Antidepressants

Question 1

Bipolar disorder is characterized by

Answer 1

Mood swings of mania and depression

Question 2

Bipolar mood swings are…

Answer 2

Not always controlled by the environment

Question 3

Bipolar mood swings usually occur…

Answer 3

In alternation of mania/depression but both can happen at the same time

Question 4

What is the monoamine theory of bipolar disorder?

Answer 4

Depression = decreased monoamine transmission

Mania = overactive monoamine transmission

Question 5

What are monoamines?

Answer 5

(Norepinephrine, serotonin 5-HT, dopamine)

Question 6

What are single-drug treatments for bipolar disorder?

Answer 6

Mood stabilizers (lithium) and antipsychotics

Question 7

What are multiple medication treatments for bipolar disorder?

Answer 7

A combination of antidepressants, antipsychotics, and lithium

Question 8

What does lithium do?

Answer 8

It may increase serotonin and GABA

it may decrease NE, Dopamine and glutamate transmission

Question 9

What does lithium do to IP3 and DAG?

Answer 9

Lithium decreases production of precursors for IP3 and DAG

Question 10

What are the 2 treatments for depression?

Answer 10

Therapy and medication

Question 11

Lithium works better in which phase of bipolar disorder?

Answer 11

It is better at stabilizing the manic phase

Question 12

What are the different types of antidepressants?

Answer 12

Amine reuptake blockers and Monoamine oxidase inhibitors

Question 13

What are the 2 categories of amine reuptake-blocking drugs?

Answer 13

Nonselective and selective reuptake inhibitors

Question 14

What is an example of a nonselective amine reuptake blocker?

Answer 14

Tricyclic Antidepressants

Ex. Impiramine

Prevents reuptake of NE and serotonin

Question 15

How effective is Imipramine

Answer 15

Imipramine (TCA) is effective in approx 70% of patient

Question 16

Is imipramine a first-line treatment?

Answer 16

No, the adverse effects and drug-drug effects make it worse than other options for first line

Question 17

What are the adverse effects of TACs?

Answer 17

Tricyclic antidepressant adverse effects inc.

Block cardiac sodium channels
Antagonize muscarinic receptors (dry mouth, constipation)
Antagonize H1 and Alpha 1 receptors (Sleepiness)

Question 18

What is an example of a selective serotonin reuptake inhibitor? (SSRI)

Answer 18

Fluoxetine (PROZAC)

Question 19

What is fluoxetine used for?

Answer 19

Depression, panic disorders, OCD, bulimia

Question 20

What are the common side effects of SSRIs?

Answer 20

Insomnia and sexual dysfunction

Increased suicide rate

Question 21

Are SSRIs dangerous?

Answer 21

Not typically unless combined with other antidepressants (inhibits CYP2D6 which metabolizes MAO inhibitors)

Can cause serotonin syndrome?

Question 22

What is serotonin syndrome?

Answer 22

A condition caused by too much brain serotonin

Symptoms:

Tachycardia, shivering, seizures, diarrhea

Question 23

How is serotonin syndrome cured?

Answer 23

Benzodiazepines to help with muscle contractions

Cyproheptadine to block serotonin production

Question 24

What are newer class antidepressants?

Answer 24

Includes drugs like SNRIs and NRIs

Question 25

What is an example of an atypical antidepressant?

Answer 25

Bupropion

Question 26

What does bupropion do?

Answer 26

Bupropion inhibits DA and NE reuptake

Question 27

What is special about bupropion?

Answer 27

It has fewer side effects than TCAs but still inhibits CYP2D6

Question 28

What are MAO inhibitors?

Answer 28

Monoamine oxidase inhibitors are drugs which inhibit monoamine oxidase, an enzyme that breaks down monoamines.

Question 29

What is an example of an MAO?

Answer 29

Phenelzine

Question 30

When are Monoamine oxidase inhibitors prescribed?

Answer 30

When TCAs arent an efficient treatment option

Question 31

What are the toxicities of MAOs?

Answer 31

Shouldn't be taken with other antidepressants, can lead to serotonin syndrome Hypertensive crisis can occur if tyramine-containing foods are ingested.

Question 32

What monoamine levels do MAOs increase?

Answer 32

inhibiting MAO-A = increased NE, Serotonin, Tyramine inhibiting MAO-B = increased dopamine

Question 33

Why are SSRIs usually prescribed first?

Answer 33

They have less side effects and can't OD on them easily

Question 34

Antidepressant therapy usually starts with a ___ dose and can take _____ weeks to show effects

Answer 34

Antidepressant therapy usually starts with a low dose and can take 3-8 weeks to show effects

Question 35

Why do antidepressants take so long to show observable effects?

Answer 35

The adaptive brain changes are likely more important than the immediate chemical changes

Question 36

Long-term treatment with antidepressants has been reported to...

Answer 36

alter the brains sensitivity levels to various CNS receptors these changes may "cure the depression"