Depression

Question 1

what are affective disorders?

Answer 1

affective disorders are characterised by disturbances in mood and the main types are depression and mania

Question 2

what is unipolar disorder?

Answer 2

the mood is always low

Question 3

what is bipolar disorder?

Answer 3

low mood alternates with mania - manic-depressive illness

Question 4

state the monoamine theory of depression

Answer 4

in depression there is a functional deficit of the transmitters noradrenaline (NA) and 5-hydroxytryptamine (5-HT)

ANTIDEPRESSIVE DRUGS AUGMENT MONOAMINE TRANSMISSION

Question 5

What effect does inhibition of monoamine oxidase (MAO) have

Answer 5

an antidepressant effect as MAO metabolises NA and 5HT

Question 6

What does reserpine do

Answer 6

it depletes monoamine stores in the nerve endings - causes depression

Question 7

what are the two main categories of drugs used in affective disorders

Answer 7

1. those used to treat unipolar depression - namely the antidepressants
2. those used to treat bipolar disorder

Question 8

what are the main classes of antidepressant drugs ?

Answer 8

1. Inhibitors of the reuptake of monoamine transmitters:
   - tricyclic antidepressants e.g. imipramine, clomipramine
   - SSRIs (selective serotonin reuptake inhibitors) e.g. fluoxetine
   - miscellaneous reuptake inhibitors e.g. maprotiline
2. MAO inhibitors e.g. phenelzine
3. Atypical antidepressants

Question 9

Name a MAO-A selective inhibitor

Answer 9

MOCLOBEMIDE

Question 10

Name a non-selective MAO inhibitor

Answer 10

PHENELZINE, ISOCARBOXAZID

Question 11

Name the non-selective MAO inhibitor that can be metabolised to MDMA and what is the problem with this

Answer 11

Tranylcypromine

can cause mdma toxicity - can cause life threatening serotenergic toxicity

Question 12

name a MAO-B inhibitor and its clinical use

Answer 12

Selegiline is a MAO-B inhibitor and it can be used in parkinsons treatment as it stops breakdown of dopamine and increases amount of L-DOPA

Question 13

Name a tricyclic antidepressant

Answer 13

imipramine

Question 14

name a tricyclic antidepressant

Answer 14

amitriptyline

Question 15

name a tricyclic antidepressant

Answer 15

clomipramine

Question 16

what does removal of a methyl group from imipramine produce

Answer 16

desipramine - active drug

Question 17

what are the side effects of TCAs

Answer 17

antimuscarinic actions: dry mouth, constipation, blurred vision, urinary retention
antihistamine action: sedation
alpha - adrenoreceptor block: hypotension

Question 18

why are SSRIs used

Answer 18

they are generally safer and have fewer side effects than TCAs

Question 19

name an SSRI

Answer 19

Fluoxetine

Question 20

name an SSRI

Answer 20

citalopram - most selective

Question 21

name an SSRI

Answer 21

paroxetine - most potent

Question 22

side effects of SSRIs

Answer 22

nausea and vomiting
sexual dysfunction

SERIOUD ADVERSE EFFECTS IF GIVEN WITH MAO INHIBTIORS

Question 23

Name a miscellaneous NA reuptake inhibitor

Answer 23

MAPROTILINE

Question 24

name an atypical antidepressant

Answer 24

Trazodone

Question 25

side effect of MAO - inhibitors

Answer 25

tyramine - cheese reaction | - tyramine free diet

Question 26

what is time course of action of antidepressants

Answer 26

2-6 weeks slow changes in receptor density desensitisation of monoamine receptors increased neurogenesis in the hippocampus

Question 27

Drugs for bipolar depression

Answer 27

lithium

Question 28

Why are MAO inhibitors considered second line treatment

Answer 28

less effective more adverse effects

Question 29

which combination is given to antidepressant resistant patients ?

Answer 29

SSRI with atypical such as trazodone