Depression Flashcards
What are the symptoms of major depressive disorder?
Low mood Loss of pleasure Disruption of appetite, sleep and concentration Fatigue Negative self concept Recurrent thoughts of death
What is reactive depression?
Depression that has an identifiable cause e.g. loss of a loved one
What is endogenous depression?
Depression that has no identifiable cause
What are the symptoms of mania?
Excessive reactions Excessive motor activity Irritability Anger Impatience Grandiose illusions
What may cause depression?
High adrenocorticotrophic hormone release
Changes in REM sleep
Lack of neurogenesis and increases neural apoptosis
Describe the monoamine hypothesis and what supports it
Depression is the result of decreased amines such as noradrenaline, serotonin and dopamine
This is supported by antidepressant effects
What is the mechanism of monoamine oxidase inhibitors?
They inhibit monoamine oxidase to increase release of NA, DA and 5-HT
What are side effects of monoamine oxidase inhibitors?
Hypomania, atropinic effects, hepatotoxicity and hypertension
Give an example of a monoamine oxidase inhibitor
Phenelzine
Tranylcypromine
Clorgyline
Moclobemide
Which monoamine oxidase inhibitors are non-selective for either MAO type?
Phenelzine and tranylcypromine
Which monoamine oxidase inhibitors are selective for MAO type A
Clorgyline and moclobemide
Which isoform of MAO breaks down which amine?
MAO-A breaks down 5-HT
MAO-B breaks down NA and DA
Describe the cheese effect
Cheese contains high amounts of tyramine which is no longer digested by MAO in the gut when MAOIs are taken. As tyromine is a precursor for catecholamines, this results in high levels of noradrenaline causing a sympathomimetic effect
Why should someone taking MAOIs not be prescribed pethidine?
Pethidine’s metabolite of norpethidine is not broken down which caused hyperpyrexia and hypotension
Describe the mechanism of tricyclic antidepressants
Non-selective inhibition of NA and 5-HT reuptake to increase functional availability
What are side effects of tricyclic antidepressants?
Atropinic effects, sedation, hypotension, cardiotoxicity, dysrhythmia and analgesia
Describe the mechanism of SSRIs
Selective inhibition of serotonin reuptake and desensitisation of serotonin autoreceptors
Give an example of a tricyclic antidepressant
Imipramine, amitriptyline, clomipramine, lofepramine
Which of the tricyclic antidepressants have fewer side effects
Clomipramine and lofepramine
Give an example of an SSRI
Fluoxetine, sertraline, paroxetine
Which drugs may be given to treat bipolar depression?
Lithium carbonate or antipsychotics
What is the mechanism of lithium carbonate?
Lithium mimics the action of sodium to cause depolarisation, but isn’t removed by the Na/K/ATPase which increases NA and 5-HT turnover but decreases release
It also reduces IP3 and cAMP production to decrease cellular signalling
Why is lithium carbonate difficult to dose?
It takes a very long time to be excreted but has a narrow therapeutic window
What are side effects of lithium carbonate?
Polyuria and thirst, hypothyroidism, weight gain and nausea
What is the mechanism of tetracyclic antidepressants?
Blocks presynaptics alpha-1 adrenoreceptors so NA cannot block its own release
Give an example of a tetracyclic antidepressant
Mianserin, mirtazapine
What is the mechanism of SNRIs
Selectively inhibits reuptake of both 5-HT and noradrenaline
Give an example of an SNRI
Venlafaxine, duloxetine, naltrexone
What other treatments are available to treat depression?
Counselling
Electroconvulsive therapy
