17 - Anti-depressant Drugs Flashcards
Symptoms of major depression
Fatigue, loss of energy, diminished ability to concentrate, depressed mood, insomnia, weight loss, decreased appetite
Brain regions associated with depression
o Amygdala o Ventrolateral prefrontal cortex o Dorsolateral prefrontal cortex o Medial prefrontal cortex o Striatal regions (ventral striatum) o Hippocampus
Function of prefrontal cortex and how it relates to depression
Prefrontal cortex gives us control over our reactions
This control is weak in depression
Genes linked to depression?
5HT transporter polymorphism
May lead to different levels of transcription of the transporter
Higher risk of depression after significant life events
Modulates response to stress
Where would there be abnormal action in a depressed brain
Sub genial prefrontal cortex
What is the default mode network
Imaging technique that shows what regions of the brain are active when brain is in wakeful rest
Which NTS are associated with mood disorders
NA
5HT
MoA of tricyclic antidepressant
Inhibits reuptake of amines (5ht and NA)
Examples of TCAs
Clomipramine Imipramine Desipramine Amitriptyline Nortritryptaline Prototypes line
Which other receptors do TCAs have affinity for
H1
Muscarinic
A1 and a2 adrenoreceptors
Adverse effects of TCAs
Overdose can cause cardiotoxicity
Adverse effects include dry mouth, blurred vision, constipation, weight gain, arrhythmia
Example of monoamine oxidase inhibitors
Phenelzine
Tranylcypromine
Iproniazid
What is the cheese effect
MOAs can react with tyramine containing foods such as mature cheese and red wine
So avoid when taking the medication
Ex of Selective Serotonin Reuptake Inhibitors
Citalopram
Fluoxetine
Parole tine
SE of SSRIs
Nausea, insomnia,headaches, GI problems
However no cardiotoxicity so safe in overdose
Example of Reversible monoamine oxidase inhibitors
Moclobemide
Serotonin noradrenaline reuptake inhibitors
Venlafaxine
noradrenaline reuptake inhibitors
Reboxetine
Noradrenic and specific serotonin antidepressants
Mirtazapine
Serotonin antagonist and reuptake inhibitor
Trazodone
Agomelatine
Melatonin mt1 and mt2 receptor agonist
5ht2c receptor antagonist
Reason for delay of action of antidepressants
Regulatory adaptation
Change in auto receptors
Drug discontinuation syndrome
When you suddenly stop taking antidepressants
Effects such as insomnia, agitation, nausea, dizziness
Prevent by gradual discontinuation of the drug
Outcomes of depression
Poor
Under diagnosis and treatment
50% patients stop treatment in first month
Phases of treatment of depression
Acute phase - first 6-12 weeks of treatment with aims of remission
Continuation - take medication for 6 months after full symptom control to maintain remission and prevent relapse
Maintenance treatment- prevention of recurrence, indicated in high risk patients
Non pharmacological treatment
Electro convulsive therapy
CBT
Vagus nerve stimulation
DBS - subcallosal singulate White matter area 25
Role of inflammation in depression
Neuronal loss in hippocampus caused by increase in cortisol and pro inflammatory cytokines
Bipolar disorder
Mood disorder characterised by cycles of depression and mania
Management of bipolar disorder
Lithium
Side effects of lithium for bd
Thirst, nausea, tremor
Must check renal and thyroid function
Narrow therapeutic margin 0.6 to 1mm
