Antidepressants Flashcards
What are the 4 types of depression?
- major depression
- bipolar disorder
- dysthymic disorder
- depressive disorder
What are the features of the syndrome profile of major depression?
- psychomotor retardation
- fatigue/loss of energy
- diminished ability to concentrate
- diminished interest in social activity
- feelings of guilt and worthlessness
- insomnia
- weight loss/decreased appetite
Which neurotransmitters are associated with depression?
- noradrenergic and serotonergic pathways
- serotonin activity decreases during sleep = slow activity during resting//waking phase
What are the brain regions associated with depression?
Amygdala Ventrolateral prefrontal cortex and dorsolateral prefrontal cortex medial prefrontal cortex striatal regions hippocampus
How are the ventrolateral prefrontal cortex and dorsolateral prefrontal cortex associated with depression?
Cortical thickness decreases
What is the default mode network?
- network of brain regions when the brain is at wakeful rest
- increased activity in depression
- important alterations in the left subgenual cingulate area
What is the significance of the amygdala and hippocampus interactions?
Process emotional stimuli
What does hyperactivation correlate to?
Increased activity in the subgenual cingulate cortex and the medial prefrontal cortex
What does decreased activation correlate to?
In prefrontal cortex
What causes rumination?
Balance between hyperactivity in the subgenual cingulate cortex and medial prefrontal cortex and decreased activation in the prefrontal cortex
What is rumination?
Deep thinking
What is serotonin transporter polymorphism?
Associated with higher risk major depression after significant life events
- gene-environment interactions
Which drugs are TCAs?
- amitriptyline
- clomipramine
- imipramine
- desipramine
- nortriptyline
- protriptyline
What is the mechanism of TCAs?
- inhibit reuptake of amines
- have a range of degree of selectivity for amines
- affinity for histamine, muscarinic alpha-1 and alpha-2 adrenoreceptors
- overdose = cardiotoxicity
What are the adverse effects of TCAs?
- dry mouth
- constipation
- urinary retention
- weight gain
- postural hypotension
- sedation
What are the monoamine oxidase inhibitors?
- phenelzine
- tranylcypromine
- iproniazid
What is the mechanism of monoamine oxidase inhibitors?
- irreversibly inhibit monoamine oxidase
- non selective - MOAa and b
- interacts with pethidine (painkiller) and sympathomimetics
- hepatoxicity
What is the cheese effect?
Tyramine is found in various cheeses/red wine/beer
- it is metabolised by monoamine oxidase
- if MOA is inhibited it gets built up
What are monoamine oxidase inhibitors used for?
Treatment of atypical depression
e.g with anxiety, phobia and hypochondria
What drugs are reversible monoamine oxidase inhibitors?
Moclobemide
What is the mechanism of reversible monoamine oxidase inhibitors?
- increased selectivity for monoamine oxidase A
- safer than irreversible as you can switch to another medication almost immediately whereas in irreversible you have to wait
- higher efficacy than irreversible
What are the adverse effects of reversible monoamine oxidase inhibitors?
- nausea
- agitation
- confusion
Which drugs are selective serotonin reuptake inhibitors?
- citalopram
- fluoxetine
- paroxetine
What is the mechanism of serotonin reuptake inhibitors?
- increased selectivity for serotonin reuptake
- no anticholinergic activity
- no cardiotoxicity = safe in overdose
