ch 23: antidepressants and mood stabilizers

Question 1

what is the cause of depression?

Answer 1

insufficient amount of NES and DA

Question 2

what is type 1 depression? type 2? type 3?

Answer 2

• reactive or exogenous (sudden “blues”)
• major or unipolar (5+ symptoms > 2 weeks)
• bipolar (mood swings)

Question 3

what are two herbel supplements for depression?

Answer 3

• st. john’s wort

- gingko biloba

Question 4

what are 3 depression treatments used before drugs?

Answer 4

• ECT
• vegus nerve simulation
• TMS

Question 5

what is ECT?

Answer 5

• thiopental and succinyl choline

- rapid onset

Question 6

what is vegus nerve simulation? what are side effects?

Answer 6

• long term therapy when at least 4 drugs have failed
• implanted device that delivers electrical pulses to the vegus nerve
• side effects: horseness, cough, and duyspnea

Question 7

what is TMS? how often do you do this? what are side effects?

Answer 7

• major depression
• magnetic coil put on the scalp that delivers magnetic field to the brain
• 40 min a day for 6 weeks
• headaches, eye aches, tooth aches, muscle twitching, and seizures

Question 8

what are the 4 antidepressant drug categories used?

Answer 8

• TCA
• SSRI
• atypical antidepressants
• MAOI

Question 9

what are TCAs? How long does it take? what are drug examples? what is important when stopping this drug? what are some drug-drug interactions for TCAs?

Answer 9

• block the uptake of NE and S
• 2-4 weeks
• maitriptyline and imipramine
• slow withdrawl, can lead to vomiting, anxiety, and akathisia
• increase effect with anticholinergics; CNS depression with opioids or alcohol; cardiovascular instability with MAOIs

Question 10

what are SSRIs? what are some drug examples? what are these drugs used for? what are the side effects? are is a drug food interaction?

Answer 10

• block uptake of S only
• fluoxetine: takes 1-12 weeks
• fluroxamine (OCD)
• anxiety, deression, and migranes
• sexual dysfunction, nausea, nervousness, insomnia, weight gain of <20 pounds, and S syndrome within 3 days
• grape fruit juice decreases the breakdown which can lead to toxicity

Question 11

what are atypical antidepressants? what are drug exmples? what are drug-drug interactions?

Answer 11

• effect one or two out of the three neurotransmitters
• amoxapine and trazodone
• do not take with MAOIs because of half life

Question 12

what are MAOIs? what is the drug example? what are drug-drug interactions? what are drug-food interactions?

Answer 12

• used for depression, not controlled by TCAs and atypical antidepressants
• selegiline
• only 1% use these due to diet restrictions
• hypertensive crisis with symathominetics
• hypertensive crisis with tyramine

Question 13

what is selegiline? what is a drug-drug interaction?

Answer 13

• MAOI
• first transdermal treatment for depression
• avoids first past effect
• cant use symathominetics drugs

Question 14

what is an example of a mood stabilizer? what is it’s mechanism of action? what is it used for? what is the therapeutic range?

Answer 14

• lithium
• bipolar disorder
• alters ion transport in muscle and nerve cells
• 0.8 to 1.2

Question 15

what is litium’s relationship with sodium?

Answer 15

• the less lithium the body retains

- no sodium=body retains lithium= toxicity

Question 16

what kind of effect does lithium have with caffeine? with NSAID?

Answer 16

• decrease lithium effect

- increase lithium effect

Question 17

what is lithiums toxicity levels? what are the signs and symptoms?

Answer 17

• > 1.5

- nausea, vomiting, diarrhea, blurred vision, ataxia, tremors, and confusion