Depression

Question 1

Diagnosis of depression

Answer 1

Over two weeks, 5 or more of;
Depression, sadness, irritability.
Diminished interest in activities.
Weight loss.
Abnormal sleep (insomnia/hypersomnia).
Fatigue.
Mental slowness / agitation (seen by others not patient)
Feelings of worthlessness or guilt.
Diminished ability to think,concentrate or decide.
Thoughts of death, suicide.

Question 2

Affective ddisorder

Answer 2

A disorder of mood

Question 3

Unipolar

Answer 3

Depression

Question 4

Bipolar

Answer 4

Manic depression

Question 5

Reactive depression

Answer 5

Short lasting, often with anxiety

Question 6

Endogenous depression

Answer 6

No clear external cause

Presents with apathy, hopelessness,inadequacy, loss of appetite and slow movements.

Question 7

Monoamine theory of depression

Answer 7

Iproniazid, which relieves depression, inhibits MAO increasing neuronal amines. MHPG is shown to be greatly reduces in the blood/CSF of those with depression. MHPG Is the main metabolite of NA and dopamine.

Question 8

Amine function can be increased by…

Answer 8

1. MAO inhibition ( as MAOa degrades NA and 5HT in humans, and MAOb degrades dopamine in humans.)
2. Inhibiting amine reuptake (esp uptake 1). - THis leads to more amine being present jn the synaptic cleft.

Question 9

MAO inhibitors

Answer 9

Mostly non-selective (hydrazines[iproniazid], propargylamines[pargyline], cyclopropylamines[tranylcypromine])
MAOa selective - clorgyline
Irreversible, action reversed when new molecule is synthesied.
Immediate effect of MAO but antidepressant effect takes two to four weeks.
Overdose leads to excitation, delerium, seizures, coma, dysrhymia, death.

Question 10

MAO inhibitor side effects

Answer 10

Muscarinic receptor block (dry mouth, blurred vision, constipation)
Hypotension (due to different metabolites of neurotransmiters)
Increased appetite and weight gain
Reduced REM sleep
Tyramine reaction, Potentiates indirect sympathomimetics.

Question 11

Uptake inhibitors / tricyclic antidepressants

Answer 11

Very good antidepressants but side effects are no rare 25% of patients.
Side effects include; muscarinic receptor block, hypotension,increased appetite and weight gain, angtagonism of antihypertensives, sedation and potentiation of ethanol.

Question 12

SSRI’s (selective serotonin reuptake inhibitors)

Answer 12

Most effective antidepressants but still have some side effects including; increased appetite, reduced libido, possible impotence and difficulty withdrawing.
Lead to development of SNRIs, slective NA reuptake inhibitors.

Question 13

Multi target drugs

Answer 13

Multi-target dose can be titrated for individuals, this is difficukt to do with separate drugs.
All pharmacological ckmponents must have similar bioavailability, Half-Life, metabolism etc.
Clinical trials of efficacy show more feasability than combination of drugs.
Diseases are multifactoral.
Multi-target agents can have synergistic actions via several receptors.

Question 14

Tetracyclics

Answer 14

Alpha2 antagonist, prevents inhibition of NA synthesis and release.

Question 15

5HT-2C antagonists

Answer 15

Inhibit the inhibition of NA and dopamine release.

No SSRI side effects.

Question 16

Diagnosis of mania

Answer 16

Over at least 1 week of abnormally elevated mood and 3 or more of;
Inflated self esteem
Decreased need for sleep
More talkaive than usual
Flights ofnideas
Reduced attention, easily distracted
Increased goal directed activity
Risky activity

Question 17

Mood stabilisers

Answer 17

For mania in bipolar depression
Lithium; narrow theraputic window, can cause reanl damage, confusion, seizures, death. Complete mevhamism unknown but affects cAMP pathway.
Carbamazepine - reduces ap exitability
Neuroleptics - blocks dopamine receptor, reducing mania.