Antidepressants: Watts Flashcards
What are the different types of Depression?
- Reactive, Major Depressive, Bipolar Affective
What are the clinical features of Depression?
- Physiological, Psychological, Cognitive
What is the Physiological clinical feature of Depression?
- Decreased sleep, Appetite Changes, Fatigue, Psychomotor
What is the Psychological clinical features of Depression?
- Dysphoric Mood [Unhappiness], Worthlessness, Guilt, Loss of interest
What is the Cognitive clinical features of Depression?
- Decrease concentration, Suicidal ideation
What are some of the drugs that can induced Depression?
- Antihypertensives [Reserpine, Methyldopa, Propranolol, Metoprolol, Prazosin…]
- Sedative [Alcohol, Benzodiazepines, Barbiturates…]
- Anti-inflammatory [Indomethacin, Phenybutazone, opiates…]
- Steroids [Corticosteroids, OC, Estrogen…]
What are the different hypothesis around Depression?
- “Biogenic Amine”, Neuroendocrine, Neurotrophic
What is Biogenic Amine hypothesis of Depression?
- 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
What is the Neuroendocrine hypothesis of Depression?
- Changes in the HPA: STRESS in hypothalamus CRF; CRF releases ACTH from pituitary; ACTH will release CORTISOL
What is Neurotrophic hypothesis of Depression?
- Stress [CORTISOL] and pain will decrease BDNF causing depression
- BDNF is important for neuronal growth [receptors]
What are the main classes of drugs that are used in Depression?
- MAOI, TCAs, SSRIs, SNRIs, 5HT2A, Tetracyclic and Unicyclic Antidepressants
What is the purpose of the Transporter Proteins and Receptors within the synapse?
- Transporter Proteins: Brings things back into the cell
- Receptors: Transduce the signal into the cell
Why does therapy take 2 - 3 weeks for antidepressant drugs?
- They cause the amount of neurotransmitters in the intrasynaptic space to INCREASE [takes time]
What is the MOA of MAOIs in Depression?
- NE and 5HT are NORMALLY degraded by MAO; inhibiting will increase the amount of NE and 5HT packed into vesicles and released
What are the MAO inhibitors used in Depression?
- Non Selective: Phenelzine, Tranylcypromine
- MAO-B: Selegiline, Safinamide
- MAO-A: Moclobemide
What are some of the side effects for the MAO Inhibitors in Depression?
- Headache, Drowsiness, Dry Mouth, Weight Gain, Orthostatic Hypotension, Sexual Dysfuntion
What are some thing to avoid when using an MAO Inhibitor in Depression?
- Interactions with: TCAs, SSRIs, LDOPA, St. John
- ## AVOID: TYRAMINE
What is the indications for the Tricyclic Antidepressants?
- Depression, Panic Disorder, Chronic Pain, Enuresis [Involuntary urination]
- OVERDOSE: dangerous in patients that are depressed [MORE SUICIDAL]
What are the two classes of TCAs?
- Tertiary Amines and Secondary Amines
What is the MOA for the Tertiary Amines?
- Inhibit both the NE and 5HT reuptake [NET and SERT]
- Can also act as: Antihistamines [H1], Antimuscarinic, Antiadrengic [a1]
What are some of the side effects for Tertiary Amines [TCAs]?
- SEDATION, Autonomic SE, Weight Gain, Conduction issues of the heart
What are the Tertiary Amines [TCAs] used?
- Imipramine, Amitriptyline, Clomipramine [used for OCD], Doxepin
What are the Secondary Amines [TCAs] used?
- Desipramine, Nortriptyline, Marprotiline [NET inhibitor]
What are the side effects for the Secondary Amines [TCAs]?
- LESS sedation, LESS anticholinergic, LESS autonomic, LESS weight gain, LESS cardiovascular
- Basically even LESS THAN tertiary
What is the MOA for the SSRIs?
- They block ALL 14 5HT receptors leading back into the cell; INCREASING the 5HT in the Synapse
What are the SSRIs that are used?
- Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Citalopram, Excitalopram
What is the use of the SSRIs?
- Depression, Alcoholism, OCD, Enuresis, PTSD, Eating Disorders, Soical Phobias, Panic Anixety, PMDD, GAD
What are some of the side effect of SSRIs?
- Nausea, Vomiting, Sexual Dysfunction, Anxiety, Insomia, tremor
- SEROTONIN SYNDROME
What happens if you were to stop a SSRI abruptly?
- SSRI Discontinuation Syndrome: “Brain Zaps”, Dizziness, Sweating, Nausea, Insomia, Tremor, Confusion, Vertigo
What are the Tetracyclic and Unicycle Antidepressants?
- Maprotiline [NET inhibitor]
- Amoxapine [NET inhibitor, D2 Antagonist]
- Mirtazapine [a2 Antagonist, 5HT2/3 Antagonist, H1 Antagonist
- Burpropion [DAT inhibitor, NET/SERT inhibitor, Treats GAD]
What is the 5HT2 Antagoinst/SERT Inhibitor Antidepressant?
- Trazodone [5HT2A Antagonist, Weak SERT Inhibitor]
What are the SNRIs used?
- Velafaxine [Treats GAD & Panic]
- Desvenlafaxine [Treats vasomotor symptoms with menopuase]
- Duloxetine [Treats GAD & Peripheral neuropathy]
- Milnacipran [Treats Fibromyalgia]
- Levomilnacipran [Active form of milnacipran]
What is the MOA for the SNRIs?
- Block the reuptake for BOTH NET and SERT; INCREASING NE and 5HT in the synapse
What are the NSRIs that are used?
- Reboxetine [less side effects than Fluoxetine]
- Atomoxetine [Used for ADHD]
What is the SNDRIs?
- Serotonin Norepinephrine Dopamine Reupatake Inhibitors
- Tesofensine & Brasofensine
What is the purpose of Brexanolone?
- Treats postpartum depression [binds to the GABAa receptor increasing Cl-]
- Helps resensitizes the GABAa receptor
What are the new agents that are in development?
- Psychedelics: MDMA, Psilocybin, LSD
- 5HT2C Antagonist
- Metabotropic Glutamate Agonist
- RIMAs
What are some of the non-pharmacological considerations for Depression?
- Electroconvulsive Therapy, Psychotherapy, Hopsitalization
- Exercise, Diet…
What is the pharmacology of Filanserin?
- Hypoactive sexual desire disorder [delevoped as antidepressant]
- 5HT2A agonist
What are the different types of Bipolar disorder?
- Bipolar I, Bipolar II, Cyclothymia, Unspecified/Related, Substane-Induced
What are the symptoms fo Bipolar Disorder?
- Mania, Hypomania, Depression, Mixed Manis and Depression [Many UP and DOWNS]
What are the main features of Mania?
- Euphoria, Irritabilitym Impulsice high risk behavior, Aggressive, grand ideas, decrease sleep and appetite…
What are some of the treatment for Bipolar disorder?
- Hospitalization, Psychotherapy [Keeps them from hurting themselves]
- Pharmacotherapy [Lithium, Anticonvulsants, CCB?, Combo
What is MOA for Lithium in Bipolar Disorder?
- MOA: NOT understood; Depletion of PIP2 [Signaling of IP3 and PKC]
What are the anticonvulsants used in Bipolar Disorder?
- Valproate, Carbamazepine, Lamotriginem, Topiramate
What are the atypical antipsychotics use in bipolar disorder?
- Olanzapine, Quetiapinem, Risperidone, Ziprasidone, Lurasidone, Aripiprazole
