Anti-Depressants and Anxiolytics

Question 1

What Anxiolytics are used to treat anxiety?

Answer 1

• Benzodiazepines
• Non-Benzodiazepines
• Sedative-Hypnotics

Question 2

What anti-depressants are used in the treatment of depression?

Answer 2

• Monoamine Oxidase Inhibitors (MAOIs)
• Tricyclic antidepressants (TCAs)
• Selective Serotonin Reuptake Inhibitors (SSRIs)

Question 3

What Antipsychotics are used to treat psychosis?

Answer 3

• Neuroleptics
• Atypical drugs
• Lithium

Question 4

Explain Monoamine Oxidase Inhibitors (anti-depressant)

Answer 4

• Phenelzine (depression and bipolar disorder)
• Tranylcypromine (severe depression)
• Non-selective blockers of the metabolism of all monoamines
• Negatives of MAOIs
  
  • Hypertensive crisis, especially due to interactions with other drugs which produce increases in BP
  • Foods high in tyramine- “cheese effect”
  • Avoid tryptophan supplements or other psychoactive drugs- “serotonin-syndrome”
  • Inhibition of cytochrome P450 (breaks down drugs)
• Side Effects - weight gain, oedema, sexual dysfunction and sedation.

Question 5

Explain Tricyclic Antidepressants

Answer 5

• Imipramine- depression
• Amitriptyline - depression
• Doxepin - depression and anxiety.
• Non-selectively blocking the reuptake of noradrenaline and serotonin, leading to increase in the availabilit of these transmitters at their respective receptors.
• Side effects - weight gain, sexual dysfunction, inhibits cytochrome P450 (breaks down drugs)
• Negative effects:
  
  • Adrenergic effects - contradicted for patients with MI, or coronary problems
  • Antihistaminergic effects - sedation, avoid other CNA depressants and antihistamines
  • Anticholinergic effects - dry mouth, blurred vision, dizziness, headache and constipation.

Question 6

Explain Selective Serotonin Reuptake Inhibitors (SSRIs) (antidepressants)

Answer 6

• Fluoxetine - depression and OCD
• Paroxetine - depression and panic disorders
• Sertraline - depression and panic disorders
• Citalopram - depression
• Side effects - sexual dysfunction, dependance and withdrawal, interact with MAOIs, benzodiazepines, cimetide and warfarin.

Question 7

What other antidepressants are used?

Answer 7

• Bupropion - depression
• Venlafaxine - depression
• Inhibit serotonin, noradrenaline (and dopamine and bupropion) reuptake.

Question 8

How are mood stabilisers used to treat mood disorders?

Answer 8

• Lithium Carbonate - prophylaxis and acute mania
• Lithium Citrate - prophylaxis and acute mania
• Carbamazepine - mania and epilepsy
• Valproate - mania and epilepsy
• Contradictions - patients with renal dysfunction, leukaemia, dehydration or sodium depletion
• Side effects - dizziness, headache, confusion, hair loss, oedema, cardiac dysrhythmias, nephrotoxicity.
• Toxicity, withdrawal and birth deformities.

Question 9

How are sedative-hypnotics used to treat anxiety?

Answer 9

• Thiopental - surgery prep
• Secobarbital - insomnia, anxiety, agitation
• Phenobarbital - insomnia, anxiety, seizures
• Zolpidem - insomnia
• Contradictions - avoid other CNS depressants, risk of fatal OD. Dependance and tolerance - seizures on withdrawal.
• Side effects - drowsiness or ‘hangover’

Question 10

How are Benzodiazepines used to treat anxiety.

Answer 10

• Diazepam - anxiety and seizures.
• Alprozolam - anxiety and panic disorders
• Temazepam - insomnia
• Lorazepam - anxiety, status epilepticus, preoperative sedation and amnesia.
• Contradictions - avoid CNS depressants, accumulation of metabolites (sedation, CNS depression and ataxia), renal/hepatic dysfunction, flaucoma, pregnancy and lactation.
• Side effects - headache, dry mouth, blurred vision, dizziness, memory loss, hypotension.

Question 11

How are Non-Benzodiazepines used to treat anxiety

Answer 11

• Buspirone - anxiety and depression
• Contradictions - avoid other CNS depressants, never with MAOIs
• Side effects - headache, dry mouth, blurred vision, dizziness, memory loss, hypotension.

Question 12

How are typical antipsychotics/neuroleptics used to treat psychosis?

Answer 12

• Chlorpromazine- psychosis and schizophrenia
• Fluphenazine - psychosis and schizophrenia
• Haloperidol - psychosis and behaviour problems
• Loxapine - mood disorders and schizophrenia
• Side Effects - parkinsonism, tardive dyskinesia, sedation, hypotension, impaired thermoregulation and lactation.
• Contradictions - avoid CNS depressants and anticonvulsants. CVD, bone marrow depression, renal, liver or thyroid dysfunction or Parkinsons disease.

Question 13

How are atypical antipsychotics used to treat psychosis.

Answer 13

• Clozapine - schizophrenia
• Amisulpride - schizophrenia
• Risperidone - schizophrenia
• Olanzapine - schizophrenia
• Contractions - avoid CNS depressants and antihypertensives, glaucoma, peptic ulcer disease, urinary retention, dysrhythmias, hepatic dysfunction.
• Side effects - headache, dry mouth, blurred vision, dizziness, memory loss, hypotension, weight gain.

Question 14

Haloperidol is a dopamine (D2) receptor antagonist used to treat psychosis. Which of the following is a likely adverse effect of this drug?

Answer 14

Parkinson’s Disease like symptoms

Question 15

Citalopram (Celexa) increases synaptic levels of

Answer 15

serotonin

Question 16

Dopamine, noradrenaline and serotonin are all

Answer 16

monoamine transmitters