Antidepressants

Question 1

What are classifications of antidepressants

Answer 1

Monamine oxidase inhibitors
Tricyclic Antidepressants
Selective serotonin reuptake inhibitors
Selective noradrenaline reuptake inhibitors
Selective serotonin and noradrenaline reuptake inhibitors ( SSNRIS)
New developments Ketamine , psilocybin

Question 2

Why are Monamine oxidase inhibitors used ?

Answer 2

Used as a last line of treatment after tricyclics and SSRIs .

Question 3

What is monoamine oxidase inhibitors most useful for ?

Answer 3

Those who have phobic or hypochondriac element to their depression

Question 4

Mode of action

Answer 4

Monamine oxidase is an enzyme in the body that breaks down noradrenaline. They inhibit the action of Monamine oxidase therefore increasing the levels of noradrenaline . They can cause the effect called the ‘cheese effect ‘ which is associated with a substance called tyramine .

Question 5

What is tyramine

Answer 5

A substance normally broken down in the gut by Monamine oxidase ,when Monamine oxidase are taken they prevent tyramine from being broken down .
It’s present in certain foods , when a person takes these foods and is on MAOIs there is a serious rise in their blood pressure.

Question 6

What foods include tyramine

Answer 6

Cheese ,bovril salami , beer,soy sauce

Question 7

What other food should also be avoided

Answer 7

Over ripe or food that is going off for example meat,fish ,poultry

Question 8

Symptoms

Answer 8

Throbbing headaches ,high temp,stiff neck ,these could be an indication to a dangerous rise in blood pressure.
Dizziness ,postural hypotension,sexual dysfunction

Question 9

Indications for use

Answer 9

Sedative action,useful in agitated depression with sleep disturbance

Question 10

Mode of action

Answer 10

Tricyclics inhibit the reuptake of noradrenaline and serotonin increasing both these neurotransmitters that have a non selective action .

Question 11

Side effects

Answer 11

Cardio toxic ,dangerous on overdose and potentially fatal

Question 12

Antimuscarinic side effects

Answer 12

Dry mouth ,constipation ,blurred vision and urinary retention

Question 13

Other side effects

Answer 13

Tachycardia ,hypotension ,arrhythmias ,sexual dysfunction ,nausea and vomitting ,weight gain and taste disturbance .

Question 14

Tricyclic antidepressants

Answer 14

Amitriptyline hydrochloride (triptafen , tryptizol)
Clomipramine hydrochloride (Anafril)
Dosulepin hydrochloride

Question 15

Selective serotonin reuptake inhibitors

Answer 15

Depression
Anxiety
Treatment of OCD,panic disorder ,bulimia nervosa

Question 16

Mode of action

Answer 16

Selectively inhibit the reuptake of serotonin thereby increasing levels in the brain

Question 17

Are selective serotonin reuptake inhibitors cardio toxic

Answer 17

No therefore safer on overdose

Question 18

Gastrointestinal side effects are common

Answer 18

E.g nausea

Question 19

Side effects

Answer 19

Sexual dysfunction is widely reported and may continue after medication is stopped
Hypersensitivity reactions including rash
Increased risk of bleeding
Fluoxetine (Prozac)
Sertealine (citalopram, escitalopram)

Question 20

What are SSRIs useful for

Answer 20

Depression with fatigue and apathy can increase energy and drive

Question 21

Mode of action

Answer 21

Inhibit the reuptake of noradrenaline therefore increasing levels in the brain

Question 22

Other side effects

Answer 22

Insomnia,sweatiness ,tiredness,postural hypotension

Question 23

Generalised anxiety disorder

Answer 23

Mode of action - inhibits the reuptake of both serotonin and noradrenaline

Question 24

Side effects

Answer 24

Nausea,headache,insomnia example venalfaxine

Question 25

New developments

Answer 25

Ketamine - dissociative anaesthetic person feels discontinued or detached
Clinical trials show some promising results

Question 26

Psilocybin

Answer 26

A psychadelic - in small doses has shown some promising results in trials for depression