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A13THP @ UoN > Depression > Flashcards

Depression Flashcards

1
Q

What are SSRIs?

A

Selective Serotonin Reuptake Inhibitors

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2
Q

What are the clinically common SSRIs?

A

Citalopram
Fluoxetine
Paroxetine
Sertraline

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3
Q

How do SSRIs work?

A

Selectively inhibit neuronal reuptake of 5-HT

Enhance synaptic concentrations and downregulate presynaptic receptors

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4
Q

When are SSRIs used?

A

1st line in depression

anxiety disorders, panic disorders, OCD

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5
Q

What are TCAs?

A

Tricyclic Antidepressants

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6
Q

What are the clinically common TCAs?

A

Amitryptyline
Dothiepin
Lofepramine
Nortriptyline

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7
Q

How do TCAs work?

A

Inhibit neuronal uptake of NA/5-HT
Enhance synaptic concentrations
Downregulation of presynaptic a2/5-HT receptors and postsynaptic beta adrenoceptors

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8
Q

Why do TCAs have a wide range of side effects?

A

Bind at a range of receptors

  • Muscarinic
  • Histamine
  • a1-adrenoceptors
  • 5-HT receptors
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9
Q

What are the main side effects of TCAs?

A 
Sedating & dangerous in overdose
Antimuscarinic
-dry mouth
-blurred vision
-constipation
-urinary retention
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10
Q

In what patients are TCAs not suitable?

A

IHD sufferers
>70 years
Suicide risk

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11
Q

What cardiac effects do TCAs have?

A

QT interval prolongation
Heart block
Arrhythmias

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12
Q

What, apart from depression, is Amitryptyline used to treat?

A

Sleep impairment
Neuropathic pain
Migraine prophylaxis
IBS

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13
Q

What are NARIs?

A

Noradrenaline Reuptake Inhibitors

REBOXETINE

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14
Q

How do NARIs work?

A

Selectively inhibit NA reuptake

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15
Q

In what patients are NARIs used?

A

Patients who cannot take TCAs but are resistant to SSRIs

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16
Q

What are SNRIs?

A

Serotonin-Noradrenaline Reuptake Inhibitors

VENLAFAXINE

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17
Q

How do SNRIs work?

A

Inhibit 5-HT & Na reuptake

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18
Q

What are the benefits of SNRIs?

A

Don’t bind to additional receptors (ie. TCAs)

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19
Q

What are the side effects of SNRIs?

A

GI side effects

Hypertension

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20
Q

What are NaSSAs?

A

Noardrenergic and Specific Serotonergic Antidepressants

MIRTAZAPINE

21
Q

How do NaSSAs work?

A

a2-adrenoceptor antagonists - inhibit neg feedback by presynaptic receptors
Increase Na/5-Ht transmission

22
Q

What are the benefits of NaSSAs?

A

Limited antimuscarinic side effects

Sedation in early treatment

23
Q

What are SRMs?

A

Serotonin Receptor Modulators

NEFAZODONE/TRAZODONE

24
Q

How do SRMs work?

A

Inhibit 5-HT reuptake

Selectively inhibit postsynaptic serotonin receptors

25
Q

What are MAOIs?

A

Mono-amine Oxidase Inhibitors

26
Q

Give examples of MAOIs

A 
Rarely used clinically
Isocarboxazid
Moclobemide
Phenelzine
Tranylcypromine
27
Q

How do MAOIs work?

A

Inhibit MAO irreversibly - increases concentration of neurotransmitters
Prevent breakdown of Tyramine

28
Q

What is the effect of elevated Tyramine?

A

Release of catecholamines - Hypertension

29
Q

For how long after cessation of MAOIs do the effects persist?

A

2-3 weeks

30
Q

What is the recommended treatment for mild depression?

A 
Watchful waiting and reassessment after 2 weeks
If drugs advised
-1st line SSRIs
-2nd line TCAs
Psychological treatment
31
Q

How long does it take for an effect to occur when treated with antidepressants?

A

2 weeks

32
Q

What should be done if initial treatment fails?

A

Switch to another SSRI/class

33
Q

How long should treatment be continued for?

A

6/12 after remission

2 years if 2 recent depressed episodes

34
Q

How should antidepressants be removed?

A

Reduced doses over >4 weeks (esp. Paroxetine)

35
Q

What is St. John’s Wort?

A

Herbal medicine w/ similar MoA to SSRIs

36
Q

Why should St. John’s Wort be avoided?

A

Toxicity w/ SSRIs

Enzyme inducer

37
Q

What is Bipolar Affective Disorder?

A

A mental health condition causing severe mood swings

38
Q

How should Bipolar Affective Disorder be treated?

A

1st line - Lithium

2nd Line - Anticonvulsants/Antipsychotics

39
Q

How does Lithium work?

A

MoA unknown

40
Q

When should Lithium be avoided?

A

Renal impairment

41
Q

How are Anticonvulsants used to treat Bipolar Affective Disorder?

A

2nd line as prophylactic mood stabilisers - CARBAMAZEPINE/VALPROATE

42
Q

What Anticonvulsants are used unlicensed when other treatments have failed?

A

LAMOTRIGINE

GABAPENTIN

43
Q

How are Antipsychotics (neuroleptics) used to treat Bipolar Affective Disorder?

A

Control psychotic symptoms

HALOPERIDOL/CHLORPROMAZINE

44
Q

What drugs are used to treat Anxiety?

A

Antidepressants to improve long-term outcome

Benzodiazepines/Beta-blockers

45
Q

How are Beta-blockers used to treat Anxiety?

A 
Treat physical symptoms
-sweating
-palpitations
-tremor
-tachycardia
PROPRANOLOL
46
Q

How are Benzodiazepines used to treat Anxiety?

A

Reduce anxiety/aggression, induce sleep

Increase GABA activity

47
Q

What is the main difficulty in treating Anxiety with Benzodiazepines?

A

Tolerance and dependence

Treatment limited 2-4 weeks

48
Q

What is Buspirone?

A

5-HT/dopamine receptor agonist

Used to treat anxiety

49
Q

What are the side-effects of Buspirone?

A

Dizzines
Nausea
Headache

A13THP @ UoN (19 decks)

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