Anti-depressant agents

Question 1

ANtidepressive pathways involve monoamines how?

Answer 1

NE and 5HT acts on GPCR and brain derived neurotropic factors (BDNF) acting on TrkB to switch on genes that promote neurogenesis and protecting against apoptosis.

Question 2

SSRI drugs

Answer 2

Escitalopram
fluoxetine
paroxetine

5HT reuptake inhibitors

(no sedative and no antimuscarinic action)

Question 3

MAOIs (phenylzine)

side effect

Answer 3

phenylzine:
can cause hypertensive crisis with decongestants or foods high in tyramine due to acute increase in NE release

(presynaptic accumulation and release into synapse)

Question 4

How many days does it take for onset of therapeutic effect of Lithium?

Answer 4

10-21 days for onset

Question 5

How does lithium work as an antimanic drug?

Answer 5

Increase 5HT action or diminish NE + DA effect by interference with PIP recycling

Question 6

DOes Lithium have a high or narrow therapeutic index?

Answer 6

Narrow

(BDZ have high)

• good for both manic and depressive episodes, common in combo with other agents

Question 7

____ disorders are the most common psychiatric illnesses, followed by ___ disorders

Answer 7

Anxiety, mood (25%)

Question 8

SIGECAPS is when how many symptoms have persisted for _____ weeks

Answer 8

Depression

5/m symptoms

2 weeks

Question 9

DIGFAST

Answer 9

mania

E for at least 1 week, and present most of the day nearly every day

Question 10

Melancholic depression

Answer 10

mood worse in the morning early morning awakenings, anorexia, weight loss, guilt

Question 11

Bipolar I vs Bipolar II

Answer 11

I: pts with only mania

II: pts with hypomania AND major depression

Question 12

Mood disorder diff dx

Answer 12

Mood disorders (bipolar + depressive disorders) can be due to :

Endocrine
- cushings, hyper/hypothyroidism, steroids
Infections

• HIV, influenza, mengitis, Creutzfeld Jakob

CNS
- Stroke, tumor, MS, epilepsy

Metabolic
- Hypercalcemia

Question 13

Depressive disorder types

Answer 13

Major depressive disorder

Dysthymic disorder

Question 14

True/False depression is a chemical imbalance as well as defect in multiple interactive pathways

Answer 14

false

• not chemical imbalance
• yes to neuroendocrine dysfxn

Question 15

Neuroendocrine dysfxn in depression

Answer 15

Activation of HPA axis to stress →
paraventricular nucleus of hypothalamus secretes CRF →
anterior pituitary secretes (ACTH) →
adrenal cortex secretes cortisol/glucocorticoids →
affects general metabolism/behavior

Question 16

Bipolar disorder is the ____ leading cause of death 25-34 years old

Answer 16

2nd

11th leading cause of death overall