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Psychopharmacology > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

What are the six SSRI’s?

A 
fluoxetine (Prozac, Prozac weekly)
sertraline (Zoloft)
paroxetine (Paxil, Paxil CR, Pexeva)
lovoxamine (Luvox, Luvox CR)
citalopram (Celexa)
escitalopram (Lexapro)
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2
Q

What percent of individuals with major depression, overall, tend to respond to 4 different medications over the course of 1 year?

A

67% responders

33% non-responders

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3
Q

citralopram

A

Celexa

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4
Q

What are the rates of responders vs. non-responders in medication trials?

A

67% responders, 33% non-responders

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5
Q

What are low levels of NE associated with?

A

Increased negative affect

decreased positive affect

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6
Q

Acute Phase

A

6-12 Weeks

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7
Q

What are the effects of the 5HT2A receptor?

A

Decreases DA & NE release (decreases positive affect)

Increases Glu release (increases anxiety)

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8
Q

What symptoms are most likely to be residual?

A 
insomnia
fatigue
pain
concentration
loss of interest
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9
Q

Gene activation has been found with use of:

A

AD’s
lithium
estrogen
exercise

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10
Q

escitalopram

A

Lexapro

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11
Q

What proportion of major depressive disorders remit after the 4th antidepressant treatment?

A

6-7%

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12
Q

What are the three main mechanisms of action of AD’s?

A

Blockade of transporters (re-uptake pumps)
5HT1A partial agonism
Inhibition of monoamine oxidase

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13
Q

What proportion of major depressive disorders remit after the first antidepressant treatment?

A

33%

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14
Q

What are the two effects of metabolic and gene transcription events initiated by AD’s?

A

Decrease in various receptors & chemicals associated withs stress, depression, & anxiety
Increase chemicals associated with healthy neurons, resiliency, less depression, & anxiety

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15
Q

What is the mechanism of action, at least initially, of AD’s?

A

Increased synaptic concentration of monoamines

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16
Q

sertraline

A

Zoloft

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17
Q

What are the three main monoamines?

A

5-HT, DA, NE

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18
Q

Low levels of which monoamine is associated with decreased “positive affect” in depression?

A

DA

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19
Q

Recurrence

A

A return of symptoms during the maintenance phase.

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20
Q

What are the rates of responders vs. non-responders in placebo trials?

A

33% responders, 67% non-responders

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21
Q

What are the symptoms linked with negative affect in depression?

A

dysphoria, rumination, guilt/disgust, worthlessness, loneliness, fear/anxiety, irritability, hostility, suicidality

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22
Q

What symptoms are related to decreased positive affect?

A

Dysphoria, anhedonia, loss of motivation & enthusiasm, apathy, anergia or psychomotor retardation, impaired attention & cognition, decreased self-confidence

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23
Q

Norephinepherine is considered what type of monoamine?

A

Catecholamine

24
Q

What do 5-HT1A receptors on dendrites or soma (somadendritic autoreceptor) do?

A

Inhibit firing, and thus, 5-HT release

25
Q

What symptoms tend to be most responsive to treatment?

A

Depressed mood
suicidal ideation
psychomotor retardation

26
Q

What terminates NE action?

A

reuptake via NR transporters (NET)
MAO inside presynaptic neurons & synapse
COMT (catechol-O-methyl transferase)

27
Q

What defines a response to an antidepressant?

A

50% or more reduction in symptoms (either in number of symptoms or in severity)

28
Q

SSRI’s

A

increased activation of 5HT1A receptors decreases negative affect (dysphoria, rumination, guilt/disgust, worthlessness, loneliness, fear/anxiety, irritability, hostility, suicide

29
Q

Acute/excessive activation of other 5HT receptors cause what?

A

Side effects (see slides for details)

30
Q

What are some of the considerations related to SE’s in regards to 5HT hypothesis of depression?

A

SE’s tend to appear within the first 1-2 weeks, but will often dissipate in several weeks once the brain has adapted to the increased concentration of 5HT and downregulates

31
Q

What proportion of major depressive disorders remit after the second antidepressant treatment?

A

20%

32
Q

When should antidepressants be discontinued after the first episode of depression?

A

gradually at the end of the continuation phase

33
Q

True or False: 5HT1A and 5HT2A receptors have identical effects.

A

False; they have opposite effects

34
Q

vilazodone

A

Vibryd; is an SSRI and 5HT1A partial agonist

35
Q

When should antidepressants be discontinued after the second episode of depression?

A

With risk factors: gradually at the end of the continuation phase
With risk factors: never; maintain for life

36
Q

What defines remission?

A

A 100% reduction of all symptoms.

37
Q

You expect a placebo effect of _____% for most treatments.

A

33%

38
Q

What are the effects of the 5HT1A receptor?

A

Increases DA & NE release (improves positive affect)

Decreases Glu release (decreases anxiety)

39
Q

When should antidepressants be discontinued after the 3rd or more episode?

A

NEVER; maintain for life.

40
Q

Maintenance Phase

A

1 or more years

41
Q

Continuation Phase

A

4-9 months

42
Q

SNRI

A

serotonin norepinephrine reuptake inhibitors

43
Q

luvoxamine

A

Luvox, Luvox CR

44
Q

How does the serotonin hypothesis of depression help explain the time course of therapeutic effects?

A

They are delayed due to the time required for 5HT1A autoreceptors to downregulate/desnsitize

45
Q

What proportion of major depressive disorders remit after the 3rd antidepressant treatment?

A

6-7%

46
Q

Relapse

A

Pt has a return of symptoms in the continuation phase, despite still being on medication; regardless of the degree to which their symptoms of

47
Q

fluoxetine

A

Prozac, Prozac weekly (Sarafem for PMDD)

48
Q

5-HT affects release of which NT’s?

A

DA, NE, Glu

49
Q

What phase is remission associated with?

A

Continuation phase (4-9 months)

50
Q

paroxetine

A

Paxil, Paxil CR, Pexeva

51
Q

What phase is recovery associated with?

A

Maintenance (>1 year)

52
Q

Where is 90% of 5-HT located within the body?

A

Outside of the CNS

53
Q

Where do NE axons project to?

A

widely across cortex, cerebellum, spinal cord

54
Q

How long should antidepressants be continued for after a response or remission to prevent relapse?

A

4-9 months

55
Q

Where are the somas of NE neurones primarily located?

A

locus coeruleus

56
Q

Low levels of which monoamine is associated with increased “negative affect”?

A

5-HT

57
Q

What is the most common mechanism of action for AD’s?

A

Blockade of transporters/re-uptake pumps

Psychopharmacology (7 decks)

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