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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
Q

What are MAO A inhibitors/ MAO A and B inhibitors used for?

A

Depression treatment

26
Q

What are MAO B inhibitors used for?

A

Parkinson’s disease treatment

27
Q

MAO A inhibitors examples

A

Clorgyline

Moclobemide

28
Q

MAO A and B inhibitors examples

A

Tranylcypromine
Iproniazid
Pargyline

29
Q

MAO B inhibitors examples

A

Selegiline

30
Q

What are problematic interactions with MAO inhibitors?

A
  • ‘Cheese reaction’ – avoid certain foods
  • Avoid cold remedies and rec drugs
  • Serotonin syndrome – interaction with other ‘serotonergic drugs’
31
Q

‘Cheese reaction’ and MAO inhibitors

A

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
Q

Irreversible blockade of enzymes through MAO inhibitors.

A

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
Q

2 TAC examples

A

Amitriptyline

Desipramine

34
Q

What differs in reuptake inhibitors? (3)

A
  • 5-HT/NA selectivity
  • Other pharmacology
  • Half-life
35
Q

2 SSRI examples

A

Citalopram

Paroxetine

36
Q

2 SNRI examples

A

Duloxetine

Venlafaxine

37
Q

5-HT/NA selectivity of reuptake inhibitors

A

The relative potency of the 5-HT and NA transporters for different drugs varies
TAC- small difference
SSRIs- big difference
SNRIs- small difference

38
Q

How are TACs non-selective and ‘dirty’?

A

Small difference. Because at the doses taken they attach to other receptors (e.g. H1, NA alpha 1 and mACh)

39
Q

How are SSRIs selective and ‘clean’?

A

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
Q

How are SNRIs non-selective and ‘clean’?

A

Small gap but do not have affinity for other unwanted receptors.

41
Q

What is blocking of histamine H1 receptor associated with? (side effects)

A

Sedation (sleepy and weight gain)

42
Q

What is blocking of 5-HT transporter associated with? (side effects)

A

Sexual defunction and GI disturbances

43
Q

What is blocking of NA alpha 1 receptor associated with? (side effects)

A

Postural hypotension

44
Q

What is blocking of mACh (muscarinic acetylcholine receptor associated with? (side effects)

A

Dry mouth, urinary retention, and constipation

45
Q

What is blocking of NA transporter associated with? (side effects)

A

Anxiety

46
Q

First line drug treatment for depression

A

SSRI- sertraline, citalopram

-Low dose and titrate up

47
Q

Lifestyle changes for depression

A
  • Dec drug/alcohol
  • Dec stress
  • Inc social and physical activity
48
Q

Poor response to treatment: Dose

A

Titrate while tolerable

49
Q

Poor response to treatment: Antidepressant type

A

Switch antidepressant

50
Q

Poor response to treatment: Additional drugs

A

Different antidepressant, antipsychotic, lithium

51
Q

Poor response to treatment: Non-drug therapy

A

CBT

52
Q

Why is SSRI first line?

A

Well tolerated and few side effects

53
Q

TCAs effectiveness and side effects

A

More side effects (but sedation may be useful for insomnia)

More dangerous in overdose

54
Q

SNRIs effectiveness and side effects

A

More efficacious in treatment for depression, but less well tolerated

55
Q

MAOIs effectiveness and side effects

A

Effective but difficult to take

56
Q

What SSRI has a long half-life?

A

Fluoxetine, so couple weeks to clear out

57
Q

Discontinuation of antidepressants management

A

Switch to fluoxetine due to long half life. Reduce dose slowly.
Treat symptoms

58
Q

Discontinuation of antidepressants withdrawal

A 
Flu-like symptoms
 Nausea
 Anxiety
 ‘Electric shocks’
 Difficulty sleeping
59
Q

What SSRI has a short half-life?

A

Paroxetine (Seroxat)/venlafaxine

Stage 3 Case 2 (7 decks)

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