Antidepressants Flashcards
what are the statistics of suicide rates in people who are depressed
10-15%
T/F depression can cause “pain in the brain” that feels the same as physical pain
True
what emotion is a potential symptom from depression that is more common in men?
anger
Define anhedonia
nothing gives pleasure
define apathy
inability to think there are good things in life
Why does bipolar depressive disorder have a higher risk of suicide?
their extreme swings of happiness can be followed by even more extreme depression
T/F men are twice as likely to suffer from depression
False, 2-3 times more common in women
what role do genetics play in depression?
40% of depression patients have a genetic disposition to it
When are antidepressants used prophylactically?
after a patient has had depression and is no longer depressed, they can be prescribed to take antidepressants to prevent recurrent depression
define reactive depression
a normal response to circumstances (such as grief)
define agitated depression
fear, insomnia, extreme irritability, and restlessness
define dysthmia
low level, long term (>2yr) melancholy
define premenstrual dysphoric disorder
depression or anxiety the week or two before your period starts and usually goes away a couple days from starting period
define post-partum depression
depression after giving birth, can last up to a year after delivery
define psychotic depression
perception of reality becomes altered
what are treatments we use for depression?
talk therapy
light therapy
antidepressants (ADMs)
exercise to reduce relapse
electroconvulsive therapy
what are potential diagnoses we should rule out before diagnosing depression?
hypothyroidism or adverse drug rxns
when do we use electroconvulsive therapy on depression patients?
when meds aren’t working or not working quick enough for the situation
what are the advantages to electroconvulsive therapy?
rapidly effective and useful in resistant depression
what are the disadvantages to electroconvulsive therapy?
typically causes confusion and memory
what are the statistics for successful treatment with antidepressants?
70-80% effectiveness
what do antidepressants improve for patients?
improve appetite, sleep, mood, and their behavior perceived by others (affect)
what are other uses for antidepressants?
neuropathic pain, fibromyalgia, anxiety, or OCD
what is the simple biogenic amine hypothesis?
extending the duration of biogenic amines (NE, serotonin, maybe dopamine) either through blockade or reuptake or inhibition of metabolism, elevates moods
what are symptoms caused by drugs that target 5-HT?
agitation, appetite disturbance, sleep disturbance, anxiety, loss of libido
what are symptoms caused by drugs that target NE?
attention deficit, poor working memory, reduced alertness, low energy, social withdrawal
what two classes of antidepressants are consider “older agents”
what are the disadvantages of the older agents?
tricyclic antidepressants and MAOIs
more side effects
what do tricyclic antidepressants block?
serotonin and NE reuptake
SNRIs also block serotonin and NE reuptake, why do they not cause the same side effects as tricyclic antidepressants?
they act at less receptors
what is a natural product/herbal remedy used to help with depression?
St. John’s Wort
explain the hypothesis: antidepressant action requires changes in brain structure
this hypothesis aims to explain why antidepressants take weeks to months to become effective. Ultimately, increased 5-HT transmission over a long term will lead to structural changes in the brain
Essentially, they increase neurotrophic agents leading to structural changes, especially on the hippocampus that improve mood
which two transporters to tricyclic antidepressants block?
what are they also useful for?
NE and 5-HT
treating neuropathic pain
list the tricyclic antidepressants
Imipramine
Amitriptyline
Desipramine
Doxepin
Maprotiline
why do we see cardiovascular side effects from tricyclic antidepressants?
what side effect in specific?
antagonism of a1 receptors -> low bp
antagonism of muscarinic cholinergic receptors -> tachycardia
NE activation of cardiac B receptors
why do tricyclic antidepressants cause drowsiness and weight gain?
antagonism of histamine H1 receptors
what do MAOIs block breakdown of?
NE and 5-HT
what are three medications that are MAOIs?
Phenelzine
Tranylcypromine
Isocarboxazid
what line of treatment do we consider MAOIs for depression? (first line? second line?…..)
last resort treatment
what are other conditions MAOIs are useful for treating?
anxiety, phobias, hypersomnia, hyperphagia (extreme unsatisfied drive to consume food)
what are some side effects of MAOIs?
insomnia followed by daytime sleepiness
dry mouth
loss of libido
hepatotoxicity (phenelzine)
what drug class should MAOIs not be mixed with due to risk of oversympathetic stimulation?
adrenergic stimulants
why is serotonin syndrome a concern with pts using MAOIs?
since they are usually add-on therapies, other drugs pt is on likely also increase serotonin in synaptic cleft, so the risk increases with more drugs used
foods high in ______ have toxic interactions with MAOIs
tyramine
what are the symptoms of serotonin syndrome?
causes hyperthermia, muscle rigidity, and mental disorientation
what are the first line agents for depression and anxiety?
SSRIs
why do SSRIs not have the same side effects as TCAs despite acting at the same receptors to treat depression?
they have no affinity for alpha, muscarinic, histamine, or dopamine receptors
which SSRI should we avoid in elderly or bulimic patients and why?
Fluoxetine b/c it causes sodium inbalances
which SSRI is the most stimulating?
Fluoxetine
Why should Sertraline be less considered for teenagers?
it may cause increases suicidal ideation
which two SSRIs have the largest selectivity for SERT over NET?
Citalopram and Escitalopram
what are the side effects of SSRIs?
nausea
headaches
nervousness
insomnia
sexual dysfunction
suicidal ideation
what is discontinuation syndrome from SSRIs?
how long does it last?
if pt abruptly stops taking they can experience nightmares, insomnia, cofusion and/or virtigo. increased irritability and agitation
can experience “brain zaps”, “brain shivers”
usually resolves after a few weeks
what would happen if a pt were to OD on SSRIs?
seizures leading to death
list the 4 SNRIs
Venlafaxine
Duloxetine
Desvenlafaxine
Levomilnacipran
T/F SNRIs have greater efficacy than SSRIs and are 1st line use for anxiety
false, same efficacy, but yes they are 1st line for anxiety
in addition to having similar SEs to SSRIs, what other side effects do SNRIs have and why?
due to increasing NE at synapse may cause mild hypertension, dry mouth, increased HR, and dilated pupils
list the serotonin antagonists and modulators
Vilazodone, Vortioxetine, Trazodone
what is Vortioxetine classified as?
a 5HT1A/B partial agonist
What is Trazodone classified as?
SERT blocker, H1 histamine and a1 antagonist
what is a natural supplement that may have similar efficacy to SSRIs in treating depression?
St. John’s Wort
what metabolic pathway does St. John’s Wort induce?
Cyp3A
what are the atypical antidepressants that treat depression but don’t target SERT/NET?
mirtazapine
bupropion
esketamine nasal spray
dextrometorphan + bupropion
brexanolone
what makes mirtazapine a good drug of choice for anxiety with depression?
when do we use it?
it has H1 antagonism
for treatment resistant depression
why is bupropion used to treat depression?
we currently do not know
when do we use esketamine nasal spray?
how long does it take to have an effect? how long does it last? how often is it given?
for treatment resistant depression
hours. about 5 days. 2x weekly dosing
what are the SEs of esketamine nasal spray?
sedation, dissociation, visual disturbances, trouble speaking, confusion, numbness, dizziness
what drug class is esketamine nasal spray?
NMDA receptor antagonist
how long does it take for dextromethorphan + bupropion to have benefits?
what is the reasoning why this combo might work for depression?
2 weeks
bupropion inhibits rapid metabolism of dextromethorphan to dextrorphan
dextromethorphan is a weak NMDA antagonist, sigma agonist, weak NET and SERT reuptake inhibitor, and mu opioid agonist
when do we use Brexanolone?
drug class?
time for effect?
length of effect?
how is it given?
how long does it take to give?
cost?
for post-partum depression
positive allosteric modulator of GABA A-receptor
within days
persist for at least a month
clinical administration only due to sedation and loss of consciousness
IV infusion for 60 hours
costs $34,000
