antidepressants

Question 1

Features of MDD

Answer 1

• depressed mood for 2+ weeks
• sleep disturbances
• thoughts of guilt, worthlessness & suicide
• elevated cortisol levels indicating dysregulation of the HPA axis
• loss of BDNF causing atrophy of hippocampus, medial cortex & anterior cingulate (pain & stress can also decrease BDNF) -> hippocampus regulates the HPA axis
• primary indication for antidepressants in treatment of MDD
• tryptophan dietary deficiency can cause decreased serotonin

Question 2

serotonin receptor

Answer 2

5-HT1a and 5-HT2c

Question 3

SSRI (6)

Answer 3

fluoxetine
sertraline
citralopram
escitralopram
paroxetine
fluvoxamine

Question 4

5-HT2a antagonists (2)

Answer 4

Trazadone (highly sedating)

Nefazodone

Question 5

MAOIs (4)

Answer 5

phenylzine
tranylcypromine
selegiline**
isocarboxazid

**has amphetamine-like metabolite so stimulates CNS

Question 6

UNIcyclic antidepressant (1)
blocks DA reuptake

Answer 6

bupropion

Question 7

TETRAcyclic antidepressants (3)

Answer 7

mirtazapine (no activity at NE or 5-HT transporter) ->sedating

• *amoxapine (NE reuptake blocker)
• *maprotiline (NE reuptake blocker)
• • = used for MDD unresponsive to other agents

Question 8

TRIcyclic antidepressants (4)

Answer 8

imipramine
desimipramine (more selective & more potent)
amitryptyline
nortriptyline

Question 9

SNRIs (4)

Answer 9

venlafaxine
desvenlafaxine
duloxetine
milnacipran ->fibromyalgia tx

Question 10

other uses for antidepressants

Answer 10

GAD, PTSD, OCD, neuropathic pain, fibromyalgia, PMDD, vasomotor symptoms of menopause, stress urinary incontinence

Question 11

primary substrates of MAO

Answer 11

A = NE, epi and serotonin
in brain, gut, liver & placenta
B= tryptamine & benzylamine

Question 12

foods with tyramine

Answer 12

cheeses, overripe fruit, fresh homemade yeast breads, air-dried meats, beer,wine, gravies & concentrated sauces