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block 3 > Depression > Flashcards

Depression Flashcards

1
Q

What are the 2 patterns of depressive states?

A

Unipolar - low level of mood affecting QoL. Dysthymia = low level, chronic, MDD - clinical depression
Treated with CBT and antidepressants

Bipolar - recurrent episodes of mania and depression. Bipolar disorder, cyclothymia, low level
Treated with antipsychotics

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2
Q

Name 2 key symptoms of depression

A

Persistent sadness or low mood and/or

Marked loss of interests or pleasure

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3
Q

What other symptoms should be looked out for if 2 key symptoms are present?

A

Disturbed sleep (more/less)

Decreased/increased appetite

Fatigue or loss of energy

Agitation/slowing of movements

Poor concentration or indecisiveness

Feeling worthless, excess inappropriate guilt

Suicidal thoughts or acts

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4
Q

What are the 3 grades of major depressive disorder?

A

Mild depression - few symptoms that result in only minor functional impairment

Moderate depression - symptoms or functional impairment are between ‘mild’ and ‘severe’

Severe depression - most symptoms that markedly interfere with functioning +/- psychosis

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5
Q

Which 2 areas of the brain are increased in depression?

A

Amygdala

Hypothalamus

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6
Q

Which 2 areas of the brain are decreased in depression?

A

Prefrontal cortex

Hippocampus

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7
Q

What are the 4 main theories for depression?

A

Neurotransmitter

  • 5HT
  • NA

Neurohormonal

  • Steroids
  • HPA axis (stress, anxiety)

Immune (?auto)

Circadian

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8
Q

What are the 4 main theories for depression?

A

Neurotransmitter

  • 5HT
  • NA

Neurohormonal

  • Steroids
  • HPA axis (stress, anxiety)

Immune (?auto)

Circadian

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9
Q

Where is the main site of 5HT production?

A

Raphe Nuclei

brainstem

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10
Q

Where is the main sites of NA production?

A

Locus Coeruleus - projects the cortex and thalamus

Lateral tegmental area - projects to cerebellum + spinal cord

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11
Q

Where is the main sites of NA production?

A

Locus Coeruleus

Lateral tegmental area

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12
Q

Describe the reactions between 5HT and NA

A

Interactions in the brainstem speed activity (cell body end)

Interactions in the cortex slow activity (dendrite end)

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13
Q

Describe the reactions between 5HT and NA

A

Interactions in the brainstem speed activity

Interactions in the cortex slow activity

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14
Q

What are the 5 main treatments for depression?

A

CBT

Pharmacological

Transcranial magnetic stimulation (TMS)

Transcranial direct current stimulation (tDCS)

Electroconvulsive therapy (ECT)

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15
Q

What are the 4 main families of drugs to treat depression?

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

Tricyclic Antidepressants (TCAs)

Monoamine Oxidase Inhibitors (MAOI-A)

Atypical Antidepressants

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16
Q

What are 2 major side effects of ECT?

A

Memory loss

Short term muscle aches

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17
Q

What are the first line SSRIs?

A

Sertraline

Citalopram

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18
Q

What is the MoA of SSRIs?

A

Answer

19
Q

Inflammatory mediators in the CNS lead to (3):

A

Microglia activation (act as RBCs)

Cell dysfunction

Cell death

20
Q

Describe the role of neurogenesis in depression

A

Depression is associated with decreased dendritic branching and decreased number of synapses

Also overproduction of receptors.

This results in a less profound transmission to the post-synaptic cell

Deficit can be reversed by neuronal growth factors and antidepressants.

21
Q

Describe transcranial magnetic stimulation (TMS)

A

Magnetic pulses targeted at prefrontal cortex and limbic system

Good for severe unresponsive depression

Fewer side effects than drug therapy

Less stigma than ECT

22
Q

Describe ECT

A

Gold standard for severe depression

50% show improvement

Side effects

  • memory loss
  • short term muscle aches
  • stigma
23
Q

What are the main classes of antidepressants?

A

SSRIs

Atypical antidepressants
-NRI
-SNRI
5HT partial agonists

Tricyclic antidepressants

Monoamine oxidase inhibitors (MAOI-A)

a-adrenoreceptors

24
Q

Describe the mechanism of action of SSRIs

A

Inhibits serotonin reuptake pump

25
Q

What are the 2 main SSRIs?

A

Sertraline

Citalopram

26
Q

Describe the mechanism of action of atypical antidepressants

A

Noradrenaline reuptake inhibitor (same principle as SSRIs) - Reboxetine

SNRI - 5HT and NA reuptake inhibitor - Venlafaxine

5HT partial agonist - reduce activity of 5HT to increase transmitter levels (more condensed) - Buspirone

27
Q

What class of drugs is reboxetine?

A

NRIs

NA reuptake inhibitors

28
Q

What class of drugs in Venlafaxine?

A

SNRI

combined NA 5HT reuptake inhibitor

29
Q

What class of drugs is Buspirone?

A

5HT partial agonist

30
Q

Describe the MoA of agomelatine

A

Melatonin agonist

Increases slow wave sleep

31
Q

What is agomelatine?

A

Melatonin agonist

32
Q

What are the 5 main actions of tricyclic antidepressants (TCAs)?

A

5HT reuptake inhibitor

NA reuptake inhibitor

a1 adrenoreceptor antagonist

H1 receptor antagonist

M1 receptor antagonist

33
Q

Give 2 examples of TCAs

A

Amitriptyline

Nortriptyline

34
Q

Give the side effects of TCAs with link to the receptors they work on

A

a1 adrenoreceptor antagonist - postural hypotension (usually constrict smooth muscle in blood vessels)

H1 receptor antagonist - antihistamine action, cause sedation

M1 receptor antagonist - cardiac arrhythmias (cardiac smooth muscle)

35
Q

What are some common side effects of TCAs?

A

Sedation

Postural hypotension

Confusion

Visual problems

Cardiac dysrhythmia

Mania

Drug interactions (aspirin, alcohol)

36
Q

What is the mechanism of action of monoamine oxidase inhibitors?

A

Increases 5HT/NA levels by reversibly inhibiting the action of the enzyme monoamine oxidase A

37
Q

What is the main MAOI-A?

A

Moclobemide

38
Q

What class of drugs is moclobemide?

A

MAOI-A

39
Q

What are some common side effects of MAOIs?

A

Postural hypotension

Restlessness

Convulsions

Sleep disorders

Cross drug reactions - not to be px with SSRIs/ TCAs

Cheese reaction - tyramine, enhances action of drug

40
Q

Outline how a-1 and a-2 receptors work under normal conditions

A

α-1 receptors increase transmitter release
α-2 receptors slow transmitter release

So α-1 agonists and α-2 antagonists increase transmission

41
Q

What is mirtazapine?

A

a-2 antagonist

increases activity of NA and 5HT in synapse

42
Q

What are the 4 aims of CBT?

A

Identify thinking that causes problematic feelings and behaviour

Question the individual’s negative thinking/feeling in order to enable positive change in thought processes

Identify unwanted behaviour patterns

Plan goals to achieve the change sought, and the step by step process for the achievement of the goals

43
Q

Name 3 drawbacks to CBT

A

May not be suitable for those with learning difficulties or complex health needs

Confrontation of emotions - can be difficult in early stages, patients need to be ready

Only focuses on individuals capacity for change, not wider family or systems problems

44
Q

What is the ABCD approach of rational emotive behaviour therapy (REBT)?

A

A = activating event

B = belief about the event

C = consequences of the event

D = disputing the belief/anticipated consequences of the event

block 3 (14 decks)

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