (norfluoxetine: 16 days)

CYP2D6 (strong inhibitor)

Activating; insomnia; long washout; serotonin syndrome risk

Fluvoxamine 

(Luvox) 

OCD, SAD; Start: 50 mg/day; Targets: compulsions, anxiety; ↑Serotonin

15–26 hrs

CYP1A2, CYP2D6

Sedating; potent inhibitor—interacts with many meds

Paroxetine 

(Paxil) 

MDD, anxiety, PTSD; Start: 20 mg/day; Targets: anxiety, mood; ↑Serotonin

~21 hrs

CYP2D6

Anticholinergic effects; withdrawal risk; sexual dysfunction

Sertraline

 (Zoloft) 

~26 hrs

CYP2B6, CYP2D6, CYP3A4

GI upset; sexual side effects; safe in cardiac patients

SNRIs

Venlafaxine

(Effexor)

MDD, GAD, panic; Start: 37.5–75 mg/day; ↑Serotonin, ↑Norepinephrine

5 hrs

CYP2D6

Dose-related HTN; withdrawal symptoms; taper needed

Desvenlafaxine

(Pristiq)

MDD; Start: 50 mg/day; ↑5-HT, ↑NE

11 hrs

CYP3A4

Nausea, dizziness; monitor BP; renal dosing required

Duloxetine

(Cymbalta) 

MDD, GAD, neuropathic pain; Start: 30–60 mg/day; ↑5-HT, ↑NE

12 hrs

CYP1A2, CYP2D6

Avoid in liver disease; monitor BP; helpful for chronic pain

Other

Mirtazapine

(Remeron)

MDD; Start: 15 mg HS; ↑5-HT, ↑NE, blocks α2

20–40 hrs

CYP1A2, 2D6, 3A4

Sedating at low doses; weight gain; good for insomnia

Trazadone

(Desyrel) 

Depression, insomnia (off-label); Start: 50–150 mg HS; ↑5-HT, 5-HT2 antagonist

5–13 hrs

CYP3A4

Sedation; priapism (rare); orthostatic hypotension

Vilazodone

(Viibryd)

MDD; Start: 10 mg/day, titrate to 40 mg; ↑5-HT, partial 5-HT1A agonist

25 hrs

CYP3A4

Take with food; GI upset; less sexual dysfunction

Vortioxetine

(Trintellix) 

MDD; Start: 10 mg/day; ↑5-HT, modulates several 5-HT receptors

66 hrs

CYP2D6

Cognitive benefit; nausea common; expensive

Bupropion 

(Wellbutrin) 

MDD, smoking cessation; Start: 150 mg/day; ↑Dopamine, ↑NE

21 hrs

Activating lowers seizure threshold; no sexual side effects.

Name

Indication (FDA approval )& 

Starting dose

Half-life (T1/2)

CYP450 enzyme 

Notes/notable side effects/precautions/required diagnostics/therapeutic levels

Lithium

 Bipolar disorder (acute mania, maintenance); Start: 300 mg BID

 18–36 hrs

Not metabolised by CYP450

 Monitor renal function, thyroid levels (0.6–1.2 mEq/L); tremor, GI upset, toxicity risk.

Carbamazepine (Tegretol) 

 Bipolar mania, seizures; Start: 200 mg BID

 12–17 hrs

CYP3A4 (inducer)

 Autoinduction; monitor CBC, LFTs, drug levels; risk of SJS (HLA-B*1502)

Valproic Acid

 9–16 hrs

CYP2C9, UGT

 Monitor LFTs, platelets, drug levels (50–125 mcg/mL); weight gain, hepatotoxicity.

Lamotrigine (Lamictal)

 Bipolar depression; Start: 25 mg/day (slow titration)

 ~25 hrs

UGT1A4

 Risk of Stevens-Johnson Syndrome; slow titration needed; good for depressive phase