Antidepressants

Question 1

Antidepressants increase what levels in the brain?

Answer 1

noradrenaline and serotonin which changes receptors in the brain

Question 2

Typical delay before symptoms improve?

Answer 2

2-4 weeks

Question 3

If not improvement is seen after 2 months.. what should you do?

Answer 3

switch to another antidepressant or augment with another agent

Question 4

Different classes of antidepressants

Answer 4

Tricyclics (TCA’S)
monoamine oxidate inhibitors (MAOI’S)
Selective Serotonin Reuptake inhibitors (SSRI’S)
Novel antidepressants

Question 5

Tricyclic side effects?

Answer 5

antihistaminic - weight gain, sleepy

anticholinergic - dry mouth, blurred vision

Question 6

What do TCA’s increase?

Answer 6

serotonin, dopamine and noradrenaline

Question 7

TCA’s can be lethal with?

Answer 7

overdose - week supply can cause death

- think if the patient is suicidal

Question 8

TCA’s cause lengthening of?

Answer 8

QT interval

Question 9

Tertiary TCA’s have what side chains?

Answer 9

amine

- cross react with other type of receptor

Question 10

give examples of tertiary TCA’S (4)

Answer 10

Amitriptyline
Clomipramine
Doxepin
Imipramine

Question 11

What are the active metabolites in Tertiary TCA’S?

Answer 11

Desipramine and Nortriptyline

Question 12

Secdonary TCA’S block?

Answer 12

noradrenaline

Question 13

MAOI’S work by?

Answer 13

preventing inactivation of amines such a norepinephrine, dopamine and serotonin = increased synaptic levels

Question 14

MAOI’S are effective for?

Answer 14

resistant depression

Question 15

Side effects of MAOI’S

Answer 15

orthostatic hypotension, weight gain, dry mouth, sedation, sexual dysfunction and sleep disturbance

Question 16

When can a hypertensive crisis develop?

Answer 16

When MAOI’s are taken with tyramine- rich foods or sympathomimetics

Question 17

MAOI’S require a restricted diet, what can’t you eat?

Answer 17

cheese
red wine
Fala beans
processed meats

Question 18

When can serotonin syndrome develop?

Answer 18

taking MAOI’s with other medications that increase serotonin or have sympathomimetic actions (+ combo of antidepressants)

Question 19

Serotonin syndrome symptoms can include?

Answer 19

abdo pain, diarrhoea, sweats, tachycardia, HTN, myoclonus, irritability, delirium

Question 20

Serotonin syndrome can ultimately lead to?

Answer 20

hyperpyrexia, cardiovascular shock and death

Question 21

how do SSRI’S work?

Answer 21

block presynaptic serotonin reuptake

Question 22

SSRI’S can treat both?

Answer 22

anxiety and depressive symptoms

Question 23

most common side effects of SSRI’S?

Answer 23

GI upset, sexual dysfunction!!!!, anxiety, insomnia, fatigue, dizziness

Question 24

The discontinuation syndrome from SSRI’S can? (4)

Answer 24

agitation, nauseam disequilibrium and dysphoria

Question 25

Activation syndrome is caused by? How long does it last?

Answer 25

increase in serotonin 2-10 days nauseas, increased anxiety, panic and agitation

Question 26

Discontinuation syndrome means that the SSRI'S have a?

Answer 26

shorter half life , consider switching them to fluoxetine

Question 27

Pro's of sertraline?

Answer 27

very weak interactions with other drugs (P450) - short half life - less sedating - can start at 50mg and move up to 200mg etc

Question 28

Con's of sertraline?

Answer 28

- max absorption when stomach is full | - GI adverse drug reactions

Question 29

Fluoxetine (Prozac) is good for?

Answer 29

- decreasing discontinuation syndrome - helping with non-compliance issues - can provide increased energy - can give 20mg tab to tier soon off SSRI'S when trying to prevent discontinuation syndrome

Question 30

Fluoxetine (Prozac) is not as good for?

Answer 30

- patients with hepatic illness - may not be good for someone already on lots of medication - increased anxiety and insomnia initially - more likely to cause mania

Question 31

SNRI'S function?

Answer 31

inhibit both serotonin and noradrenergic reuptake but without the TCA's side effects

Question 32

SNRI'S are used for?

Answer 32

depression | anxiety and neuropathic pain

Question 33

SNRI'S example?

Answer 33

Venlafaxine | Duloxetine

Question 34

Venlafaxine pros?

Answer 34

doesn't interact with other drugs | - short half life so good for those with renal problems

Question 35

Venlafaxine cons? (6)

Answer 35

- increases in BP - 10-15 mmHG - significant nausea - can cause bad discontinuation syndrome - taper recommended after 2 weeks of administration - QT prolongation - sexual dysfunction

Question 36

Duloxetine pros and cons?

Answer 36

can treat physical symptoms of depression - doesn't increase BP - neuropathic pain treatment - anxiety and depression symptoms can be treated - CYP2D6 and CYP1A2 inhibitor

Question 37

Switching from SSRI to SNRI but patient has cardio symptoms - what do you prescribe?

Answer 37

Duloxetine

Question 38

Novel antidepressants example?

Answer 38

Mirtazapine (sedative medication)

Question 39

Cons of Mirtazapine?

Answer 39

- increases serum cholesterol - weight gain - very sedating at lower doses

Question 40

Hyperphagia is?

Answer 40

eating too much

Question 41

hypersomnolence is?

Answer 41

excessive sleeping

Question 42

Examples of SSRI'S you would prescribe on first episode?

Answer 42

Citalopram, sertraline, fluoxetine

Question 43

drugs which can cause sedation and weight gain?

Answer 43

paroxetine and mirtrazapine

Question 44

Treatment resistance - start with what? - what else can be used

Answer 44

SSRI - SNRI - mirtazepine - Lithium - ECT

Question 45

treatment with atypical antipsychotics - give 3 examples?

Answer 45

Quetipaine , Olanzapine, Aripiprazole

Question 46

Prophylaxis - first episode, send episode and 3rd episode?

Answer 46

1st = 6 month -1 year 2nd - 2 years 3rd - life long

Question 47

Anxiety treatment?

Answer 47

Serotonergic anti-depressant agents | - SSRI'S, SNRI'S

Question 48

TCA for anxiety ?

Answer 48

Chlomipramine

Question 49

Anxiety with adjunctive treatment?

Answer 49

antipsychotics - risperidone or quetiapine

Question 50

Avoid symptomatic relief in anxiety - what drug?

Answer 50

diazepam