Anti-depressant drugs Flashcards
How many people worldwide have depression
350 million people
Name some symptoms of major depression
Feelings of guilt and worthlessness Depressed mood Psychomotor retardation Fatigue Diminished ability to concentrate Diminished interest in social activity Psychomotor agitation Insomnia Weight loss Adhedonia Suicidal ideation
Name 5 genes thought to be related to depression
GRIK4 CRHR1 SLC6A4 COMT MAOA
What does GRIK4 stand for
kainic acid type glutamate receptors KA1
What does CRHR1 stand for
corticotropin releasing hormone receptor 1
Which 2 pathways are mainly associated with mood disorders
Noradrenergic and serotonergic pathway
When does 5-HT neuronal activity decrease
Sleep
When do 5-HT neurones have slow activity
During resting/ waking phase
Name some brain areas associated with depression
Amygdala Ventrolateral prefrontal cortex Dorsolateral prefrontal cortex Medial prefrontal cortex Striatal regions Hippocampus
Is there increased or decreased brain metabolism in these areas
Decreased
Increased or decreased cortical thickness in majoro depression
Decreased
When is 5-HT transporter polymorphism associated with major depression
After a significant life event
Name 4 areas of the brain that are hyperactive in major depression
Hippocampus
Amygala
Subgenual cingulate
Medial prefrontal cortex
Name 2 areas of the brain that are hypoactive in major depression
Ventrolateral prefrontal cortex
Dorsolateral prefrontal cortex
What does interaction between key structures involved in depression explain
Circuit propses explanation for rumination
Name 4 classes of antidepressant drugs
Tricyclic antidepressants
Monoamine oxidase inhibitor
Selective serotoninc reuptake inhibitors
Reversable monoamine oxidase inhibitors
Name 5 TCAs
Clomipramine Imipramine Desipramine Amitriptyline Nortriptyline Protriptyline
What do TCAs do?
Inhibit amine reuptake
What receptors do TCA have a high affinity for
H1 muscarinic
alpha 1
alpha 2
Adverse effects of TCA?
Dry mouth Blurred vision Constipation Urinary retention Fatigue Sedation Postural hypotension
Name 3 monoamine oxidase inhibitors
Phenelzine
Tranylocypromine
Iproniazid
How do MAOIs work
Irreversible inhibition of this enzyme
What do MAOIs have interactions with
Tyramine containing foods
Pethidine and sympathomimetic compounds
What kind of depression do MAOIs treat
atypical
Name 3 SSRIs
Citalopram
Fluoxetine
Paroxetine
Which is the most selective SSRI
Citalopram
Adverse effects of SSRI
Nausea Headaches GI problems Increased aggresion Insomina Anxiety Sexual dysfunction
Name a reversible monoamine oxidase inhibitor
Maclobemide
Adverse effects of reverse monoamine oxidase inhibitors
Nausea
Agitation
Confusion
Which receptor are monoamine selective for
MOAa
Name 4 other/ minor classes of antidepressant
Serotonin noradrenaline reuptake inhibitors
Noradrenaline reuptake inhibitors
Serotonin antagonist reuptake inhibitor
Noradrenergic and specific serotonergic
Give an example of serotonin noradrenaline reuptake inhibitor
Venlafaxine
Give an example of a noradrenaline reuptake inhibitor
Reboxetine
Give an example of serotonin antagonist and reuptake inhibitor
Trazodone
Give an example of noradrenergic and specific serotonergic
Mirtazapine
How does the drug agomelatine work as an antidepressant
Agonist at melatonin MT1 and MT2 receptor
Antagonist at 5-HT2c receptor
Why is there a delay in action of anti-depressant drugs
Due to changes in autoreceptors
Describe the changes in autoreceptors that occur when somebody takes TCAs
Inhibit amine reuptake
Immediate increase in synaptic concentration of amines may lead to activation of somatic autoreceptors
Activated autoreceptors= decreased firing of neurones
During first few weeks, autoreceptors desensitise, so neurones return to normal rate
Inhibition of reuptake continues, amine levels remain high= full efficacy
When does antidepressant drug discontinuation syndrome happen
Decrease in dosage/ stopping anti depressant
Symptoms of antidepressant drug discontinuation syndrome
Insomnia Anxiety Nausea Vomiting Electric shock sensation Mood swings Agitation Diarrhoea/ abdominal cramps
What is bipolar disorder
Mood disorder characterised by cycles of depression and mania
What can be used as maintenance treatment for bipolar disorder
Lithium
Adverse effects of lithium treatment for bipolar disorder
Thirst Nausea Fine tremor Polyuria Weight gain Oedema Acne
Name 2 mood stabilisers used for bipolar disease
Carbamezapine
Sodium valproate
What is the ‘risk order’ from most to least risky in types of anti-depressants causing manic episodes
TCA
SNRI
MAOI
SSRI
What is phase 1 of treating depression
6-12 weeks
Aims at remission (control of symptoms)
What is phase 2 of treating depression
Continuation treatment
6 months after to prevent relapse
What is phase 3 of treating depression
Prevention of further recurrence
Name 4 non pharmacological treatments for depression
CBT
DBS
Electroconvulsive therapy
Vagal nerve stimulation
Do depression patients have more or less white matter in hippocampus
Less
How do levels of cortisol and proinflammatory cytokines differ in patients with depression
They are higher
