Antidepressants

Question 1

WHat does SIGECAPS stan for?

Answer 1

S: sleep, I: Interests, G: Guilt, E: Energy, C: Concentration/cognition, A: appetite, P: psychomotor, S: suicide

Question 2

Mean onset of depression?

Answer 2

25-25 years of age. 10% of US population. 30,000 suicides a year.

Question 3

What is the theory behind the pathophysiology of depression?

Answer 3

Overall decreased levels on monoaminergic NTs (NE, 5-HT, DA, etc.). Also, costant stress releases corticosteroids like cortisol, which will cause a decrease in neurogeneration and a decrease in dendritic branching. Cortisol inhibits CREB which will increase cAMP and cause a decrease in BDNF release.

Question 4

How are antidepressants metabolized? What is the significance behind this?

Answer 4

CYP2D6 enzyme system. There are 75 alleles of this enzyme, and people can have up to 13 copis (ultrametabolizers) or none (poor metabolizers).

Question 5

In general how do antidepressants work?

Answer 5

They work by increasing the monoaminergic release and concentration in the brain. This increase cAMP, which can activate BDNF and dendritic branching. You must be on te medication for over abouta month for them to start working. (althoughthere is an immediate increase in monoamines, probablyneed to generate down streat signals (CREB, BDNF).

Question 6

What are the various syndromes that can present with depressive sympoms?

Answer 6

1) Major Depressive Disorder (debilitating), 2) dysthmia (interferes with functioning, but to a minor degree AK not disabling) 3) Anxiety disorder can present as depression, 4) Bipolar disorder (fluctuations of mood)

Question 7

Tricyclic Antidepressants (TCAs)

Answer 7

Work by blocking the reuptake of 5-HT and NE. They also block muscarinic, alpha-1, and histamine receptors. Used t treat depression.

Question 8

What are the two major TCAs?

Answer 8

Imipramine and amitriptyline

Question 9

What toxicities are involved with TCAs?

Answer 9

Antimuscarinic affects will cause dry mouth, urinary incontinence, constipation, etc. Also block alpha-1 receptors, causes orthostatic hypotensive and cardiac arrhythmias, and feflex tachycardia. Histamine: sedation. Weight gain, decreased seizure threshold, and sexual dysfunction.

Question 10

What is the #1 risk when using a TCA?

Answer 10

Causes major birth defects in the first trimester! Category D drug.

Question 11

If apatient takes too many TCAs what may happen?

Answer 11

Cardiovascular collapse. Treat with a stomach lavage and activated charcoal.

Question 12

What are the three main SSRIs?

Answer 12

Fluoxetine, Paroxetine, and Sertaline

Question 13

What is the number 1 side effect when giving an SSRI to treat depression?

Answer 13

Sexual dysfunction and weight gain!

Question 14

SSRIs are relatively safe, however you should be aware of…

Answer 14

Its drug interactions. Can cause serotonin syndrome if given with another SSRI or MAO, or if given with another P450 inhibitory drug. Although it is difficult to overdose due to high therapeutic index!

Question 15

Both paroxetine and sertaline also block which receptors?

Answer 15

Also block DA receptors at high enough concentrations. Selectivity depends on the dosage.

Question 16

Wha are the symptoms of Serotonin syndrome?

Answer 16

hyperthermia, increased blood pressure, flushing, hyperreflexia, tremor, agitation, excitement, ataxia, chills, diarrhea.

Question 17

How do you treat Serotonin syndrome?

Answer 17

Treat it with benzodiazepines, and CYPROHEPTADINE (blocks 5-HT receptors)!!!!!

Question 18

What is the SNRI that we need to know? What is it used for? And what is its toxicities?

Answer 18

Venlafaxine; SNRIs block both 5-ht and NE reuptake; category C

Question 19

Atypical Antidepressants: what are the two main drugs?

Answer 19

Bubropion (wellbutren) and mirtazapine.

Question 20

Bubropion: MOA, uses, toxicities?

Answer 20

Bubropion is used in treating depression. It appears to block NE and DA receptors. It can cause seizures in those pron to them. And it is a Caegory C drug. Pretty straight forward drug.

Question 21

Mirtazapine (MOA and side-effects)

Answer 21

blocks alpha-2 receptor, increasing NE release. This causes Alpha-1 receptors to become activated and release 5-HT. This drug is anti-muscarinic!

Question 22

Selegiline in depression?

Answer 22

Of course bato, at high concentrations it not only inhibits MAO-B (DA) but also MAO-A (5-HT and NE). it is used as a transdermal patch to minimize GI effects.