Ch 32: Antidepressants

Question 1

Clinical observations in the 1960s led to formulation of the…

Answer 1

…monoamine-deficiency hypothesis of depression.

p. 339

Question 2

What does the monoamine-deficiency hypothesis of depression assert?

Answer 2

That depression is caused by a functional deficiency of monoamine neurotransmitters (norepinephrine, serotonin, or both).

(p. 339)

Question 3

What are the 5 classes of antidepressants?

Answer 3

SSRIs
SNRIs
TCAs
MAOIs 
atypical antidepressants

(p. 341)

Question 4

Once an antidepressant has been selected for initial treatment, it should be used for __ to __ weeks to assess efficacy.

Answer 4

4 - 8 weeks

p. 342

Question 5

The risk of suicidality appears _____ with all _______________.

Answer 5

equal; antidepressants

p. 343

Question 6

Fluoxetine produces CNS…

Answer 6

…excitation rather than sedation.

p. 344

Question 7

What are the 6 SSRI’s? (Think C-E-F-F-P-S)

Answer 7

citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline   

(p. 346)

Question 8

Which is the only SSRI known to cause sedation?

Answer 8

fluvoxamine

p. 346 - 347

Question 9

What is the mechanism of action of SSRI’s?

Answer 9

blockade of 5-HT reuptake and with a resulting increase of 5-HT in the synapse

Question 10

Venlafaxine may be cautiously combined with an SSRI or another SNRI, however, combined use with an ____ is contraindicated.

Answer 10

MAOI

p. 348

Question 11

What are the 4 SNRI’s?

Answer 11

venlafaxine and desvenlafaxine
duloxetine
levomilnacipran

(p. 346)

Question 12

What was the 2nd SNRI approved for major depression?

Answer 12

duloxetine (Cymbalta)

p. 348

Question 13

Due to their similar structures, both the TCA’s and the phenothiazine antipsychotics produce the following effects:

Answer 13

sedation and anticholinergic effects, and orthostatic hypotension which is the most serious adverse effect

(p. 349)

Question 14

How do TCA’s work?

Answer 14

They block neuronal reuptake of NE and 5-HT (although some only block reuptake of NE).

(p. 349)

Question 15

Why are TCA’s not first-line antidepressants?

Answer 15

Because the SSRI’s and SNRI’s are generally safer and better tolerated.

(p. 351)

Question 16

Cardiac toxicity is one of the more serious adverse effects of TCA’s. What are the 2 ways that TCA’s affect the heart?

Answer 16

1.) decreasing vagal influence on the heart secondary to muscarinic blockade
2.) acting directly on the bundle of His to slow conduction.
Both of these effects increase the risk of dysrhythmias.

(p. 351)

Question 17

What do TCA’s do to the seizure threshold?

Answer 17

lower it

p. 351

Question 18

What is the greatest concern with prescribing MAOI’s?

Answer 18

Hypertensive crisis, which can be triggered by eating foods rich in tyramine.

(p. 352)

Question 19

What is MAO, where is it, and what is its function?

Answer 19

MAO is monoamine oxidase, and it is an enzyme found in the liver, the intestinal wall, and terminals of monoamine containing-neurons.
Its function is to convert monoamine neurotransmitters (NE, 5-HT, and dopamine) into inactive products.

(p. 352)

Question 20

All of the MAOIs in current use cause ____________ inhibition.

Answer 20

irreversible

p. 352

Question 21

What is one major benefit of transdermal selegiline?

Answer 21

The risk of hypertensive crisis from dietary tyramine is much lower than with oral dosing.

(p. 355)

Question 22

Bupropion (Wellbutrin) is an atypical antidepressant similar in structure to…

Answer 22

…amphetamine. Like amphetamine, bupropion has stimulant actions and suppresses appetite.

(p. 356)

Question 23

In contrast to SSRI’s, bupropion does not cause…

Answer 23

…weight gain or sexual dysfunction. In fact, it appears to increase sexual desire and pleasure.

(p. 356)

Question 24

Bupropion is approved to treat…

Answer 24

…major depression, seasonal affective disorder, and as an aid in smoking cessation.

(p. 356)

Question 25

Antidepressant therapy should continue for how long after symptoms resolve?

Answer 25

4 to 9 months

p. 359

Question 26

What are 5 TCA drugs available which block both NE and 5-HT reuptake? (A-C-D-I-T)

The 4 which block both only NE reuptake? (D-M-N-P)

Answer 26

amitriptyline
clomipramine
doxepin
imipramine
trimipramine

desipramine
maprotiline
nortriptyline
protriptyline

(p. 350)

Question 27

What is the risk if MAOI’s are combined with an SSRI or an SNRI?

Answer 27

serotonin syndrome, symptoms of which begin 2 - 72 hours after treatment onset. Signs and symptoms include AMS, incoordination, myoclonus, hyperreflexia, excessive sweating, tremor, and fever.

(p. 345)