Antidepressants

Question 1

What are the major types of antidepressants?

Answer 1

The major antidepressants include:
* Selective serotonin reuptake inhibitors (SSRIs)
* Serotonin and norepinephrine reuptake inhibitors (SNRIs)
* Norepinephrine dopamine reuptake inhibitors (NDRIs)
* Tricyclic antidepressants (TCAs)
* Monoamine oxidase inhibitors (MAOIs)

None

Question 2

What are some examples of SSRIs?

Answer 2

Examples of SSRIs include:
* Fluoxetine (Prozac, Sarafem)
* Fluvoxamine (Luvox)
* Paroxetine (Paxil)
* Sertraline (Zoloft)
* Citalopram (Celexa)
* Escitalopram (Lexapro)

None

Question 3

What is the most frequently prescribed class of antidepressants?

Answer 3

SSRIs are the most frequently prescribed antidepressants

None

Question 4

What are SSRIs generally considered for treating?

Answer 4

SSRIs are generally considered to be the first-line pharmacological treatment for:
* Major depressive disorder
* Persistent depressive disorder

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Question 5

What other disorders can SSRIs be used to treat?

Answer 5

SSRIs are also used to treat:
* Premenstrual dysphoric disorder
* OCD
* Panic disorder
* Generalized anxiety disorder
* Social anxiety disorder
* PTSD
* Bulimia nervosa
* Premature ejaculation
* Bipolar I disorder (in conjunction with a mood stabilizer)

None

Question 6

How do SSRIs exert their effects?

Answer 6

SSRIs exert their effects by blocking the reuptake of serotonin by presynaptic neurons

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Question 7

What receptors do SSRIs increase serotonin availability at?

Answer 7

SSRIs increase serotonin availability at multiple postsynaptic serotonin receptors, including:
* 5-HT1A
* 5-HT2A
* 5-HT2C

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Question 8

Fill in the blank: SSRIs are _______ that increase serotonin availability.

Answer 8

indirect agonists

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Question 9

True or False: SSRIs are only used for treating major depressive disorder.

Answer 9

False

SSRIs are used for various other disorders, not just major depressive disorder.

Question 10

What are SSRIs comparable to in terms of effectiveness?

Answer 10

TCAs

SSRIs are compared to tricyclic antidepressants (TCAs) regarding their effectiveness.

Question 11

What are some side effects of SSRIs?

Answer 11

• Mild anticholinergic effects
• Gastrointestinal disturbances
• Insomnia
• Anxiety
• Sexual dysfunction

Sexual dysfunction can affect both men and women and may persist after discontinuation.

Question 12

What syndrome can occur with abrupt cessation of an SSRI?

Answer 12

Discontinuation syndrome

Symptoms include headaches, dizziness, mood lability, impaired concentration, sleep disturbances, and flu-like symptoms.

Question 13

What can occur when combining an SSRI with an MAOI, lithium, or other serotonergic drugs?

Answer 13

Serotonin syndrome

Serotonin syndrome is potentially fatal and involves extreme agitation, confusion, autonomic instability, hyperthermia, tremor, seizures, and delirium.

Question 14

What is tachyphylaxis in the context of SSRIs?

Answer 14

Antidepressant tolerance

Tachyphylaxis can also be referred to as antidepressant poop-out.

Question 15

What are some treatment strategies for tachyphylaxis?

Answer 15

• Increasing the current drug dosage
• Switching to a different SSRI
• Switching to an SNRI or a TCA
• Augmenting the current SSRI with another medication or depression-focused therapy

These strategies aim to address the issue of reduced effectiveness over time.

Question 16

How long does it typically take for initial therapeutic effects of SSRIs to occur?

Answer 16

2 to 4 weeks

Full effects are usually not achieved until 6 to 8 weeks.

Question 17

What does SNRI stand for?

Answer 17

Serotonin-Norepinephrine Reuptake Inhibitor

Question 18

List four examples of SNRIs.

Answer 18

• venlafaxine (Effexor)
• duloxetine (Cymbalta)
• desvenlafaxine (Pristiq)
• levomilnacipran (Fetzima)

Question 19

What disorders are SNRIs used to treat?

Answer 19

• major depressive disorder
• social anxiety disorder
• generalized anxiety disorder
• neuropathic pain and other pain disorders

Question 20

How do SNRIs exert their therapeutic effects?

Answer 20

By blocking the reuptake of serotonin and norepinephrine by presynaptic neurons

Question 21

True or False: SNRIs are considered to be less effective than SSRIs for severe depression.

Answer 21

False

Question 22

What potential side effect is common to both SNRIs and SSRIs?

Answer 22

Discontinuation syndrome when abruptly stopped

Question 23

What syndrome can occur when SNRIs are combined with other serotonergic drugs?

Answer 23

Serotonin syndrome

Question 24

Fill in the blank: SNRIs can elevate _______ due to their effects on norepinephrine.

Answer 24

blood pressure

Question 25

Why may SNRIs be contraindicated for patients with hypertension?

Answer 25

Because they can elevate blood pressure

Question 26

What is the relationship between SNRIs and SSRIs in terms of effectiveness?

Answer 26

SNRIs are similar to SSRIs in terms of effectiveness

Question 27

What type of agonists are SNRIs?

Answer 27

Indirect agonists

Question 28

What are NDRIs and name one example?

Answer 28

NDRIs are a class of antidepressants that include bupropion (Wellbutrin, Zyban) ## Footnote NDRIs are used to treat major depressive disorder and assist with smoking cessation.

Question 29

How do NDRIs exert their therapeutic effects?

Answer 29

By inhibiting the reuptake of norepinephrine and dopamine at synapses ## Footnote This mechanism increases the levels of these neurotransmitters in the brain.

Question 30

List some side effects of bupropion.

Answer 30

* Skin rash * Decreased appetite and weight loss * Agitation * Insomnia * Dizziness * Seizures ## Footnote These side effects vary in severity among individuals.

Question 31

What are the advantages of bupropion compared to other antidepressants?

Answer 31

* Causes few anticholinergic effects * Does not cause sexual dysfunction * Not cardiotoxic ## Footnote These advantages make bupropion a preferred choice for some patients.

Question 32

For which type of patients is bupropion particularly useful?

Answer 32

Patients who have low energy and motivation ## Footnote It is not suitable for those who have insomnia or are very anxious.

Question 33

How are TCAs categorized?

Answer 33

As tertiary or secondary amines based on their chemical structure ## Footnote This classification affects their pharmacological properties.

Question 34

Name some tertiary amine TCAs.

Answer 34

* Amitriptyline (Elavil) * Imipramine (Tofranil) * Clomipramine (Anafranil) * Doxepin (Sinequan) ## Footnote Tertiary amines generally have a stronger effect on serotonin.

Question 35

What is the primary mechanism of action of TCAs?

Answer 35

Inhibiting the reuptake of both serotonin and norepinephrine ## Footnote Some TCAs have a stronger effect on serotonin than norepinephrine.

Question 36

List some conditions treated by TCAs.

Answer 36

* Major depressive disorder * Panic disorder * Obsessive-compulsive disorder * Neuropathic pain ## Footnote Clomipramine is particularly effective for obsessive-compulsive disorder.

Question 37

What are some side effects of TCAs?

Answer 37

* Cardiovascular effects (e.g., hypertension, tachycardia, orthostatic hypotension) * Anticholinergic effects * Sedation * Weight gain * Sexual dysfunction ## Footnote The severity and presence of these side effects can vary by individual.

Question 38

Which type of TCAs has fewer side effects?

Answer 38

Secondary amines ## Footnote Secondary amines are less likely to cause sedation and anticholinergic effects.

Question 39

True or False: TCAs can induce a manic or hypomanic episode in bipolar depression.

Answer 39

True ## Footnote They are most likely to do so compared to other antidepressants.

Question 40

Why must TCAs be prescribed with caution?

Answer 40

They are cardiotoxic and lethal in overdose ## Footnote Caution is especially necessary for patients with heart disease or suicidal tendencies.

Question 41

What are the three MAOIs mentioned?

Answer 41

Phenelzine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate) ## Footnote These medications are used for specific types of depression.

Question 42

What types of depression are MAOIs useful for?

Answer 42

Treatment-resistant depression, atypical depression ## Footnote Atypical depression involves reversed vegetative symptoms.

Question 43

What are reversed vegetative symptoms associated with atypical depression?

Answer 43

Hypersomnia, increased appetite, reactive dysphoria ## Footnote These symptoms contrast with typical vegetative symptoms.

Question 44

What is the role of the enzyme monoamine oxidase?

Answer 44

Deactivates norepinephrine, serotonin, and dopamine ## Footnote This enzyme is inhibited by MAOIs.

Question 45

How do MAOIs affect neurotransmitter levels?

Answer 45

Increase levels by inhibiting monoamine oxidase ## Footnote This leads to enhanced mood and emotional regulation.

Question 46

What are common side effects of MAOIs?

Answer 46

Anticholinergic effects, orthostatic hypotension, sedation, sexual dysfunction ## Footnote These side effects can impact patient compliance.

Question 47

What can trigger a hypertensive crisis in patients taking MAOIs?

Answer 47

Certain drugs (e.g., amphetamines, antihistamines), food containing tyramine ## Footnote Tyramine-rich foods include aged cheese, meat, soy products.

Question 48

List some foods that contain tyramine.

Answer 48

* Aged cheese * Aged meat * Soy products * Beer * Red wine * Sauerkraut * Fava beans * Ripe bananas ## Footnote Avoiding these foods is crucial for patients on MAOIs.

Question 49

What are symptoms of a hypertensive crisis?

Answer 49

* Severe throbbing headache * Neck pain or stiffness * Rapid heart rate * Nausea and vomiting * Sweating * Sensitivity to light * Confusion * Delirium ## Footnote Immediate medical attention is required for these symptoms.