Depression

Question 1

How do SSRIs work?

Target, location, mechanism, effect

Answer 1

Target: 5HT transporters
Location: presynaptic membrane
Mechanism: blocks reuptake of serotonin
Effect: increased serotonin in synaptic cleft

Question 2

How does venlafaxine work?

Target, location, mechanism, effect

Answer 2

Target: serotonin transporters & noradrenaline transporters
Location: presynaptic membrane
Mechanism: blocks reuptake of serotonin and noradrenaline (more potent with serotonin)
Effect: more noradrenaline and serotonin available

Question 3

How does mirtazapine work?

Answer 3

Target: 5HT2 receptor, alpha-2 adrenergic receptors
Mechanism: antagonises alpha-2 adrenergic receptors, causing increased release of serotonin and noradrenaline. Antagonises 5HT2, so 5HT1 unopposed = antidepressant

Question 3

How does mirtazapine work?

What receptor and effect does it preferably bind to first?

Answer 3

Target: 5HT2 receptor, alpha-2 adrenergic receptors
Mechanism: antagonises alpha-2 adrenergic receptors, causing increased release of serotonin and noradrenaline. Antagonises 5HT2, so 5HT1 unopposed = antidepressant

H1 receptor, causing sedation

Question 4

Which SSRI is contraindicated with warfarin?

Answer 4

Fluoxetine

Question 5

How do citalopram, erythromycin and venlafaxine affect the heart? What condition will be more likely to occur?

Answer 5

Prolongs QT interval and increases risk of Torsade de Pointes

Question 6

What questionnaire can be used to screen for depression?

Answer 6

PHQ-9