Depression and Mania

Question 1

Pathophysiology of Depression

Answer 1

decreased brain levels of NE, 5-HT, and DA

Question 2

Treatment Phases of Depression

Answer 2

acute- 6-12 weeks- remission
continuation- 4-9 months after remission, prevent relapse, eliminate residual symptoms
maintenance- 12-36 months to prevent recurrence

Question 3

Tx for Depressive Disorders

Answer 3

SSRIs- first line
SNRIs
Bupropion

Question 4

Examples of SSRIs for Depression

Answer 4

paroxetine

citalopram

Question 5

MOA of SSRIs

Answer 5

blocks SERT and inhibits reuptake of serotonin

Question 6

Advantages of SSRIs

Answer 6

higher TI- safer

no cardiovascular SE from M or a block

Question 7

SE of SSRIs

Answer 7

sexual dysfunction- 5-HT2

GI- 5-HT3

Question 8

Examples of SNRIs for Depression

Answer 8

Venlafaxine

Question 9

MOA of SNRIs

Answer 9

blocks SERT and NET to inhibit reuptake of serotonin and NE

Question 10

Bupropion MOA

Answer 10

blocks reuptake of DA and NE

Question 11

Bupropion is also used for…..

Answer 11

smoking cessation

Question 12

SE of SNRIs

Answer 12

sexual dysfunction

Question 13

SE of Bupropion

Answer 13

higher risk of seizures with high doses

no sexual side effect

Question 14

Examples of TCAs

Answer 14

amitriptyline

imipramine

Question 15

MOA of TCAs

Answer 15

blocks SERT and NET to inhibit reuptake of serotonin and NE

Question 16

SE of TCAs

Answer 16

ANS side effects
low TI- dangerous
block H1- sedation

Question 17

MAOI Examples

Answer 17

phenelzine

tranylcypromine

Question 18

MOA of MAOI

Answer 18

irreversibly inhibits MAOa- metabolizes and increases lvls of NE and 5-HT
inhibits MAOb- metabolizes and increases lvls of DA

Question 19

SE of MAOIs

Answer 19

ANS effects from M and a1 block
many drug interactions
serotonin syndrome with drugs that increase 5-HT

Question 20

Examples of Mood Stabilizers- Bipolar

Answer 20

Lithium
Valproic Acid
Carbamazepine

Question 21

MOA of Lithium

Answer 21

inhibits inositol monophosphatase and inositol diphosphatase

inhibits glycogen synthase kinase-3B (GSK-3B) that increases hippocampal levels of B-catenin

Question 22

Pharmacokinetics of Lithium

Answer 22

low TI
onset of 5-7 days
eliminated by kidney- t1/2 of 24 hrs
competes with Na for renal reabsorption- diuretics increase toxicity

Question 23

SE of Lithium

Answer 23

hand tremor, edema
nephrogenic diabetes insipidus
hypothyroidism

Question 24

Lithium and Pregnancy

Answer 24

Ebstein’s anomaly of the new born- disformed tricuspid valve

Question 25

MOA of Valproic Acid

Answer 25

blocks NA and Ca channels

facilitates GABA

Question 26

Pharmacokinetics of Valproic Acid

Answer 26

onset of 3-5 days; faster than lithium

Question 27

SE of Valproic Acid

Answer 27

life threatening pancreatitis

Question 28

Valproic Acid and Pregnancy

Answer 28

spina bifida- neural tube defects

Question 29

SE of Carbamazepine

Answer 29

Stevens- Johnson Syndrome