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Stage 3 Case 2 > Depression > Flashcards

Depression Flashcards

1
Q

Core symptoms of depression diagnosis

A
  • feeling down, depressed, or hopeless

- loss of interest or pleasure

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2
Q

Other considerations for diagnosis

A
  • Need number of symptoms

- Severity of functional impairment

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3
Q

What is the duration of symptoms required for diagnosis?

A

2 weeks minimum

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4
Q

Mild depression

A

Minimum number of symptoms (5+)

Mild functional impairment

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5
Q

Moderate depression

A

More symptoms and/or more functional impairment

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6
Q

Severe depression

A

Most symptoms

Marked functional impairment

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7
Q

Treatment for mild depression

A

Lifestyle changes and counselling

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8
Q

Treatment for moderate depression

A

Lifestyle changes, counselling, pharmacotherapy, non-drug treatments

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9
Q

What environmental factors can cause depression?

A
  • Stress- early life and on-going (psychological/physical)
  • Drugs/alcohol
  • Medicines
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10
Q

Pathology of depression

A
  • Uncertain
  • Some patients have increase cortisol
  • Some patients have structural bairn changes (older)
  • Effective drugs suggest deficit in monoamine neurotransmission
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11
Q

Iproniazid

A

Inhibits monoamine oxidase

Causing euphoria and increased energy

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12
Q

Imipramine

A

Inhibits reuptake of 5-HT and noradrenaline

Relieving depressive symptoms

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13
Q

What do MAO inhibitor and neurotransmitter reuptake inhibitors essentially do?

A

Increase post synaptic receptor activity.

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14
Q

What determines synthesis of 5-HT?

A

TPH/TH

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15
Q

What determines breakdown of 5-HT?

A

MAO (monoamine oxidase)

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16
Q

What determines the 5-HT vesicular content?

A

The synthesis and the breakdown. This determines the amount of 5-HT released per action potential.

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17
Q

What determines the release rate of 5-HT?

A

Firing activity

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18
Q

What determines the reuptake rate of 5-HT?

A

Transporter activity

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19
Q

What does the release and reuptake rate determine?

A

The level and duration of 5-HT in synaptic clef and cation of receptor.

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20
Q

MAO inhibitor

A

Inhibits monoamine oxidase

  • Increase neurotransmitter in the vesicle
  • Increases neurotransmitter release per impulse
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21
Q

Inhibition of 5-HT reuptake

A
  • Increases duration and concertation of 5-HT/Noradrenaline synaptic cleft
  • Increases postsynaptic receptor activation
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22
Q

Reuptake inhibitor drugs

A

Tricyclics (Non-selective 5-HT/NA)
SSRIs
NARIs
SNRIs

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23
Q

MAO A

A

Serotonin > Noradrenaline > Dopamine

(Serotonin highest affinity)

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24
Q

MOA B

A

Dopamine > Noradrenaline > Serotonin

(Dopamine highest affinity)

25
What are MAO A inhibitors/ MAO A and B inhibitors used for?
Depression treatment
26
What are MAO B inhibitors used for?
Parkinson’s disease treatment
27
MAO A inhibitors examples
Clorgyline | Moclobemide
28
MAO A and B inhibitors examples
Tranylcypromine Iproniazid Pargyline
29
MAO B inhibitors examples
Selegiline
30
What are problematic interactions with MAO inhibitors?
- ‘Cheese reaction’ – avoid certain foods - Avoid cold remedies and rec drugs - Serotonin syndrome – interaction with other ‘serotonergic drugs’
31
‘Cheese reaction’ and MAO inhibitors
MAO part of cytochrome P450 enzyme, so responsible for breaking down tyramine and other amines. MOA inhibitors cause amine levels to increase. -Increases BP (alpha-1 vasoconstriction) -Provoke hypertensive crisis
32
Irreversible blockade of enzymes through MAO inhibitors.
MAOI can bind to enzyme irreversible, so effects outlast clearance of the drug (drug not present in plasma levels). New enzymes required to synthesis (6 weeks)
33
2 TAC examples
Amitriptyline | Desipramine
34
What differs in reuptake inhibitors? (3)
- 5-HT/NA selectivity - Other pharmacology - Half-life
35
2 SSRI examples
Citalopram | Paroxetine
36
2 SNRI examples
Duloxetine | Venlafaxine
37
5-HT/NA selectivity of reuptake inhibitors
The relative potency of the 5-HT and NA transporters for different drugs varies TAC- small difference SSRIs- big difference SNRIs- small difference
38
How are TACs non-selective and ‘dirty’?
Small difference. Because at the doses taken they attach to other receptors (e.g. H1, NA alpha 1 and mACh)
39
How are SSRIs selective and ‘clean’?
Big gap for affinity for 5-HT transporter and affinity for other receptors. So at the doses taken not going to be blocking other unwanted receptors.
40
How are SNRIs non-selective and ‘clean’?
Small gap but do not have affinity for other unwanted receptors.
41
What is blocking of histamine H1 receptor associated with? (side effects)
Sedation (sleepy and weight gain)
42
What is blocking of 5-HT transporter associated with? (side effects)
Sexual defunction and GI disturbances
43
What is blocking of NA alpha 1 receptor associated with? (side effects)
Postural hypotension
44
What is blocking of mACh (muscarinic acetylcholine receptor associated with? (side effects)
Dry mouth, urinary retention, and constipation
45
What is blocking of NA transporter associated with? (side effects)
Anxiety
46
First line drug treatment for depression
SSRI- sertraline, citalopram | -Low dose and titrate up
47
Lifestyle changes for depression
- Dec drug/alcohol - Dec stress - Inc social and physical activity
48
Poor response to treatment: Dose
Titrate while tolerable
49
Poor response to treatment: Antidepressant type
Switch antidepressant
50
Poor response to treatment: Additional drugs
Different antidepressant, antipsychotic, lithium
51
Poor response to treatment: Non-drug therapy
CBT
52
Why is SSRI first line?
Well tolerated and few side effects
53
TCAs effectiveness and side effects
More side effects (but sedation may be useful for insomnia) | More dangerous in overdose
54
SNRIs effectiveness and side effects
More efficacious in treatment for depression, but less well tolerated
55
MAOIs effectiveness and side effects
Effective but difficult to take
56
What SSRI has a long half-life?
Fluoxetine, so couple weeks to clear out
57
Discontinuation of antidepressants management
Switch to fluoxetine due to long half life. Reduce dose slowly. Treat symptoms
58
Discontinuation of antidepressants withdrawal
``` Flu-like symptoms Nausea Anxiety ‘Electric shocks’ Difficulty sleeping ```
59
What SSRI has a short half-life?
Paroxetine (Seroxat)/venlafaxine

Stage 3 Case 2 (7 decks)

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