Ch 32 Antidepressants

Question 1

The principal symptoms of major depression are __.

Answer 1

depressed mood and loss of pleasure or interest in one’s usual activities and pastimes

Question 2

Patients with mild depression can be treated equally well
with ___.

Patients with severe depression respond better to a ___.

Answer 2

antidepressant drugs or psychotherapy

combination of drugs plus psychotherapy than to either intervention alone

Question 3

Patients with depression often think about or attempt suicide. During treatment with antidepressants, especially initially, the risk of suicide may__. To reduce the risk of suicide, patients should be followed closely by family members, caregivers, and the prescriber. Suicide risk is greatest in ___.

Answer 3

increase

children and young adults

Question 4

All antidepressants appear equally effective. Differences

relate primarily to __(3)__.

Answer 4

side effects, drug interactions, and cost

Question 5

Therapeutic responses to antidepressants develop slowly. Initial responses develop in ___. Maximal
responses may not be seen until __.

Answer 5

1 to 3 weeks

12 weeks

Question 6

Antidepressant therapy should continue for __

after symptoms resolve.

Answer 6

4 to 9 months

Question 7

___ block reuptake of serotonin, and thereby intensify
transmission at serotonergic synapses. Over time, this
induces adaptive cellular responses that are ultimately
responsible for relieving depression.

Answer 7

SSRIs

Question 8

SSRIs have two major advantages over TCAs:

Answer 8

they causefewer side effects and are safer when taken in overdose

Question 9

Most SSRIs have stimulant properties, and hence can cause __. This contrasts with TCAs, which cause sedation.

Answer 9

insomnia and agitation

Question 10

Like most other antidepressants, SSRIs can cause __.

Answer 10

weight gain

Question 11

___ is more common with SSRIs than with most other antidepressants.

Answer 11

Sexual dysfunction (e.g., impotence, anorgasmia)

Question 12

SSRIs can cause ___, especially when
combined with MAOIs.

Combined use of SSRIs and MAOIs is contraindicated,
and combined use with other serotonergic drugs should be done with extreme caution, if at all.

Answer 12

serotonin syndrome

Symptoms include agitation, confusion, hallucinations, hyperreflexia, tremor, and fever.

Question 13

SNRIs block reuptake of __.

Effects are similar to those of the SSRIs.

Answer 13

serotonin and norepinephrine

Question 14

The most common side effects of SNRIs include __.

Answer 14

nausea, insomnia, and hypertension.

SNRIs can also contribute to sexual dysfunction.

Question 15

SNRIs, like SSRIs, can cause __.

Answer 15

serotonin syndrome

Question 16

___ block reuptake of NE and 5-HT and thereby intensify transmission at noradrenergic and serotonergic synapses. Over time, this induces adaptive cellular responses that are ultimately responsible for relieving depression.

Answer 16

TCAs

Question 17

The most common adverse effects of TCAs are (3).

Answer 17

sedation, orthostatic hypotension, and anticholinergic effects (e.g., dry mouth, constipation).

Question 18

The most serious adverse effect of TCAs is __.

Answer 18

cardiotoxicity, which can be lethal if an overdose is taken

Question 19

TCAs can cause a ___ if combined with
an MAOI. Accordingly, the combination is generally
avoided.

Answer 19

hypertensive crisis

Question 20

TCAs intensify responses to __ and diminish responses to __.

Answer 20

direct-acting sympathomimetics (e.g., epinephrine)

indirect-acting sympathomimetics (e.g., amphetamine)

Question 21

__ increase neuronal stores of NE and 5-HT, and
thereby intensify transmission at noradrenergic and serotonergic synapses. Over time, this induces adaptive cellular responses that are ultimately responsible for relieving depression.

Answer 21

MAOIs

Question 22

__ are as effective as SSRIs and TCAs, but are

potentially more hazardous.

Answer 22

MAOIs

Question 23

MAOIs are first-choice drugs only for patients with __.

Answer 23

atypical depression

Question 24

Like SSRIs and SNRIs (and unlike TCAs), MAOIs cause

direct __.

Answer 24

CNS stimulation

Question 25

Like TCAs (and unlike SSRIs or SNRIs), MAOIs cause
\_\_.

Answer 25

orthostatic hypotension

Question 26

Patients taking MAOIs must not eat __ because hypertensive crisis can result. Hypertensive crisis can be treated with an __.

Answer 26

tyramine-rich foods

IV vasodilator (e.g., sodium nitroprusside, labetalol, phentolamine)

Question 27

MAOIs must not be combined with __ because

hypertensive crisis can result.

Answer 27

indirect-acting sympathomimetics (e.g., amphetamine, cocaine)

Question 28

MAOIs must not be combined with (3) because serotonin syndrome could result.

Answer 28

SSRIs, SNRIs, or other serotonergic drugs

Question 29

__ relieves depression faster than antidepressant drugs, and often helps when antidepressants have failed.

Answer 29

ECT

Question 30

ECT as practiced today is safer and less traumatic than in the past, owing to adjunctive use of (2).

Answer 30

(1) a short-acting IV anesthetic (e.g., propofol, etomidate) to produce unconsciousness and
(2) a short-acting muscle relaxant (succinylcholine) to prevent convulsions