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Behavioural Pharmacology > Chapter 13: Antidepressants > Flashcards

Chapter 13: Antidepressants Flashcards

1
Q

Monoamine Theory of Depression?

A
  1. originate from: reduced activity in NE, SE and DA systems
  2. Current focus is on: 5-HT dysfunction (decreased activity)
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2
Q

Glucocorticoid Theory of Depression?

A
  • Heightened HPA-axis activity leads to elevation of stress hormone levels (cortisol)
  • Stress–> Hypothalamus: CRH–> Pituitary: ACTH–> Adrenal Cortex: Cortisol –(inhibits): Hypothalamus, Pituitary
  • > Cortisol stimulates Prefrontal Cortex, Amygdala and Hippocampus…Amygdala stimulates hypothalamus and the other two inhibit.
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3
Q

Problems in living theory?

A
  • depression is NOT a disease

- stressors can cause changes in the physiology and functioning of the brain

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4
Q

What are the first generation AD’s?

A
  1. Monoamine Oxidase Inhibitors
    L> first ever: Iproniazid (1950) originally used to treat TB- unwanted SE such as liver damage
  2. Tricyclic Antidepressants - safer
    L> firs: imipramine
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5
Q

What is the difference between new MAOIs vs old ones?

A
  • they are reversible

- less likely to effect diet or cause liver damage

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6
Q

What are the second Generation AD’s?

A
  1. SSRI’s: first choice….
    L> Prozac = first…..slightly different than Tricyclic
    L> less SE
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7
Q

What are the third generation AD’s?

A
  1. SNRI’s : effecting SE and NE
    * do not effect muscarinic acetylcholine receptors…therefore do not produce SE associated with older AD’s
    - enhancing NE treats tiredness and loss of energy etc
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8
Q

Neurophysiology:
1. First Gen AD’s
I) MAOI’s

A
  1. inhibit monoamine oxidase causing NE, SE, DA to float freely in cytoplasm
    - new ones are selective for MAO-A(degrades all three) or B(DA mostly)
    - some new ones are reversible
    - low doses = B, high= A
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9
Q

Neurophysiology:

  1. First Gen AD’s
    - tricyclic
A
  • block reuptake of 5-HT and NE

- block muscarinic acetylcholine receptors and they antagonize histamine and adrenergic receptors.

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10
Q

Neurophysiology:

2. Second and Third Gen AD’s

A

-SSRI : block reuptake of SE..Build up in synapses prolonging stimulation (fluoxetine - Prozac)
- SNRI: block reuptake of 5-HT and NE and in some cases DA
L> Bupropion ( NE and DA but not Sert!) aka Wellbutrin
L> goes against SE hypothesis
L> Zyban= smoking cessation aid!
*both are Bupropion

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11
Q

Which absorbs faster: TCA’s or SSRIS and SRNIs

A
  • TCAS
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12
Q

Do they undergo significant first pass metabolism?

A
  • yes via digestive system and liver
  • alcohol inhibits this therefore increasing the amount of drug being reabsorbed from a specific dose.
    BUT SSRIs and SNRIs barely react with alcohol
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13
Q

Do they readily cross the blood brain barrier and placental ?Where do they become concentrated ?

A

YES

- kidneys, lungs, liver and brain can be found in breast milk!

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14
Q

Excretion?

A

MAOI (2-4 hours) >SSRI (15-25 hours) > TCA (24 hours, single dose daily)

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15
Q

Excretion and Fluoxetine?

A
  • extremely long half life
  • nearly 4 days
  • active metabolite norfluoxetine has one of 7-15 days
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16
Q

Effects on the body?

  1. MAOI?
  2. TAC?
  3. SSRI
A
  1. tremors, weight gain, blurry vision, dry mouth and lowering of BP and postural hypotension. Can have dangerous SE when in combination with foods with tyramine (cheese, beer, wine, chocolate)…MAOI-A metabolizes it normally and B picks up whatever was missed. It can cause sweating, nausea and increased bp…headaches, internal bleeding and even stroke or death. (cheese effect)
    - also drugs such as Amph, decongestants and nose drops release NE which potentiates MAOI
17
Q

Effects on the Body?

2. TAC

A
  • ANS……PD specifically

- dry mouth, constipation, blurred vision, ringing in ears and retention of urine

18
Q

Effects on the Body?

3. SSRI

A
  • nausea, gastrointestinal probs, agitation, headache, dizziness, sweating , nervousness
  • cause weight loss
19
Q

Bupropion SE

A
  • restlessness, agitation, tremor, constipation, nausea, headache, dry mouth and loss of appetite.
  • seizures
20
Q

Why is serzone no longer sold ?

A
  • risk of liver damage
21
Q

MAOI’s effect on sleep?

A
  • insomnia or sedation
22
Q

TAC effect on sleep?

A
  • drowsiness (anticholinergic effect )
23
Q

Fluoxetine effect on sleep?

A
  • reduces REM but increases vividness of dreams
24
Q

Bupropion effect on sleep?

A
  • increases REM
25
Q

Subjective effects?

A
  • no euphoria
  • low doses: tiredness, apathy and weakness
  • high doses: impaired comprehension and produce confusion..
26
Q

performance ?

A

mixed feelings

27
Q

Personality effects?

A
  • cosmetic pharmacology: cover some part of the personality one is not happy about
  • useful in treating Personality Disorders (OCD ex) and compulsive behaviour
28
Q

Effectiveness?

A
  • ineffective for 1/3

- 50% reduction in symptoms for 2/3 but much of it is due to placebo

29
Q

Reproduction effects?

A
  • impairment in sexual functioning in males and females except not with bupropion
  • little effects on human fetus( teratogenic)
  • increased chance of miscarriage
30
Q

Violence and suicide?

A
  1. Prozac made me do it
  2. black box: warnings of suicidal ideation or suicide attempts in children and adolescents (negligible really)
  3. Risks of not treating depression may out weight risks of suicide?
31
Q

What is serotonin syndrome?

A
  • acute increase in SE…….interaction between drug and food containing tryptophan…
  • cognitive symptoms as disorientation, agitation, and confusion….life threatening due to deregulation of ANS…increasing BP, flushing, fever, shivering, irregular HB, diarrhea and shock..can lead to coma or death.
32
Q

Withdrawal?

A
  • TAC: restlessness, anxiety, chills, akathisia (compulsion to move), and muscle aches.
  • SSRI: dizziness, light headedness, insomnia, fatigue, anxiety, nausea, fatigue and sensory disturbances.
  • SNRI: heart palpitations, nausea and delusions…symptoms similar to a stroke
33
Q

Tolerance?

A
  • some to therapeutic effects

- SE usually occur in several weeks….may not develop totally to SSRI tiredness

34
Q

SSRI overdose?

A

combination of stimulants..causes serotonin syndrome..

  • untreated can cause respiratory failure, circulatory and kidney failure…
  • Citalopram and Venalfaxine = issues with cardiac functioning ( SSRI and SNRI)
35
Q

Alt treatment?

A
  • ECT: seizures are induced
  • Brain Derived Neurotopic Factor: increases via ECT
  • Deep brain stimulation: electrodes in prefrontal cortex
  • Transcranial Magnetic Stimulation: neuron depolarization is induced…
  • CBT

Behavioural Pharmacology (52 decks)

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