Depression Flashcards
What are SSRIs?
Selective Serotonin Reuptake Inhibitors
What are the clinically common SSRIs?
Citalopram
Fluoxetine
Paroxetine
Sertraline
How do SSRIs work?
Selectively inhibit neuronal reuptake of 5-HT
Enhance synaptic concentrations and downregulate presynaptic receptors
When are SSRIs used?
1st line in depression
anxiety disorders, panic disorders, OCD
What are TCAs?
Tricyclic Antidepressants
What are the clinically common TCAs?
Amitryptyline
Dothiepin
Lofepramine
Nortriptyline
How do TCAs work?
Inhibit neuronal uptake of NA/5-HT
Enhance synaptic concentrations
Downregulation of presynaptic a2/5-HT receptors and postsynaptic beta adrenoceptors
Why do TCAs have a wide range of side effects?
Bind at a range of receptors
- Muscarinic
- Histamine
- a1-adrenoceptors
- 5-HT receptors
What are the main side effects of TCAs?
Sedating & dangerous in overdose Antimuscarinic -dry mouth -blurred vision -constipation -urinary retention
In what patients are TCAs not suitable?
IHD sufferers
>70 years
Suicide risk
What cardiac effects do TCAs have?
QT interval prolongation
Heart block
Arrhythmias
What, apart from depression, is Amitryptyline used to treat?
Sleep impairment
Neuropathic pain
Migraine prophylaxis
IBS
What are NARIs?
Noradrenaline Reuptake Inhibitors
REBOXETINE
How do NARIs work?
Selectively inhibit NA reuptake
In what patients are NARIs used?
Patients who cannot take TCAs but are resistant to SSRIs
What are SNRIs?
Serotonin-Noradrenaline Reuptake Inhibitors
VENLAFAXINE
How do SNRIs work?
Inhibit 5-HT & Na reuptake
What are the benefits of SNRIs?
Don’t bind to additional receptors (ie. TCAs)
What are the side effects of SNRIs?
GI side effects
Hypertension
What are NaSSAs?
Noardrenergic and Specific Serotonergic Antidepressants
MIRTAZAPINE
How do NaSSAs work?
a2-adrenoceptor antagonists - inhibit neg feedback by presynaptic receptors
Increase Na/5-Ht transmission
What are the benefits of NaSSAs?
Limited antimuscarinic side effects
Sedation in early treatment
What are SRMs?
Serotonin Receptor Modulators
NEFAZODONE/TRAZODONE
How do SRMs work?
Inhibit 5-HT reuptake
Selectively inhibit postsynaptic serotonin receptors
What are MAOIs?
Mono-amine Oxidase Inhibitors
Give examples of MAOIs
Rarely used clinically Isocarboxazid Moclobemide Phenelzine Tranylcypromine
How do MAOIs work?
Inhibit MAO irreversibly - increases concentration of neurotransmitters
Prevent breakdown of Tyramine
What is the effect of elevated Tyramine?
Release of catecholamines - Hypertension
For how long after cessation of MAOIs do the effects persist?
2-3 weeks
What is the recommended treatment for mild depression?
Watchful waiting and reassessment after 2 weeks If drugs advised -1st line SSRIs -2nd line TCAs Psychological treatment
How long does it take for an effect to occur when treated with antidepressants?
2 weeks
What should be done if initial treatment fails?
Switch to another SSRI/class
How long should treatment be continued for?
6/12 after remission
2 years if 2 recent depressed episodes
How should antidepressants be removed?
Reduced doses over >4 weeks (esp. Paroxetine)
What is St. John’s Wort?
Herbal medicine w/ similar MoA to SSRIs
Why should St. John’s Wort be avoided?
Toxicity w/ SSRIs
Enzyme inducer
What is Bipolar Affective Disorder?
A mental health condition causing severe mood swings
How should Bipolar Affective Disorder be treated?
1st line - Lithium
2nd Line - Anticonvulsants/Antipsychotics
How does Lithium work?
MoA unknown
When should Lithium be avoided?
Renal impairment
How are Anticonvulsants used to treat Bipolar Affective Disorder?
2nd line as prophylactic mood stabilisers - CARBAMAZEPINE/VALPROATE
What Anticonvulsants are used unlicensed when other treatments have failed?
LAMOTRIGINE
GABAPENTIN
How are Antipsychotics (neuroleptics) used to treat Bipolar Affective Disorder?
Control psychotic symptoms
HALOPERIDOL/CHLORPROMAZINE
What drugs are used to treat Anxiety?
Antidepressants to improve long-term outcome
Benzodiazepines/Beta-blockers
How are Beta-blockers used to treat Anxiety?
Treat physical symptoms -sweating -palpitations -tremor -tachycardia PROPRANOLOL
How are Benzodiazepines used to treat Anxiety?
Reduce anxiety/aggression, induce sleep
Increase GABA activity
What is the main difficulty in treating Anxiety with Benzodiazepines?
Tolerance and dependence
Treatment limited 2-4 weeks
What is Buspirone?
5-HT/dopamine receptor agonist
Used to treat anxiety
What are the side-effects of Buspirone?
Dizzines
Nausea
Headache
