Depression

Question 1

biogenic amine hypothesis of mood disorders

Answer 1

depression = too little CNS Norepi and/or serotonin (amounts and/or activity)

Question 2

what is mechanism of most anti-depressant drugs?

Answer 2

block reuptake of both NE and 5-HT to varying degrees

Question 3

strange occurrence with anti-depressants

Answer 3

pharmacological effect happens within minutes to hours, while clinical improvement does not occur for weeks or months. receptor re-regulation may be the cause

Question 4

neurotronic hypothesis

Answer 4

BDNF (brain derived neurotrophic factor) drop leads to depression. effective antidepressant therapy increases BDNF gene transcription and neurogenesis

Question 5

placebo effect

Answer 5

several studies suggest that there is very little evidence of true drug effect in patients with mild to moderate depression. most agree that the meds are beneficial for patients with severe depression

Question 6

MAOIs

Answer 6

monoamine oxidase inhibitors. MAOa and MAOb in nerve mitochondria. A deals with NE, 5-HT, tyramine, while B deals with DA and phenylethylamine. MAOIs irreversibly inhibit both.

Question 7

two MAOIs

Answer 7

tranylcypromine and phenelzine. inhibit both A and B.

Question 8

side effects of MAOIs

Answer 8

some anticholinergic, pronounced orthostatic hypotension, sexual dysfunction, weight gain, sedation varies

Question 9

life threatening side effects of MAOIs

Answer 9

liver MAO is also inhibited, losing first pass metabolism that protects against tyramine in food. if you eat fermented stuff, you accumulate tyramine and cause hypertensive crisis

Question 10

MAOI + SSRI

Answer 10

leads to serotonin syndrome (hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status and vital signs, potentially lethal)

Question 11

noticeable features of tricyclines, SSRIs, and atypicals

Answer 11

varying potencies and selectivities for NE and 5-HT reuptake transporter inhibition. Many have active metabolites which are much longer acting than the parent compound. most are fairly rapidly absorbed, and most are metabolized by P450 enzymes.

Question 12

list 4 tricyclics

Answer 12

the mines and the lines. Desipramine, Imipramine, amitriptyline, nortriptyline.

Question 13

problem with tricyclics

Answer 13

produce varying degrees of block at several other neurotransmitter receptors. this causes several side effects

Question 14

tricyclic adverse effects

Answer 14

antimuscarinic: blurred vision, constipation, confusion
alpha antagonist: orthostatic hypotension
histamine antag: sedation
sympathomimetic: tremor, insomnia
cardiac: arrhythmias, conduction defects especially at overdose,
seizures

Question 15

SSRI difference from tricyclics

Answer 15

longer duration of action. some SSRIs inhibit P450. Much safer in Overdose, no seizures or cardiac arrhythmia. SSRIs have less side effects but more nausea and sexual dysfunction

Question 16

list 5 SSRIs

Answer 16

Fluoxetine, Paroxetine, Sertraline, Escitalopram, Citalopram

Question 17

name two SNRIs

Answer 17

duloxetine, venlafaxine

Question 18

adverse reactions with SSRIs

Answer 18

some SSRIs (mainly fluoxetine and paroxetine) inhibit P450 which causes other drugs cleared by P450 to reach toxic levels.

Question 19

buproprion

Answer 19

only agent with notable selectivity for DA uptake transporter. can lower seizure threshold as a side effect. useful in improving nicotine abstinence in quitting smokers

Question 20

uses of antidepressants

Answer 20

used to treat depression, anxiety disorders, PTSD, chronic pain, enuresis, bulimia, pre-menstrual dystrophic disorder, alcoholism treatment, and adjunct to many conditions

Question 21

electroconvulsive shock therapy

Answer 21

treatment of last resort. for patients with immediate suicide risk, could be first choice. used for patients not being helped by drugs

Question 22

anticonvulsants used in bipolar disorder

Answer 22

carbamazepine and valproate