Anti-depressants Flashcards
Monoamine hypothesis
Generally a consistenet deficiency in the monoaminergic NTs (NE & 5-HT)
(functional deficiency = how much is available at the synapse, can neurotransmission be maintained by the amount that is there?)
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only ______% of patients responsd to anti-depressants
40-50
(most end up on combination drugs)
What are the top drugs used in households?
- Sertraline
- Escitalopram
- Fluoxetine
(antidepressants)
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The last antidepressant was developed in _____.
1990
(they’ve been around since the 50’s. They are the most used drugs, says a lot about how we are doing w/mental health)
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______ helps with neural plasticity.
Psychedelics - use must be monitored by physicians
(sprouts new dendrites. These will likely be used in psychiatry soon. research trials are increasing)
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What are some substances being researched for future depression treatment?
- NO
- Psychodelics (psilocybin)
Most common mood disorders
- Depression
- Bipolar disorder
- Seasonal affective disorder (SAD)
- Self-harm
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Reserpine: MOA
blocks VAMT → inhibits NE re-uptake
(depletion of monoamine & symptoms of depression)
Iproniazid: MOA
inhibits MAO (monoamine oxidaze) enzymes
(alleviates symptoms of depression)
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Limitations of the monoamine hypothesis of depression
- Therapeutic lag for up to 1 month
- No scientific basis for depletion / lack of NTs
- Hippocampal atrophy and loss of BDNF (brain derived neurotropic factor - food for the brain)
Serotonin promotes neurogenesis through ____ during depression and may underlie the beneficial effect of certain antidepressants.
BDNF
Rapid relief of depressive symptoms with ______.
Ketamine
Stress hypothesis of depression (3)
- Chronically elevated levels of glucocorticoids limits transcription and translation of BDNF (brain food)
- Thyroid dysregulation→ increases thyroxine
- Estrogen & testosterone decreases
(loss of dendritic sprouts, decreased TH4)
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Why is there a therapeutic lag with antidepressants?
It takes time to increase the transcription of “brain food” (BDNF)
(note how cortisol inhibits this process)
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Comorbidities of antidepressants
- Smoking cessation
- Epilepsy or bulimia
- Chronic pain
- Anxiety
(antidepressants may also treat these conditions)
Bupropion treats depression & ______.
- smoking cessation
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SNRI’s & TCAs treat depression & also ______ .
- chronic pain (fibromyalgia & diabetic peripheral neuropathy)
SNRI & TCA pain modulation MOA
Facilitate descending pain modulation at second and first order neurons
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Which antidepressant is being used to treat covid symptoms?
Fluvoxamine
(prevents cytokine storm)
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Considerations in prescribing antidepressants
- Sexual dysfunction
- Weight gain
- Hypertension (SNRI’s)
- Bipolar
(this is especially important for PCP’s to understand)
______ (2) antidepressant types that increase the incidence of sexual dysfunction
- SSRI
- SNRI
(bupropion does not cause this, and actually may alleviate it)
Antidepressant that may increase the risk of hypertension
SNRI
(it basically activates the sympathetic nervous system)