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Medicine > Depression > Flashcards

Depression Flashcards

1
Q

What are the three severities of depression?

A

Mild
Moderate
Severe

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2
Q

Depression is more common when in the presence of what other things?

A 
Physical disease
Excessive and chronic alcohol misuse
Social stresses
Interpersonal difficulties
Lack of social support
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3
Q

Name the three main types of antidepressant.

A

Tricyclic antidepressants
Selective serotonin reuptake inhibitors
Monoamine oxidase inhibitors

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4
Q

What are the characteristic features of depression?

A 
Low mood
Early morning wakening
Lethargic
Anhedonia
Feelings of guilt
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5
Q

How long do features of depression need to have been persisting for it to be classed as depression?

A

2 weeks

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6
Q

What is the most effective treatment for depression?

A

Combination of cognitive behavioural therapy and an antidepressant

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7
Q

What things can determine the choice of antidepressant prescribed?

A

Side effects (either positive or negative for patient)
Co-morbid illness
Interactions

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8
Q

How do SSRIs work?

A

Inhibit reuptake of serotonin within synapse, therefore prolonging its effects

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9
Q

Name the SSRIs.

A 
Citalopram
Escitalopram
Fluvoxamine
Fluoxetine
Sertraline
Paroxetine
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10
Q

What are the common side effects of SSRIs?

A 
Nausea
GI disturbances
Dry mouth
Insomnia
Loss of libido
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11
Q

Why are SSRIs preferred over TCAs? (in terms of side effects)

A

SSRIs have no anti-cholingeric side effects

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12
Q

Why are SSRIs not prescribed to under 18s?

A

Studies have shown there to be a higher risk factor for the development of suicidal/self harm ideation in under 18s taking SSRIs

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13
Q

What is serotonin syndrome?

A

A toxic hyperserotonergic state

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14
Q

What is serotonin syndrome caused by?

A

Ingestion of two or more drugs that increase serotonin levels, e.g. SSRIs combined with MAOIs, dopaminergic drugs or TCAs

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15
Q

What are some symptoms of serotonin syndrome?

A 
Agitation
Confusion
Tremor
Diarrhoea
Tachycardia
Hypertension
Hyperthermia
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16
Q

How can you reduce the effect of insomnia caused by SSRIs?

A

Advise to take in morning

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17
Q

What are some adverse effects of SSRIs?

A

Hyponatraemia
GI bleeding
Serotonin syndrome
QT prolongation

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18
Q

Why are patients gradually reduced off SSRIs instead of just being stopped?

A

Sudden stopping can lead to withdrawal syndrome

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19
Q

Why should care be taken when giving SSRIs to epileptics?

A

SSRIS lower the seizure threshold

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20
Q

What are the characteristics of withdrawal syndrome

A 
Shivering
Dizziness
Anxiety
Headache
Nausea
'Electric shocks'
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21
Q

Name some tricyclic antidepressants.

A 
Imipramine
Amitriptyline
Lofepramine
Nortriptyline
Clomipramine
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22
Q

How do TCAs work?

A

Potentiate actions of monoamines (serotonin and noradrenaline) by inhibiting reuptake into nerve terminals

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23
Q

What are the oldest antidepressants and therefore have the most evidence for them?

A

MAOIs

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24
Q

What are the antimuscarinic effects of TCAs?

A 
Dry mouth
Constipation
Tremor
Blurred vision
Urinary retention
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25
Q

What cardiovascular side effects can TCAs cause?

A

QT prolongation
Arrhythmias
Postural hypotension

26
Q

Why is it not wise to prescribe TCAs to patients with suicidal thoughts?

A

TCAs are toxic in overdose

27
Q

What are some side effects of TCAs?

A

Weight gain
Sedation
Confusion
Motor incoordination

28
Q

Why do TCAs have cardiovascular side effects?

A

Block the alpha1-adrenoreceptor

29
Q

What are the contraindications of prescribing TCAs?

A

Prostatism
Narrow angle glaucoma
Recent MI
Heart block

30
Q

In which patients should you be cautious to prescribe TCAs?

A

Those with:
Ischaemic heart disease
Epilepsy

31
Q

What kind of drugs can TCAs interact with?

A 
Those with sedative effect, e.g.
Alcohol
Opioids
Sedative anti-histamines
Anxiolytics
Those that prolong QT interval, eg.
Amiodarone
Catecholamines, eg adrenaline
32
Q

How does venlafaxine work?

A

Potent blocker of serotonin reuptake, with some action on noradrenaline reuptake

33
Q

In which individuals should venlafaxine not be prescribed?

A

Those with uncontrolled hypertension

Those prone to cardiac arrhythmias

34
Q

How do MAOIs work?

A

Irreversibly inhibit intracellular enzymes monoamine oxidase A and B, leading to increase of noradrenaline, dopamine and serotonin in the brain

35
Q

What should be avoided when taking MAOIs?

A

Foods rich in tyramine, e.g. mature cheese, pickled herring, yeast extracts

36
Q

In someone diagnosed with depression what should they be advised to stop doing?

A

Drinking alcohol

Taking depressive drugs, e.g. steroids

37
Q

What are examples of MAOIs?

A 
Phenelzine
Isocarboxazid
Isoniazid
Tranylcypromine
Moclobemide
38
Q

What does monoamine oxidase A have a preference to?

A

Serotonin

39
Q

What does monoamine oxidase B have a preference to?

A

Phenylethylamine

Dopamine

40
Q

What are some adverse effects of MAOIs?

A

Postural hypotension
Atropine-like effects
Weight gain
CNS stimulation (insomnia, restlessness, hallucinations)

41
Q

How long can MAOIs stay in the body after they are stopped?

A

Up to 3 weeks

42
Q

What type of drug can MAOIs interact with?

A

Ephedrine-containing drugs, e.g. OTC cough and cold medications, other antidepressants

43
Q

How does mirtazapine act?

A

Antagonises presynaptic alpha2-adrenoreceptors, enhancing release of serotonin and noradrenaline
Also blocks H1-receptors

44
Q

What kind of drug is trazodone?

A

A tetracyclic antidepressant

45
Q

How does trazodone work?

A

Blocks 5-HT(2a) and 5-HT(2c) receptors, blocking serotonin reuptake

46
Q

What are the side effects of mirtazapine and trazodone?

A

Sedative effect

Risk of increased appetite (therefore weight gain)

47
Q

Why are mirtazapine and trazodone less dangerous in overdose than TCAs?

A

Fewer autonomic side effects, so are less cardiotoxic

48
Q

How does duloxetine work?

A

Inhibits both noradrenaline and serotonin reuptake

49
Q

When is venlafaxine used?

A

In severe cases of depression

50
Q

When is duloxetine used?

A

Major depressive disorder

Can be used to treat urinary incontinence and diabetic neuropathy

51
Q

What is the first line treatment for depression in someone post-MI?

A

Sertraline

52
Q

Which TCA has the least anticholinergic activity?

A

Lofepramine

53
Q

What are the two subtypes of benzodiazepines?

A

Hypnotics

Anxiolytics

54
Q

What are hypnotic BZDs used to treat?

A

Insomnia

55
Q

Name some hypnotic BZDs.

A 
Temazepam
Nitrazepam
Zopiclone
Zopidem
Zaleplon
56
Q

What are anxiolytic BZDs used to treat?

A

Anxiety

57
Q

Name some anxiolytic BZDs.

A

Diazepam
Chlordiazepoxide
Lorazepam
Oxazepam

58
Q

How do BZDs work?

A

Agonists that bind to site on GABAa receptor, enhancing inhibitory effect of GABA by opening chloride channels

59
Q

Why should BZDs not be taken with alcohol?

A

Danger of overdosing, due to both affecting same receptor (BZDs indirectly, alcohol directly)

60
Q

What are some adverse effects of BZDs?

A 
Drowsiness
Falls
Impairment judgement and dexterity
Forgetfulness
Confusion
Irritability
Aggression
61
Q

What are BZDs usually indicated for?

A

Short-term relief of severe, disabling anxiety or insomnia

Medicine (19 decks)

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