Antidepressants

Question 1

When is ECT used?

Answer 1

suicidal depression

Question 2

ECT

Answer 2

• patient anestethized and given a muscle relaxant
• electric current passed through head for .5s - 4s
• induces a grand mal seizure
• low level of current used, short duration
• memory loss can occur

Question 3

depressive disorder

Answer 3

• prolonged disturbance of mood
• sad, empty, or irritable modd accompanied by: somatic and cognitive changes that affect individuals capacity to function

Question 4

MDD symptoms

Answer 4

at least two weeks of depressed mood or anhedonia and:
-weight change
-sleep problems
-psychomotor agitation
-fatigue
-feelings of worthlessness/guilt
-difficulty concentrating
-thoughts of death/suicide
episodes can last months to years

Question 5

monoamine oxidase inhibitors

Answer 5

block monoamine oxidase in nerve terminals and glia, as well as liver and kidney

Question 6

catechol-o-methyltransferase is invovled in:

Answer 6

monoamine degredation

Question 7

How many forms of mao are there? Which degrades monoamines?

Answer 7

• two forms (a and b)

- a degrades monoamines

Question 8

limitations/side effects of maois

Answer 8

• lots of side effects due to the widespread location of maos
• interact with foods rich in tryptamine (life-threatening)

Question 9

monoamine theory of depression and its problems

Answer 9

• hypoactivity of mono amino neurons causes depression

- problem: why is there a theraputic lag in the imporvement of symptoms?

Question 10

maois given chronically and numbers of mao receptors:

Answer 10

neurons down-regulate the numbers of mao receptors on post synaptic neuron

Question 11

revised monoamine theory of depression

Answer 11

• the hypoactivity of monoamine neurons increases postsynaptic receptor sensitivity, causing depression
• antidepressants decrease postsynaptic receptor sensitivity

Question 12

tricyclic antidepressants

Answer 12

• closely related in structure to phenothiazines (antipsychotics)
• inhibit NE/5-HT uptake

Question 13

second generation antidepressants

Answer 13

• fewer side effects
• 5-HT reuptake inhibitors
• NE reuptake inhibitors
• DA reuptake inhibitors
• 5-HT/NE reuptake inhibitors

Question 14

Paxil, Prozac, Zoloft

Answer 14

SSRIs

Question 15

Reboxetine

Answer 15

NRIs

Question 16

Wellbutrin

Answer 16

DA reuptake inhibitor

Question 17

Effexor

Answer 17

SNRI (5-HT/NE reuptake inhibitors)

Question 18

autoreceptors function to

Answer 18

shut off neurotransmitter release from neurons

Question 19

do autoreceptors have high or low affinity for neurotransmitters? why?

Answer 19

high affinity; there is low neurotransmitter concentration of the edge of the synapse

Question 20

chronic reuptake inhibition and autoreceptors

Answer 20

chronic reuptake inhibition results in autoreceptor downregulation (consistent with theraputic lag)

Question 21

further refinement of monoamine theory of depression

Answer 21

• hyopactivity of monoamine neurons increases autoreceptor sensitivity
• antidepressants decrease autoreceptor sensitivity

Question 22

What do all antidepressants act on?

Answer 22

5-HT2 autoreceptors; reduce 5-HT2a binding

Question 23

What does ECT do to 5-HT2a binding?

Answer 23

increases 5-HT2a binding

Question 24

newest antidepressants:

Answer 24

noradrenergic and specific serotonergic antidepressants (NaSSAs)

Question 25

mirtazapine

Answer 25

noradrenergic and specific serotonergic antidepressants (NaSSAs)

Question 26

rTMS

Answer 26

repeated transcrainial magnetic stimulation; brief magnetic stimulation, localized to a brain area

Question 27

HPA axis pathway

Answer 27

- in response to stress the hypothalamus secretes corticotropin releasing hormone - then the anterior pituitary relases adrenocorticotropin hormone - the adrenal gland relased glucocorticoids - glucocorticoids have a negative feedback to the hypothalamus and hippocampus

Question 28

plasma levels of cortisol in depressed patients

Answer 28

increased cortisol levels, indicative of hyperactive HPA axis

Question 29

relationship between cortisol levels and BDNF

Answer 29

increased cortisol levels, decreased BDNF

Question 30

Decreased levels of BDNF linked to:

Answer 30

atrophy of neurons and decreased neuronal survival

Question 31

Role of BDNF

Answer 31

important for the birth and growth of neurons

Question 32

Where does adult neurogenesis occur?

Answer 32

hippocampus

Question 33

certain antidepressants can increase ____

Answer 33

neurogenesis in the hippocampus

Question 34

What receptors could another class of next generation antidepressants target?

Answer 34

NMDA glutamate receptors

Question 35

GLYX13

Answer 35

glycine site partial agonist on NMDA receptors; phase 3 clinical trials in 2016

Question 36

Phase I drug trials

Answer 36

small group to evaluate saftey, dosage, & side effects

Question 37

Phase II drug trials

Answer 37

larger group to access efficacy and safety

Question 38

Phase III drug trials

Answer 38

large group to confirm efficacy, monitor side effects, and compare to other treatments

Question 39

Phase IV drug trials

Answer 39

drug marketed, but efficacy and side effects are sill monitored