Case study 3- Depression 1.1 Flashcards
What are the symptoms of depression
- Lack of energy
- Low moods
- Anhedonia
Symptoms must be present for 2 weeks in order for it to be depression
List 4 types of antidepressants
SSRIs- Serotonin reuptake inhibitors
TCAD- Tricyclic anti-depressants
SNRI- Serotonin and Noradrenaline Reuptake inhibitor
NARI- Noradrenaline reuptake inhibitors
NaSSA- noradrenergic and specific
serotoninergic antidepressants
MAOI- Mono amine oxidase inhibitor
RIMA- Reversible inhibitor of monoamine oxidase A
Lithium
These can be used in combination when prescribed by a specialist
How do SSRIs work?
When they’re taken orally they travel through the bloodstream into the brain
Increase levels of serotonin in the brain as depression is caused by low levels of serotonin in the brain
-Inhibits/prevents the re-uptake of serotonin/monoamine transmitters within the synaptic cleft
- This causes levels of serotonin within the synaptic cleft
- Depression is thought to be associated with the depletion of serotonin in the brain, therefore SSRIs are a treatment
What happens when st johns wort is taken alongside serotonin?
Serotonin syndrome
What is serotonin syndrome?
Serotonin syndrome/serotonin toxicity is caused by excessive central and peripheral serotonergic activity.
Symptoms include:
Neuromuscular hyperactivity
- Tremor
- Hypperreflexia
- Clonus
- Myoclonus
- Rigidity
Autonomic dysfunction
- Tachycardia
- Blood pressure changes
- Hyperthermia
- Diaphoresis
- Shivering
- Diarrhoea
Altered mental state
- Agitation
- Confusion
- Mania
What are the pros of SSRI’s compared to TCAD?
SSRI’s have a good safety profile
TCAD can make you feel:
- Drowsy
- Suicidal
- Increase risk of overdose
- Has more interactions
Why do SSRIs take 2-4 weeks to work?
Takes time for serotonin to accumulate in the synaptic cleft and to have an effect on depression
They not only work by inactivating individual serotonin transporters but also the genes in our DNA that code for the transporters
Alteration of genes takes a long time
Takes time for se
Give examples of SSRIs
- Fluoxetine
- Sertraline
- Citalopram
What does SNRIs stand for?
Selective Noradrenaline reuptake inhibitors
Give an example of an SNRI
Duloxetine
What is the mechanism of action of SNRIs?
Act to inhibit both serotonin and noradrenaline receptors
Increasing their levels in the synaptic cleft
What do different serotonin receptors in the body do ?
control
mood
sleep
appetite
sexual function
What side effects are associated with SNRIs and SSRIs?
Anxiety
agitation
insomnia or drowsiness
loss of appetite
sexual dysfunction
headache
dizziness
sweating
hyponatermia
bruxism
dry mouth
nausea
vomiting
diarrhoea
When can serotonin syndrome occur?
When SSRIs or SNRIs are combined with other antidepressants that increase serotonin in the brain, especially in MAOI
What are the common symptoms of serotonin syndrome
skin flushing
hyperthermia
agitation
muscle rigidity
seizures
altered mental state
coma
