Anxiety and Depression

Question 1

Characterise anxiety.

Answer 1

Concern about the future, inappropriate fear response, heightened somatic and autonomic effects.

Question 2

What disorders are associated with anxiety?

Answer 2

PTSD, OCD, panic disorder, GAD and phobias.

Question 3

What are the symptoms of anxiety?

Answer 3

Heightened autonomic responses, eg: palpitations, tachycardia etc.. (must rule out other medical conditions eg: asthma)

Question 4

What are the non-pharmacological treatments of anxiety?

Answer 4

CBT, meditation etc..

Question 5

What are the pharmacological treatments of anxiety? Describe each drug.

Answer 5

Beta-adrenoreceptor antagonism - reduces autonomic effect, used as required, if been taking for a long time then must not stop abruptly.
Benzo’s - sedative, muscle relaxant, hypnotic, amnesic.
Some tolerance but no enzyme induction. 45% dependance and withdrawal. Safe in over dose. Used for short term relief.

Question 6

How are benzo’s metabolised?

Answer 6

Oxidised and conjugated, oxidation is reduced in old age, therefore effectiveness may be prolonged in older patients.

Question 7

What is the mechanism of action for Benzo’s?

Answer 7

GABA-benzo receptor complex. When the benzo molecule couples the complex, it increases it’s affinity for GABA. This causes and influx of Cl- and hyperpolarisation and a decrease in neurotransmitter.

Question 8

What are 3 other anxiolytics?

Answer 8

Serotogenic drugs for eg: Buspirone (rarely used) and SSRI’s

Question 9

How is depression diagnosed?

Answer 9

By being in a depressed mood and losing interest, along with 3 of the following. Weight change, altered sleep, psychomotor agitation, fatigue, reduced ability to think, feeling of worthlessness/guilt, recurrent thoughts of suicide.

Question 10

What are the symptoms of bipolar disease?

Answer 10

Symptoms from depression to mania.

Question 11

Bipolar is treated prophylactically with what?

Answer 11

Lithium salts - inhibit the turnover of phosphoinositol.

Question 12

What are the 3 theories of depression?

Answer 12

1. Amine dysfunction - reduce NA function, post-synaptic 5HT receptor down regulation and altered dopamine function.
2. Hypothalamic-pituitary-adrenal axis dysfunction - elevated cortisol, insensitivity to dexamethasone. Complex interaction between brain 5HT and HPA.
3. Neurotrophic and neuroplasticity hypothesis - physical changes in cortical areas in severe depression could relate to cortisol abnormalities.

Question 13

What are the 4 lines of treatment for depression/bipolar?

Answer 13

Drugs, electroconvulsive treatment (ECT), natural products, CBT etc..

Question 14

There are 3 main anti-depressant drugs. What are they?

Answer 14

Tricyclics, MAO inhibitors, SSRI’s.

Question 15

Give examples of tricyclic amine re-uptake blockers.

Answer 15

Imipramine, desipramine, chlorimipramine.

Question 16

Give an example of a H1 histamine receptor antagonist.

Answer 16

Amitryptaline.

Question 17

What are some problems associated with MAOIs?

Answer 17

Initial euphoria but slow onset of therapeutic effect. Some anticholinergic effects. Insomnia/ reduced REM sleep, postural hypotension, weight gain, liver damage.

Question 18

What is the cheese effect?

Answer 18

Potentially fatal hypertensive crisis. occurs when sympathomimetic amine tyramine and dopamine containing foods kick out MAO, leading to increase in transmitter, increase activation of heart and increased vasoconstriction.

Question 19

What are the side effects of SSRIs?

Answer 19

Nausea and vomiting - 5HT3 receptors. Anorgasmia, akathisia - restless leg syndrome (5HT2), agitation and anxiety at start.

Question 20

How long is the onset of SSRIs?

Answer 20

10-20 days (70% response rate)