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S3 Case 2 - Mental Health > Depression + Antidepressants > Flashcards

Depression + Antidepressants Flashcards

1
Q

What are the depressive symptoms?

A

Depressed mood
Loss of interest
Weight loss/gain
Insomnia
Agitation
Fatigue
Feeling worthless
Decreased concentration
Thoughts of death/suicide

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2
Q

What is mild depression?

A

Minimum of 5 symptoms
Mild functional impairment

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3
Q

What is moderate depression?

A

More symptoms
More functional impairment

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4
Q

What is severe depression?

A

Most symptoms present
Marked functional impairment

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5
Q

What is aetiology of depression?

A

Stress - early-life + on-going
Drugs/alcohol
Medicines
Genetics - more likely if relation has it

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6
Q

What is the pathology of depression?

A

UNCERTAIN
BUT increased cortisol levels

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7
Q

How do you treat mild depression?

A

Lifestyle changes
Counselling

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8
Q

How do you treat moderate/severe depression?

A

Lifestyle changes
Counselling
Pharmacotherapy
Non-drug treatments

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9
Q

What is Iproniazid?

A

Inhibits monoamine oxidase

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10
Q

What is Imipramine?

A

Inhibits reuptake of 5-HT + noradrenaline

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11
Q

Describe the biochemistry of 5-HT terminal

A

Activity of TPH determine synthesis rate
Activity of MAO determines breakdown
Synthesis + breakdown determine vesicular content
Content of vesicles determines amount of 5-HT released per AP
Firing activity determines release rate
Transporter activity determines reuptake rate
Release + reuptake determine level + duration of 5-HT in synaptic cleft + activation of receptors

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12
Q

What does the inhibition of MAO do?

A

Increased neurotransmitter in vesicles
Increased release per impulse

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13
Q

What does the inhibition of reuptake do?

A

Increased duration + concentration of 5-HT/NA in synaptic cleft

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14
Q

What targets metabolism?

A

MAO inhibitors

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15
Q

What targets the reuptake?

A

TCAs
SSRIs
NARIs = noradrenaline reuptake inhibitors
SNRIs

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16
Q

What does MAOa target the most?

A

5-HT>NA>DA

17
Q

What does MAOb target the most?

A

DA>NA>5-HT

18
Q

What are the MAOa drugs?

A

Clorgyline
Moclobemide

19
Q

What are the MAOb drugs?

A

Selegiline

20
Q

What are the MAOa+b drugs?

A

Pargyline
Iproniazid
Tranylcypromine

21
Q

What are the interactions for MOA inhibitors?

A

Interaction with foods
Serotonin syndrome = interact with other serotonergic drugs

22
Q

What is the patient advice for MOA inhibitors?

A

Avoid certain foods
Avoid OTC cold remedies + drugs of abuse
Do NOT take any other antidepressants

23
Q

What is the main problem with MOA inhibitors?

A

Irreversible enzyme inhibitors
= their effects outlast the clearance of the drug
= take around 6 weeks for enzyme protein turnover

24
Q

What are the side effects of TCAs/SSRIs/SNRIs?

A

GI disturbance
Sexual dysfunction
Dry mouth

25
Q

What are the TCAs side effects?

A

Sedation
Hypotension
Weight gain
Dry mouth
Urinary retention

26
Q

What is the problem with antidepressants?

A

Delayed action (4-8 weeks)

27
Q

What is the 1st line treatment for depression?

A

SSRI
eg. Sertraline, Citalopram

28
Q

What do you need to do with SSRIs?

A

Low dose first
THEN increase if tolerated
BUT must be safe

29
Q

What to do if there is a poor response to treatment?

A

Ensure positive lifestyle changes
Increase dose - BUT safe
Switch antidepressant
Additional drug
Additional non-drug therapy = CBT therapy
Other drug treatments = transcranial magnetic stimulation (TMS)

30
Q

Why is TCAs NOT 1st line?

A

More side effects
More dangerous in overdose

31
Q

Why is SNRIs NOT 1st line?

A

More efficacious in treatment of resistant depression
BUT less well tolerated

32
Q

Why is MAO inhibitors NOT 1ST line?

A

Effective
BUT difficult to take

33
Q

What can happen of you come off antidepressants suddenly?

A

Withdrawal symptoms
Associate with relapse

34
Q

Why do you come off antidepressants?

A

Depression is episodic + recurrent
Discontinuation associated with relapse

35
Q

What are the withdrawal symptoms?

A

Flu-like symptoms
Nausea
Anxiety
Electric shocks
Difficulty sleeping

36
Q

How do you avoid discontinuation syndrome for long half life drugs?
eg. Fluoxetine

A

Gradually decrease amount of tablets
= plasma levels fall very slowly

37
Q

How do you avoid discontinuation syndrome for short half life drugs?
eg. Paroxetine

A

Switch to fluoxetine
Reduce doses slowly over several weeks
Treat symptoms -eg. constipation

38
Q
A

S3 Case 2 - Mental Health (15 decks)

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