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Phar 301 > Depression > Flashcards

Depression Flashcards

1
Q

True/False? Antidepressants are the best-selling drugs on the market

A

True

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2
Q

True/False? Major depression is an affective disorder

A

True

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3
Q

Define Monozygotic concordance

A

The chance of having the same illness if your identical twin has it (confers genetic linkage)

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4
Q

True/False? Depression is not a chronic relapsing disorder

A

False

After a first episode, almost 70% will have at least one more episode within 5 years

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5
Q

List the 3 different types of major depressive disorder

A

Reactive depression

 - specific stress
 - responds well to antidepressants

Endogenous (melancholic) depression

- no obvious external cause
- often runs in families

Atypical depression (not covered in course)

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6
Q

Where does the term “melancholy” come from?

A

Melan + choly
black bile
The notion that moods were based off the 4 humors

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7
Q

According to the monoamine hypothesis of depression, what causes depression?

A

A deficit in monoamine transmission (at certain sites in the brain

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8
Q

How was the monoamine hypothesis of depression founded?

A

Based on drugs that appeared to relieve and cause depression

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9
Q

What are the monoamines targeted by the monoamine hypothesis of depression?

A

Noradrenaline, NA

5-hydroxytryptamine (serotonin)

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10
Q

Describe the NA synapse

A
  1. Tyrosine is converted to DOPA, which is converted to Dopamine (DA), which is then converted to Noradrenalin (NA)
  2. NA is the released from the presynaptic neuron and acts on receptors of the postsynaptic neuron and autoreceptors of the presynaptic neuron (-ve feedback)
  3. NA is then reuptaken into the presynaptic terminal by NAT where it can either be reused, or metabolised by Monoamine Oxidase (MAO)
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11
Q

What is reserpine and what was it reported to do?

A

Found in snakeroot:
Antihypertensive
Caused depression
Depletes monoamine transmitters

Blocks vesicular monoamine transporter (sends monoamine out of the presynaptic neuron, different from NAT)

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12
Q

What is Iproniazid and what does it do?

A

Monoamine Oxidase inhibitor: blocks MAO so that more reuptaken NA can be released per vesicle

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13
Q

What is Imipramine and what does it do?

A

Tricyclic antidepressant:

blocks plasmalemmal NET/NAT, which causes more NT in synapse, which causes more APs at postsynapse

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14
Q

True/False? Imipramine depletes NA

A

False

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15
Q

What were Axelrod’s 2 experiments, and what were the results?

A

1) Give normal mouse and SNS-lesioned mice and give labelled NA - accumulation in sympathetic innervation (must be some sort of NA pump)
2) Take same mice and give NA, measure BP - slight increase in intact rat, large increase in denervated rat (no organs to receive NA, all ends up at brain postsynaptic receptors)

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16
Q

What are 2 consequences of inhibiting NA reuptake?

A

Decreased Recycled NA - less in release vesicles

Increased autoreceptor-mediated inhibition of NA release

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17
Q

True/False? Iproniazid blocks metabolism of NA and 5-HT

A

True (some MAOIs are more selective)

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18
Q

Name one brand name of fluoxetine

A

Prozac

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19
Q

What is fluoxetine and what does it do?

A

Selective Serotonin Reuptake Inhibitor

Blocks SERT more than NET

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20
Q

What does reserpine actually do?

A

Blocks vesicular pump (not selective for DA/NA/5-HT

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21
Q

What are three facts that support the monoamine hypothesis?

A
  • Low 5-HIAA (5-HT metabolite) in suicide attempters CSF
  • Increased 5-HT1A autoreceptors in suicide victims
  • Drugs that improve/worsen mood have mechanisms that follow the hypothesis
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22
Q

What are 3 ways to worsen mood?

A
  • Take reserpine (maybe)
  • Tryptophan-free diet (only if you’re at risk for depression)
  • alpha-methyl-para-tyrosine
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23
Q

What are the three main problems with the monoamine hypothesis?

A
  • not all drugs “agree” with the hypothesis
  • Therapeutic effect is delayed
  • Logical issue
24
Q

True/False? Reserpine causes depression

A

False

The study had small n, uncontrolled trials

25
Q

Which 4 drugs do not agree with the monoamine hypothesis?

A

L-DOPA: increases NA synthesis (should be AD but isn’t)

Drugs that should be depressant but aren’t:

  • Reserpine
  • 5-HT antagonists
  • NA antagonists (alpha/beta blockers)
26
Q

Define the therapeutic delay and its average value

A

The time difference between plateau of AD levels in blood and rise in mood level, typically 3-6 weeks

27
Q

Describe a logical issue and give an example

A

The treatment is known but its origin is not.
eg. asthma, something causes asthma, beta adrenoreceptor agonists happen to fix it (the problem doesn’t have to do with beta-adrenoceptors)

28
Q

True/False? We can map “where” depression happens in the brain

A

False

29
Q

Define a synaptome

A

A pinched off nerve terminal

30
Q

How would one use a synaptome to measure reuptake blockage?

A

Apply labelled NA with(out) test drug, isolate synaptosomes, count NA

31
Q

True/False? Synaptomes metabolize drugs

A

False

32
Q

True/False? NA and 5-HT pathways interact physiologically

A

True, either directly or indirectly (through other types of neurons)

33
Q

What is microdialysis and how is it used?

A

Drilling a hole in the skull and measuring concentrations in CSF

Used to “eavesdrop” on the brain and measure NT concentrations

34
Q

How do antidepressants work chronically? (3 effects)

A
  • Decreased beta adrenergic receptors (but we don’t know why)
  • Decreased 5-HT autoreceptors (increased 5-HT transmission)
  • Decreased alpha2 adrenergic autoreceptors (increased NA transmission)
35
Q

What is a consequence of acute SSRI?

A

Inhibition of 5-HT reuptake, slight increase in 5-HT release

36
Q

What is a consequence of chronic SSRI

A

Downregulation of autoreceptors, fewer negative feedback, huge increase in 5-HT release

37
Q

True/False? Neuron dendrites release Neurotransmitters

A

True

38
Q

Do antidepressants need NA or 5-HT in order to be clinically effective?

A

Kinda. You need to boost one or the other

39
Q

Why does a low-tryptophan diet exacerbate depression?

A

Trp is the precursor to 5-HT

40
Q

True/False? Tryptophan has antidepressant effects on its own

A

True (mild tho)

41
Q

True/False? 5-HT depletion worsens mood in most non-patients (or in patients on selective NAT-blocking drugs)

A

False

42
Q

What happens if you take NAT-selective blockers chronically and acutely challenge with a) AMPT, which depletes NA, and b) low TRP, which depletes 5-HT?

A

a) worsens mood

b) no change

43
Q

What happens if you take SERT-selective blockers chronically and acutely challenge with a) AMPT, which depletes NA, and b) low TRP, which depletes 5-HT?

A

a) no change

b) worsens mood

44
Q

What is the most prescribed antidepressant and why?

A

SSRIs, cause they tend to work better

45
Q

True/False? Most TCAs are prescribed for depression

A

False

46
Q

What are two things that determine clinical effectiveness?

A

Efficacy (how much does the patient improve on the drug?)

Compliance (will the patient take the drug reliably?)

47
Q

True/False? Half of patients who begin therapy will be well one year later

A

True

48
Q

True/False? NET and SERT blockers are partially effective

A

True

49
Q

What are 6 Adverse effects of antidepressants?

A
  • Postural hypotension (cause uncertain)
  • Dry mouth (musc. ACh receptor block)
  • The cheese reaction
  • Agitation
  • Sexual Dysfunction
  • Nausea
50
Q

What is the cheese reaction?

A

Tyramine (found in cheeses) is broken down in the gut by MAOs. Taking a MAOI will inhibit all MAO, not just the ones in the brain, which leads to an excess of tyramine in the blood, which raises blood pressure

51
Q

What are 4 adverse effects of TCAs?

A
  • Initial sedation, confusion, incoordination
  • Antagonization of certain receptor types
    • Sedation (histamine H1)
    • Dry mouth etc (musc. ACh)
  • Drug interactions
    • aspirin (plasma binding proteins)
    • steroid drugs reduce TCA breakdown (compete for P450)
    • STRONGLY potentiate ethanol’s effect (dangerous)
  • Overdose
    • Convulsions, then coma
    • cardiac arrhythmias
52
Q

What is/are the adverse effect/s of SSRIs?

A

5-HT syndrome

53
Q

List the 3 antidepressant drugs in terms of their adverse effects

A

(worse) MAOIs > TCAs > SSRIs (best)

54
Q

What drugs is proposed as a future antidepressant?

A

Ketamine

Botulinum toxin

55
Q

Name a treatment for depression that is not drug-related

A

Electroconvulsive Therapy

56
Q

What is the main issue with St. John’s Wort

A

Seriously dangerous drug-drug interactions

Phar 301 (23 decks)

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