Antidepressants

Question 1

• NE/5HT/ DA on PFC? On Amygdala?
• MOA: Immediate? Weeks to months? (2) Leads to increased? (2) Leads to?
• Treatment: First line = SSRI drugs (3) 2.) Next? Advantages? (2) Doesn’t work for? 3.) SNRI’s?
• Effects on wt gain? (3)
• Better with sexual side effects? (2)
• TCADS: Drugs? (2) 3 side effects?

Answer 1

• mood; guilt/mood/suicidality
• Increase NE/5HT; Gs –> Increase cAMP/ PKA; Gq = Ca2+ depend. kinases; Incr. Creb/BDNF; surv/growth of neurons
• Sertaline, Fluoxetine, Citalopam 2.) Bupropion (less wt gain/ sexual se’s), anxious depression; Venlafaxine
• TCAD’s worst; SSRI’s/SNRI’s next; Buproprion best
• Mirtazapine/ Buproprion
• Mitrazapine/paroxentine; anti chol se’s; increase QT; orthostatic hypotension

Question 2

• Trazadone: Side effect?
• MAOI’s SE’s? (2)
• Flu like withdrawal with? (2)
• Htx with? (2)
• SSRI + MAOI =?
• SSRI’s inhibit what?

Answer 2

• Ortho hypotension
• ortho hypotension; Hypertensive crisis with thyamine rich foods
• paroxentine, venlafaxine
• Seratonin syndrome = hyperthermia/muscle rigid
• P450

Question 3

• Buproprion MOA?
• Effective in very depressed?
• Major sedation with?
• ECT SE?
• Most common psych disorder in US?
• Percent that die on first suicide attempt?

Answer 3

• NDRI
• TCAD’s
• Trazadone
• Memory loss
• Anxiety disorders then mood disorders
• 56-75%

Question 4

• Types of mood disorders? Subcategories of each?
• Depression symptoms? 5+ > weeks
• Depression subcategories: 1.) Atypical: Lead paralysis? Respond well to? Should suspect? 2.) Psychotic: Must treat with? (2) 3.) Melancholic: Mood worse when? Weight loss? Guilt? 4.) Seasonal Affective

Answer 4

1. ) Depressive (MDD, Dysthmic, DD NOS) 2.) Bipolar (BP1, BP2, BP NOS
   - Sleep change, Interest down, Guilt, Energy down, Conc. down, Appetite change, Psychomotor, Suicide
2. ) yes; anti depressants; Bipolar 2.) anti depresseant and antipsychotics 3.) morning, yes; yes

Question 5

• Anti manic:
  1. ) Lithium: Onset? Use dependent? MOA?
• SE’s? (2) Used to treat? (2) Eliminated via? Therapeutic window?
• High sodium?
• Moderate toxicity? Severe?
• D-D’s? (2)

Answer 5

• Slow; yes; interfere with IP3 and DAG and Gs/Gi
• Anti TSH = hypothyroid; Anti ADH = polyuria; prevent/maintain manic and depressive episodes; kidney; small
• Lower Li+
• Confusion/lethargy/twitching; seizures/stupor/coma
• NSAIDs and Diuretics decrease clearance of Li

Question 6

• Bipolar spectrum? (3)
• Secondary manias often due to? (2)
• Dx made by mania > 1 wk + > 3 symptoms if euphoric or >4 if irritable: symptoms?
• Perfect drug? (3)
  1. ) Valproic acid moa?
  2. ) a2 antag MOA?
• Treatment order for bipolar depression? (3) Use?
• anti depressant for BP depression? Lithium?

Answer 6

• CT –> BP2 –> BP1
• head injury/ drugs
• Distracted, Insomnia, Grandios, Fleeting ideas, Activity incr., Speak nonstop, Thoughtlessness
• Anti manic, anti depressive, no future events
• Blocks VSSC
• Increase NE in synapse like for depression
• Quetapine (Bipolar depression/mania); Lamotrigine (Maintenence); Olanzapine+flouextine (Bipola depression)
• Hasn’t beet shown better; unclear with antidepressant