Anxiety and depression Treatment Flashcards
Where are the reductions in brain regions in depression
prefrontal cortex
hippocampus
Amygdala
What is the HPA axis in depression
Hypothalamus releases CRH to anterior pituitary
Anterior pituitary releases ACTH to Adrenal cortex
Adrenal cortex releases cortisol
Depressed patients displayed HPA hyper activation
What is
- CRH
- cortisol
- pituitary and adrenal glands
- negative feedback of HPA axis
like in depressed patients
increased cortisol in saliva, plasma and urine
Increased CRH in CSF and in limbic brain region
Increased size and activity of the pituitary and adrenal glands
Impaired negative feedback of HPA axis
Mode of action of antidepressants
Enhance negative feedback in HPA axis and decrease HPA axis hyperactivity
How to treat depression in those <18yo with mild depression
Psychological therapy e.g. CBT
How to treat depression in those <18yo with moderate to severe depression
Psychological therapy
if not working, use combined therapy i.e. psychological + fluoxetine
If unresponsive to combined therapy, consider alternative psychological therapy
If experiencing side effects to fluoxetine, use sertraline or citalopram
What to give to <18yo patients who are experiencing side effects to fluoxetine
sertraline or citalopram
How to treat depression adults with mild depression
Appropriate psychological intervention
Not recommended drug treatment unless under certain circumstances e.g. previous history of moderate/severe depression
How to treat moderate/severe depression in adults
Combined therapy (psychological + antidepressant)
What are the 3 main modes of action of antidepressants
Reuptake inhibition
Receptor blocked
MOA enzyme inhibition
Mode of action of Tricyclic antidepressant
other effects of TCA antidepressants
Inhibit serotonin and noradrenaline reuptake
sedative properties
Anticholinergic side effects (e.g. dry mouth, blurred vision)
CV effects can be Fatal in overdose
Effect of Monoamine Oxidase Inhibitor reaction
Cheese reaction- MOA increases tyramine in periphery and this displaces noradrenaline from vesicle storage
-Too much noradrenaline present so you can hypertensive crisis
Effect of SSRI
Selective Serotonin Reuptake Inhibitors
advantages of SSRIs
favourable side effect profile and less toxic in overdose
What is the first line option of antidepressants
SSRI (selective serotonin reuptake inhibitors)
What are other antidepressant drugs
Serotonin-Noradrenaline Reuptake Inhibitor
Noradrenaline Reuptake Inhibitor
Mirtazapine
Mode of action of Mirtazapine
Enhances NA and 5-HT transmission
Presynaptic a2 adrenoceptors responsible for inhibiting noradrenaline release are blocked
Presynaptic 5-HT2 responsible for inhibiting 5-HT release are also blocked
What can be used to treat autonomic symptoms in anxiety
What is their mode of action
B-adrenoceptor antagonists
-Reduces autonomic effect
What should you not do with B-adrenoceptor antagonists
Do not withdraw abruptly to prevent rebound effects
How to treat anxiety symptoms
SSRI as first option
Psychological interventions
When should you and should you not offer benzodiazepine for anxiety
Not offer it executor for short term use during a crisis
What are Benzodiazepines used for
Muscle relaxation Insomnia Pre-medicatin Epilepsy Alcohol withdrawal Anxiety
How do benzodiazepines work
They are positive allosteric modulators on GABAa receptor complex
They occupy site on GABAa complex
Conformation change allows GABA to bind
GABA binding causes a conformational change in GABAa receptor chloride channel
There is a greater flow of Cl- into neurone
Hyperpolarisation=inhibition
What is the depressed mood and the Mania mood like in Bipolar disorder
Depressed mood- period of at least 2 weeks with core symptoms accompanied by at least 4 other symptoms
Mania- elevated mood, increased energy, incomprehensible speech, racing thoughts, poor concentration
