Antidepressants Quiz Flashcards
The monoamine hypothesis of depression suggests that depression is related to a deficiency in the brain of the amount or function of serotonin, norepinephrine, and dopamine. All of the statements below are CORRECT. The monoamine hypothesis explains all of the statements EXCEPT:
A) Treatments such as reserpine, which depletes monoamines, are associated with depression
B) A clinical response to an SSRI can be reversed by eliminating tryptophan from the diet. A clinical response to an SNRI can be reversed by agents which deplete catecholamines
C) Central monoamine levels increase immediately with antidepressant use, while maximal beneficial results are not seen for many weeks. Adverse effects of SSRI, SNRI, and TCA agents are seen immediately
D) All available antidepressants appear to have significant effects on the monoamine system
C
SSRI MOA
Inhibits serotonin reuptake transporter (SERT)
SNRI MOA
Chemical analogs of TCAs but reuptake blockade is limited to SERT and NERT
TCA MOA
Block reuptake of monoamines, histamine, acetylcholine and alpha 2 adrenoreceptors
Buildup of what chemical is associated with sedation?
Histamine
Buildup of what NT is associated with anxiety like sx/anticholinergic sx?
NE
Buildup of what NT is associated with increased bleeding risk?
Serotonin (d/t 5-HT receptors on platelets)
Unicyclic antidepressant MOA (bupropion)
Resembles dopamine in structure
MAO-B inhibitors serious ADRs?
Serotonin syndrome – clonus, diarrhea, fever, hypertension
Hypertensive crisis d/t tyramine ingestion (high [tyramine] causes NE release)
Identify the INCORRECT statement:
A) SSRIs and SNRIs act to reduce the buildup of brain derived neurotrophic factor and thereby promote NT activity
B) SNRIs are used to treat major depression and chronic pain disorders. Since SSRIs do not improve chronic pain sx, the mechanism of chronic pain is likely d/t inhibition of NE reuptake
C) Bupropion is used to treat major depression and as an aid in smoking cessation. Bupropion is not useful for generalized anxiety disorders most likely d/t its mechanism of action
D) TCAs have uses that are similar to SNRIs
A – reduced amounts of brain derived neurotrophic factor would DECREASE NT activity, not promote it.
SSRIs MC ADR
Nausea, GI upset, diarrhea
SNRIs MC ADR
Serotonin increased effects (nausea, GI upset, diarrhea) PLUS increased NE effects (increased BP, HR, and CNS activation)
TCA MC ADR
Anticholinergic effects – dry mouth, constipation, dizziness, effects on near vision (TCAs block NERT, SERT, histamine, and autonomic pathways)
Unicyclic antidepressants MC ADR
Agitation, insomnia
According to APA guidelines on the treatment of patients in the acute phase of MDD, which of the following drug classes are associated with fewer adverse effects?
A) Monoamine oxidase inhibitors (isocarboxazid)
B) Serotonin modulators (nefazodone)
C) Dopamine-norepinephrine reuptake inhibitors (bupropion)
D) Tricyclics and tetracyclics (amitriptyline)
C – for most patients, optimal treatments include a selective serotonin reuptake inhibitor, a serotonin-norepinephrine reuptake inhibitor, mirtazapine, or bupropion. Dose should be titrated on the basis of age, setting, concurrent disorders, concomitant pharmacotherapy, and adverse effects
Tricyclic antidepressants:
A) Have few drug interactions
B) Can cause anticholinergic and other adverse effects and are potentially lethal in overdose
C) Are the drugs of choice for first line treatment of anxiety
D) All of the above
B – TCAs are generally used for treatment of anxiety that has not responded to an SSRI or SNRI. Cumulative exposure to drugs with strong anticholinergic properties, such as TCAs, has been associated with dementia
A 29 year old woman with MDD would like to start pharmacologic therapy, but she is concerned about gaining weight. You are concerned about her risk of bleeding. Which of the following drugs is least likely to cause these adverse effects?
A) Sertraline
B) Fluoxetine
C) Mirtazapine
D) Bupropion
D – inhibition of NE and dopamine is not sedating and is not associated with weight gain, sexual dysfunction or an increased risk of bleeding (b/c it doesn’t act on the serotonin pathway)
Which of the following patients with MDD would be a good candidate for treatment with mirtazapine?
A) A 22 y/o woman with marked weight loss
B) A 61 y/o man with hypersomnia
C) A 36 year old obese woman
A – mirtazapine causes extensive WEIGHT GAIN and can be helpful in patients with insomnia (not hypersomnia) b/c it acts on the histamine pathway
Mirtazapine is also useful in patients who experience significant nausea with SSRIs, SNRIs, or bupropion
Which of the following statements about antidepressant use during pregnancy is true?
A) SSRIs are contraindicated for use during the first trimester because of an increased risk of fetal mortality
B) Use of an SSRI during the third trimester has been associated with a self limited neonatal syndrome
C) SSRI use during any trimester of pregnancy is associated with a 10-fold increase in the risk of autism in the offspring
B – the risk of congenital malformations after taking an SSRI during pregnancy appears to be very low, and no increase in perinatal mortality has been demonstrated. Both untreated maternal depression and SSRI use during pregnancy have been associated with delayed fetal development, preterm birth, and low birth weight
