Antidepressants

Question 1

what are the statistics of suicide rates in people who are depressed

Answer 1

10-15%

Question 2

T/F depression can cause “pain in the brain” that feels the same as physical pain

Answer 2

True

Question 3

what emotion is a potential symptom from depression that is more common in men?

Answer 3

anger

Question 4

Define anhedonia

Answer 4

nothing gives pleasure

Question 5

define apathy

Answer 5

inability to think there are good things in life

Question 6

Why does bipolar depressive disorder have a higher risk of suicide?

Answer 6

their extreme swings of happiness can be followed by even more extreme depression

Question 7

T/F men are twice as likely to suffer from depression

Answer 7

False, 2-3 times more common in women

Question 8

what role do genetics play in depression?

Answer 8

40% of depression patients have a genetic disposition to it

Question 9

When are antidepressants used prophylactically?

Answer 9

after a patient has had depression and is no longer depressed, they can be prescribed to take antidepressants to prevent recurrent depression

Question 10

define reactive depression

Answer 10

a normal response to circumstances (such as grief)

Question 11

define agitated depression

Answer 11

fear, insomnia, extreme irritability, and restlessness

Question 12

define dysthmia

Answer 12

low level, long term (>2yr) melancholy

Question 13

define premenstrual dysphoric disorder

Answer 13

depression or anxiety the week or two before your period starts and usually goes away a couple days from starting period

Question 14

define post-partum depression

Answer 14

depression after giving birth, can last up to a year after delivery

Question 15

define psychotic depression

Answer 15

perception of reality becomes altered

Question 16

what are treatments we use for depression?

Answer 16

talk therapy
light therapy
antidepressants (ADMs)
exercise to reduce relapse
electroconvulsive therapy

Question 17

what are potential diagnoses we should rule out before diagnosing depression?

Answer 17

hypothyroidism or adverse drug rxns

Question 18

when do we use electroconvulsive therapy on depression patients?

Answer 18

when meds aren’t working or not working quick enough for the situation

Question 19

what are the advantages to electroconvulsive therapy?

Answer 19

rapidly effective and useful in resistant depression

Question 20

what are the disadvantages to electroconvulsive therapy?

Answer 20

typically causes confusion and memory

Question 21

what are the statistics for successful treatment with antidepressants?

Answer 21

70-80% effectiveness

Question 22

what do antidepressants improve for patients?

Answer 22

improve appetite, sleep, mood, and their behavior perceived by others (affect)

Question 23

what are other uses for antidepressants?

Answer 23

neuropathic pain, fibromyalgia, anxiety, or OCD

Question 24

what is the simple biogenic amine hypothesis?

Answer 24

extending the duration of biogenic amines (NE, serotonin, maybe dopamine) either through blockade or reuptake or inhibition of metabolism, elevates moods

Question 25

what are symptoms caused by drugs that target 5-HT?

Answer 25

agitation, appetite disturbance, sleep disturbance, anxiety, loss of libido

Question 26

what are symptoms caused by drugs that target NE?

Answer 26

attention deficit, poor working memory, reduced alertness, low energy, social withdrawal

Question 27

what two classes of antidepressants are consider "older agents" what are the disadvantages of the older agents?

Answer 27

tricyclic antidepressants and MAOIs more side effects

Question 28

what do tricyclic antidepressants block?

Answer 28

serotonin and NE reuptake

Question 29

SNRIs also block serotonin and NE reuptake, why do they not cause the same side effects as tricyclic antidepressants?

Answer 29

they act at less receptors

Question 30

what is a natural product/herbal remedy used to help with depression?

Answer 30

St. John's Wort

Question 31

explain the hypothesis: antidepressant action requires changes in brain structure

Answer 31

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

Question 32

which two transporters to tricyclic antidepressants block? what are they also useful for?

Answer 32

NE and 5-HT treating neuropathic pain

Question 33

list the tricyclic antidepressants

Answer 33

Imipramine Amitriptyline Desipramine Doxepin Maprotiline

Question 34

why do we see cardiovascular side effects from tricyclic antidepressants? what side effect in specific?

Answer 34

antagonism of a1 receptors -> low bp antagonism of muscarinic cholinergic receptors -> tachycardia NE activation of cardiac B receptors

Question 35

why do tricyclic antidepressants cause drowsiness and weight gain?

Answer 35

antagonism of histamine H1 receptors

Question 36

what do MAOIs block breakdown of?

Answer 36

NE and 5-HT

Question 37

what are three medications that are MAOIs?

Answer 37

Phenelzine Tranylcypromine Isocarboxazid

Question 38

what line of treatment do we consider MAOIs for depression? (first line? second line?.....)

Answer 38

last resort treatment

Question 39

what are other conditions MAOIs are useful for treating?

Answer 39

anxiety, phobias, hypersomnia, hyperphagia (extreme unsatisfied drive to consume food)

Question 40

what are some side effects of MAOIs?

Answer 40

insomnia followed by daytime sleepiness dry mouth loss of libido hepatotoxicity (phenelzine)

Question 41

what drug class should MAOIs not be mixed with due to risk of oversympathetic stimulation?

Answer 41

adrenergic stimulants

Question 42

why is serotonin syndrome a concern with pts using MAOIs?

Answer 42

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

Question 43

foods high in ______ have toxic interactions with MAOIs

Answer 43

tyramine

Question 44

what are the symptoms of serotonin syndrome?

Answer 44

causes hyperthermia, muscle rigidity, and mental disorientation

Question 45

what are the first line agents for depression and anxiety?

Answer 45

SSRIs

Question 46

why do SSRIs not have the same side effects as TCAs despite acting at the same receptors to treat depression?

Answer 46

they have no affinity for alpha, muscarinic, histamine, or dopamine receptors

Question 47

which SSRI should we avoid in elderly or bulimic patients and why?

Answer 47

Fluoxetine b/c it causes sodium inbalances

Question 48

which SSRI is the most stimulating?

Answer 48

Fluoxetine

Question 49

Why should Sertraline be less considered for teenagers?

Answer 49

it may cause increases suicidal ideation

Question 50

which two SSRIs have the largest selectivity for SERT over NET?

Answer 50

Citalopram and Escitalopram

Question 51

what are the side effects of SSRIs?

Answer 51

nausea headaches nervousness insomnia sexual dysfunction suicidal ideation

Question 52

what is discontinuation syndrome from SSRIs? how long does it last?

Answer 52

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

Question 53

what would happen if a pt were to OD on SSRIs?

Answer 53

seizures leading to death

Question 54

list the 4 SNRIs

Answer 54

Venlafaxine Duloxetine Desvenlafaxine Levomilnacipran

Question 55

T/F SNRIs have greater efficacy than SSRIs and are 1st line use for anxiety

Answer 55

false, same efficacy, but yes they are 1st line for anxiety

Question 56

in addition to having similar SEs to SSRIs, what other side effects do SNRIs have and why?

Answer 56

due to increasing NE at synapse may cause mild hypertension, dry mouth, increased HR, and dilated pupils

Question 57

list the serotonin antagonists and modulators

Answer 57

Vilazodone, Vortioxetine, Trazodone

Question 58

what is Vortioxetine classified as?

Answer 58

a 5HT1A/B partial agonist

Question 59

What is Trazodone classified as?

Answer 59

SERT blocker, H1 histamine and a1 antagonist

Question 60

what is a natural supplement that may have similar efficacy to SSRIs in treating depression?

Answer 60

St. John's Wort

Question 61

what metabolic pathway does St. John's Wort induce?

Answer 61

Cyp3A

Question 62

what are the atypical antidepressants that treat depression but don't target SERT/NET?

Answer 62

mirtazapine bupropion esketamine nasal spray dextrometorphan + bupropion brexanolone

Question 63

what makes mirtazapine a good drug of choice for anxiety with depression? when do we use it?

Answer 63

it has H1 antagonism for treatment resistant depression

Question 64

why is bupropion used to treat depression?

Answer 64

we currently do not know

Question 65

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?

Answer 65

for treatment resistant depression hours. about 5 days. 2x weekly dosing

Question 66

what are the SEs of esketamine nasal spray?

Answer 66

sedation, dissociation, visual disturbances, trouble speaking, confusion, numbness, dizziness

Question 67

what drug class is esketamine nasal spray?

Answer 67

NMDA receptor antagonist

Question 68

how long does it take for dextromethorphan + bupropion to have benefits? what is the reasoning why this combo might work for depression?

Answer 68

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

Question 69

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?

Answer 69

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