Antidepressants: Watts

Question 1

What are the different types of Depression?

Answer 1

• Reactive, Major Depressive, Bipolar Affective

Question 2

What are the clinical features of Depression?

Answer 2

• Physiological, Psychological, Cognitive

Question 3

What is the Physiological clinical feature of Depression?

Answer 3

• Decreased sleep, Appetite Changes, Fatigue, Psychomotor

Question 4

What is the Psychological clinical features of Depression?

Answer 4

• Dysphoric Mood [Unhappiness], Worthlessness, Guilt, Loss of interest

Question 5

What is the Cognitive clinical features of Depression?

Answer 5

• Decrease concentration, Suicidal ideation

Question 6

What are some of the drugs that can induced Depression?

Answer 6

• Antihypertensives [Reserpine, Methyldopa, Propranolol, Metoprolol, Prazosin…]
• Sedative [Alcohol, Benzodiazepines, Barbiturates…]
• Anti-inflammatory [Indomethacin, Phenybutazone, opiates…]
• Steroids [Corticosteroids, OC, Estrogen…]

Question 7

What are the different hypothesis around Depression?

Answer 7

• “Biogenic Amine”, Neuroendocrine, Neurotrophic

Question 8

What is Biogenic Amine hypothesis of Depression?

Answer 8

• When there is a DECREASE of neurotransmitters [serotonin and norepinephrine ] within the synapse/vesicles [found out by Reserpine]
• INCREASING 5HT and NE will treat depression

Question 9

What is the Neuroendocrine hypothesis of Depression?

Answer 9

• Changes in the HPA: STRESS in hypothalamus CRF; CRF releases ACTH from pituitary; ACTH will release CORTISOL

Question 10

What is Neurotrophic hypothesis of Depression?

Answer 10

• Stress [CORTISOL] and pain will decrease BDNF causing depression
• BDNF is important for neuronal growth [receptors]

Question 11

What are the main classes of drugs that are used in Depression?

Answer 11

• MAOI, TCAs, SSRIs, SNRIs, 5HT2A, Tetracyclic and Unicyclic Antidepressants

Question 12

What is the purpose of the Transporter Proteins and Receptors within the synapse?

Answer 12

• Transporter Proteins: Brings things back into the cell
• Receptors: Transduce the signal into the cell

Question 13

Why does therapy take 2 - 3 weeks for antidepressant drugs?

Answer 13

• They cause the amount of neurotransmitters in the intrasynaptic space to INCREASE [takes time]

Question 14

What is the MOA of MAOIs in Depression?

Answer 14

• NE and 5HT are NORMALLY degraded by MAO; inhibiting will increase the amount of NE and 5HT packed into vesicles and released

Question 15

What are the MAO inhibitors used in Depression?

Answer 15

• Non Selective: Phenelzine, Tranylcypromine
• MAO-B: Selegiline, Safinamide
• MAO-A: Moclobemide

Question 16

What are some of the side effects for the MAO Inhibitors in Depression?

Answer 16

• Headache, Drowsiness, Dry Mouth, Weight Gain, Orthostatic Hypotension, Sexual Dysfuntion

Question 17

What are some thing to avoid when using an MAO Inhibitor in Depression?

Answer 17

• Interactions with: TCAs, SSRIs, LDOPA, St. John
• ## AVOID: TYRAMINE

Question 18

What is the indications for the Tricyclic Antidepressants?

Answer 18

• Depression, Panic Disorder, Chronic Pain, Enuresis [Involuntary urination]
• OVERDOSE: dangerous in patients that are depressed [MORE SUICIDAL]

Question 19

What are the two classes of TCAs?

Answer 19

• Tertiary Amines and Secondary Amines

Question 20

What is the MOA for the Tertiary Amines?

Answer 20

• Inhibit both the NE and 5HT reuptake [NET and SERT]
• Can also act as: Antihistamines [H1], Antimuscarinic, Antiadrengic [a1]

Question 21

What are some of the side effects for Tertiary Amines [TCAs]?

Answer 21

• SEDATION, Autonomic SE, Weight Gain, Conduction issues of the heart

Question 22

What are the Tertiary Amines [TCAs] used?

Answer 22

• Imipramine, Amitriptyline, Clomipramine [used for OCD], Doxepin

Question 23

What are the Secondary Amines [TCAs] used?

Answer 23

• Desipramine, Nortriptyline, Marprotiline [NET inhibitor]

Question 24

What are the side effects for the Secondary Amines [TCAs]?

Answer 24

• LESS sedation, LESS anticholinergic, LESS autonomic, LESS weight gain, LESS cardiovascular
• Basically even LESS THAN tertiary

Question 25

What is the MOA for the SSRIs?

Answer 25

• They block ALL 14 5HT receptors leading back into the cell; INCREASING the 5HT in the Synapse

Question 26

What are the SSRIs that are used?

Answer 26

• Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram, Excitalopram

Question 27

What is the use of the SSRIs?

Answer 27

• Depression, Alcoholism, OCD, Enuresis, PTSD, Eating Disorders, Soical Phobias, Panic Anixety, PMDD, GAD

Question 28

What are some of the side effect of SSRIs?

Answer 28

• Nausea, Vomiting, Sexual Dysfunction, Anxiety, Insomia, tremor
• SEROTONIN SYNDROME

Question 29

What happens if you were to stop a SSRI abruptly?

Answer 29

• SSRI Discontinuation Syndrome: “Brain Zaps”, Dizziness, Sweating, Nausea, Insomia, Tremor, Confusion, Vertigo

Question 30

What are the Tetracyclic and Unicycle Antidepressants?

Answer 30

• Maprotiline [NET inhibitor]
• Amoxapine [NET inhibitor, D2 Antagonist]
• Mirtazapine [a2 Antagonist, 5HT2/3 Antagonist, H1 Antagonist
• Burpropion [DAT inhibitor, NET/SERT inhibitor, Treats GAD]

Question 31

What is the 5HT2 Antagoinst/SERT Inhibitor Antidepressant?

Answer 31

• Trazodone [5HT2A Antagonist, Weak SERT Inhibitor]

Question 32

What are the SNRIs used?

Answer 32

• Velafaxine [Treats GAD & Panic]
• Desvenlafaxine [Treats vasomotor symptoms with menopuase]
• Duloxetine [Treats GAD & Peripheral neuropathy]
• Milnacipran [Treats Fibromyalgia]
• Levomilnacipran [Active form of milnacipran]

Question 33

What is the MOA for the SNRIs?

Answer 33

• Block the reuptake for BOTH NET and SERT; INCREASING NE and 5HT in the synapse

Question 34

What are the NSRIs that are used?

Answer 34

• Reboxetine [less side effects than Fluoxetine]
• Atomoxetine [Used for ADHD]

Question 35

What is the SNDRIs?

Answer 35

• Serotonin Norepinephrine Dopamine Reupatake Inhibitors
• Tesofensine & Brasofensine

Question 36

What is the purpose of Brexanolone?

Answer 36

• Treats postpartum depression [binds to the GABAa receptor increasing Cl-]
• Helps resensitizes the GABAa receptor

Question 37

What are the new agents that are in development?

Answer 37

• Psychedelics: MDMA, Psilocybin, LSD
• 5HT2C Antagonist
• Metabotropic Glutamate Agonist
• RIMAs

Question 38

What are some of the non-pharmacological considerations for Depression?

Answer 38

• Electroconvulsive Therapy, Psychotherapy, Hopsitalization
• Exercise, Diet…

Question 39

What is the pharmacology of Filanserin?

Answer 39

• Hypoactive sexual desire disorder [delevoped as antidepressant]
• 5HT2A agonist

Question 40

What are the different types of Bipolar disorder?

Answer 40

• Bipolar I, Bipolar II, Cyclothymia, Unspecified/Related, Substane-Induced

Question 41

What are the symptoms fo Bipolar Disorder?

Answer 41

• Mania, Hypomania, Depression, Mixed Manis and Depression [Many UP and DOWNS]

Question 42

What are the main features of Mania?

Answer 42

• Euphoria, Irritabilitym Impulsice high risk behavior, Aggressive, grand ideas, decrease sleep and appetite…

Question 43

What are some of the treatment for Bipolar disorder?

Answer 43

• Hospitalization, Psychotherapy [Keeps them from hurting themselves]
• Pharmacotherapy [Lithium, Anticonvulsants, CCB?, Combo

Question 44

What is MOA for Lithium in Bipolar Disorder?

Answer 44

• MOA: NOT understood; Depletion of PIP2 [Signaling of IP3 and PKC]

Question 45

What are the anticonvulsants used in Bipolar Disorder?

Answer 45

• Valproate, Carbamazepine, Lamotriginem, Topiramate

Question 46

What are the atypical antipsychotics use in bipolar disorder?

Answer 46

• Olanzapine, Quetiapinem, Risperidone, Ziprasidone, Lurasidone, Aripiprazole