Depression and Anxiety

Question 1

List some mood/affective disorders?

Answer 1

Major depressive disorder
Bipolar mood disorder
Dysthymia
Mood disorder secondary to medical conditions
Substance induced mood disorder

Question 2

Can antidepressants be given in bipolar patients? Why or why not?

Answer 2

No. It may precipitate a manic episode.

Question 3

Examples of drugs (prescription or OTC) that may cause drug-induced depression?

Answer 3

Beta-blockers
Calcium channel blockers
Benzodiazepines
L-dopa
M-dopa
Corticosteroids / anabolic steroids

Question 4

Explain the monoamine hypothesis in terms of drug induced depression?

Answer 4

Decreased/lack of monoamine neurotransmitters as a result of the drug leads to depression

Upregulation of receptors as a result of decreased neurotransmitters results in further greater depression

Question 5

List the classes of antidepressants?

Answer 5

SSRI's (selective serotonin re-uptake inhibitors)
TCA (tricyclic antidepressants)
SNRI's
Monoamine inhibitors
Atypical antidepressants

Question 6

Examples of SSRI’s?

Answer 6

Fluoxetine

Citalopram

Question 7

MoA of SSRI’s?

Answer 7

Inhibition of the serotonin transporter SERT, resulting in increased concentration of serotonin in the synaptic cleft

Question 8

ADR of SSRI’s?

Answer 8

GIT - nausea, vomiting

Sexual - decreased libido, anorgasmia, delayed ejaculation

CNS - agitation, anxiety, restlessness, akathasia, movement disturbances, parkisonism, dystonic reactions)

Question 9

Syndrome Syndrome - clinical presentation and causes?

Answer 9

Diaphoresis (sweating)
Mydriasis (pupil dilatation)
Agitation
Hyperflexia
Tremor
Clonus
Increased bowel sounds
Autonomic instability
Tachycardia

Causes: congenital or drug induced

Question 10

Examples of TCA’s?

Answer 10

Amytriptaline

Imipramine

Question 11

Indications for the use of TCA?

Answer 11

Depressive disorders
Anxiety disorders
Nocturnal enuresis
Analgesia
Insomnia

Question 12

Side effects of TCA’s?

Answer 12

Weight gain
Drowsiness
Dizziness
Blurred vision
Dry mouth
Constipation
Hypotension

Question 13

TCA overdose clinical presentation?

Answer 13

Coma
Seizure
Arrythmia
Cardiac arrest

Question 14

Contraindications to TCA’s?

Answer 14

Elderly
Co-morbidities - glaucoma, cardiovascular disease, BPH
Suicidal ideation

Question 15

In a healthy patient with depression alone - SSRI or TCA?

Answer 15

SSRI - less side effects

Question 16

Role of lithium in mood disorders?

Answer 16

Mechanism not well understood
Not protein bound, thus widely distributed throughout
Indicated for mood stabilisation in bipolar patients and for use as an anticonvulsant

Narrow therapeutic index
Can cause thyroid dysfunction
Can also causes diabetes insipidous
Requires therapeutic drug monitoring

Question 17

When to refer a patient to a psychiatrist?

Answer 17

First line medication not tolerated
Suicidal ideation
Bipolar suspicion
Co-morbidities

Question 18

How long until patients experience clinical improvement on antidepressant medication?

Answer 18

2-6 weeks

Question 19

Treatment of choice for anxiety?

Answer 19

SSRI’s:
Effective in reducing symptoms of anxiety an fear
Slow onset of action, thus minimal efficacy in acute anxiety

Benzodiazepines

Question 20

MoA of benzodiazepines?

Answer 20

Enhances the effect of GABA (inhibitory) neurotransmitter, resulting in a sedative, hypnotic and anxiolytic effect

GABA:
Allosteric enhancement of Cl- conduction, increasing the frequency of channel opening events, resulting in hyperpolarisation

Question 21

Examples of benzodiazepines?

Answer 21

Ultra-short acting: midazolam
Short acting: oxazepam
Intermediate acting: lorazepam
Long acting: diazepam

Question 22

ADR’s of benzodiazepines?

Answer 22

Common:
Drowsiness
Oversedation
Amnesia (common)

Uncommon:
Depression
Confusion
Disorientation
Ataxia

Paradoxical effect in children: results in hyper-excitability, depression and dependence

Question 23

Overdose antidote for benzodiazepines?

Answer 23

Flumazenil

Question 24

What is depression clinically?

Answer 24

Intense feeling of sadness, hopelessness and despair
Inability to experience pleasure with usual activities (anhedonia)
Changes in appetite, weight and sleep patterns
Loss of energy
Suicidal thoughts

Question 25

What is bipolar mania clinically?

Answer 25

Enthusiasm
Rapid thought and speech patterns
Extreme self confidence
Impaired judgements

Question 26

Examples of SNRI’s?

Answer 26

Venlafaxine

Duloxetine

Question 27

Lists of mood stabilisers suitable for bipolar mood disorder?

Answer 27

Lithium
Carbamazepine
Valproate

Question 28

Broad MoA of antidepressants?

Answer 28

Blocks neurotransmitter degradation (MAO-I)

Blocks neurotransmitter uptake (serotonin/noradrenlaline/dopamine reuptake inhibitors)

Question 29

MoA of TCA’s?

Answer 29

Serotonin reuptake inhibitors

Noradrenaline reuptake inhibitors