Anti-depressant drugs

Question 1

What is depression characterizsed by?

Answer 1

↓ in NE and 5-HT activity

Question 2

Traetment aim for depression?

Answer 2

increase monoaminergic neurotransmitters in the brain–> ↑ NE, 5-HT and DA

Question 3

Categories of Anti-depressant drugs

Answer 3

1) Amine reuptake inhibitors
- TCAs- Tricyclic antidepressants
- SSRIs- Serotonin selective reuptake inhibitors
- SNRIs- Serotonin/Norepinephrine reuptake inhibitors

2) Monamine oxidase inhibitors (MOAIs)
3) Atypical anti-depressant drugs

Question 4

TCAs drugs

Answer 4

1) Imipramine
2) clomipramine
3) Amitriptyline

Question 5

MoA of TCAs?

Answer 5

Non-specific blockade of 5-HT
and NE reuptake

Question 6

Clinical uses of TCAs?

Answer 6

1) Major depression
2) OCD
3) Phobic/anxious states
4) Neuropathic pain

Question 7

Adverse effects of TCAs

Answer 7

1. Sedation (H1 block).
2. Postural hypotension (a-adrenoceptor block).
3. Dry mouth, blurred vision, constipation (muscarinic block)

Toxicity:
The “3 Cs” –> Coma, Convulsions, and Cardiotoxicity

Question 8

TCAs drug interactions

Answer 8

1) Hypertensive crisis with MAO inhibitors
2) Serotonin syndrome with SSRIs, MAO inhibitors, and meperidine.
3) Prevent antihypertensive action of a2 – agonists.

Question 9

SSRIs drugs

Answer 9

1) Fluoxetine
2) Paroxetine
3) Citalopram
4) Sertaline

Question 10

MoA of SSRIs

Answer 10

Highly selective blockade of serotonin transporter (SERT) –> ↓ 5-HT reuptake

Question 11

Indication of SSRIs

Answer 11

1) Major depression
2) OCD
3) bulimia
4) Anxiety disorders ( chronic/acute Tx w/ BZPs)

Question 12

Adverse effects of SSRIs

Answer 12

1) bruxism (teeth clenching)
2) Sexual Dysfunction
3) weightloss

Toxicity
Serotonin syndrom (sever muscle rigidity, Hyperthermia, cardiovascular instability& seizures)

Question 13

SSRIs drug interactions?

Answer 13

Serotonin syndrome with MAO inhibitors, meperidine, and TCAs

Question 14

A withdrawel syndrome of SSRIs are described as?

Answer 14

**FLUSH **
1) flue-like symptoms –> fatigue, nausea, Diarrhea, Diaphoresis (sweating)
2) Light headedness
3) Uneasiness/ restlessness
4) Sleep, sensory disturbance
5) Headache

Question 15

SNRIs drugs

Answer 15

1) Duloxetine
2) Venlafaxine

Question 16

Indication of SNRIs

Answer 16

**Venlafaxine and Duloxetine **
1) Major depression
2) chronic pain
3) OCD

**Duloxetine **
1) Neuropathic pain
2) Fibromylagia

Question 17

Indications of Duloxetine

Answer 17

1) Major depression
2) Neuropathic pain
3) Fibromayalgia

Question 18

MoA of SNRIs

Answer 18

SNRIs bind to transporters for both 5-HT and NE

Question 19

Adverse effects of SNRIs

Answer 19

Toxicities:
1. Anti-cholinergic
2. Sedation
3. Hypertension (venlafaxine)

Question 20

MOAIs drugs

Answer 20

1) Phenylzine
2) Tranylcypromine

Question 21

MoA of MOAIs

Answer 21

Inhibition of MAO A and MAO B.

Question 22

Indications of MOAIs

Answer 22

1. Significant anxiety
2. Phobia
3. Hypochondriasis

Question 23

Adverse effects of MOAIs

Answer 23

1. ↑ NE leads to hypertensive crisis;
2. ↑ 5-HT leads to serotonin syndrome

Question 24

First line treatment for depression

Answer 24

SSRIs –> First line agents, particularly in patients with significant fatigue or pain syndromes associated with the episode of depression.
* SNRIs –> second-line agents in patients who have not responded to SSRIs.
* MAOIs –> most useful in patients with significant anxiety, phobic features and hypochondriasis