Depression

Question 1

Drugs

Answer 1

Setraline
Citalopram
Fluoxetine
Venlafaxine
Mirtazapine

Question 2

Setraline action

Answer 2

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.

Question 3

Sertraline target

Answer 3

Serotonin transporter

Question 4

Sertraline side effects

Answer 4

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia

Question 5

Sertraline other

Answer 5

Mild inhibition of dopamine transporter

Must be gradually decreased on discontinuation. Partial inhibition of CYP2D6 at high doses (150 mg).

In 2020 – Sertraline was the 16th most commonly prescribed drug in West London area

Question 6

Citalopram action

Answer 6

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.

Question 7

Citalopram target

Answer 7

Serotonin transporter

Question 8

Citalopram side effects

Answer 8

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia

Question 9

Citalopram other

Answer 9

Mild antagonism of muscarinic and histamine (H1) receptors

Must be gradually decreased on discontinuation. Metabolized by CYP2C19.

In 2020 – Citalopram was the 27th most commonly prescribed drug in West London area

Question 10

Fluoxetine action

Answer 10

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.

Question 11

Fluoxetine target

Answer 11

Serotonin transporter

Question 12

Fluoxetine side effects

Answer 12

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia

Question 13

Fluoxetine other

Answer 13

Mild antagonism of 5HT2A and 5HT2C receptors

Complete inhibition of CYP2D6 and significant inhibition of CYP2C19 (caution with warfarin).

In 2020 – Fluoxetine was the 68th most commonly prescribed drug in West London area

Question 14

Venlafaxine action

Answer 14

Venlafaxine is a more potent inhibitor of serotonin reuptake than norepinephrine reuptake.
Noradrenaline in the central nervous system is implicated in the regulation of emotions and cognition.

Question 15

Venlafaxine target

Answer 15

Serotonin transporter

Noradrenaline transporter

Question 16

Venlafaxine side effects

Answer 16

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia, hypertension (at higher doses)

Question 17

Venlafaxine other

Answer 17

Must be gradually decreased on discontinuation

In 2020 – Venlafaxine was the 83rd most commonly prescribed drug in West London area

Question 18

Mirtazapine action

Answer 18

Antagonises central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine.
Antagonises central 5HT2 receptors, which leaves 5HT1 receptors unopposed causing anti-depressant effects.

Question 19

Mirtazapine target

Answer 19

Alpha-2 receptor

5-HT2 receptor

Question 20

Mirtazapine side effects

Answer 20

Weight gain

Sedation

Question 21

Mirtazapine other

Answer 21

Low probability of sexual dysfunction. May exacerbate REM sleep behaviour disorder

In 2020 – Mirtazapine was the 30th most commonly prescribed drug in West London area