Depression Core Drugs

Question 1

What is the primary mechanism of action for sertraline?

Answer 1

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness

Question 2

What is the drug target for sertraline?

Answer 2

Serotonin transporter

Question 3

What are the main side effects of sertraline?

Answer 3

1. GI effects (nausea, diarrhoea)
2. Sexual dysfunction
3. Anxiety
4. Insomnia

Question 4

What does sertraline partially inhibit?

Answer 4

1. Mild inhibition of dopamine transporter

2. Partial inhibition of CYP2D6 at high doses (150 mg)

Question 5

How commonly were these drugs prescribed in 2020 in West London?

Answer 5

1. Sertraline: 16th
2. Citalopram: 27th
3. Fluoxetine: 68th
4. Venlafaxine: 83rd
5. Mirtazapine: 30th

Question 6

How do you decrease sertraline?

Answer 6

Must be gradually decreased on discontinuation

Question 7

What is the primary mechanism of action for citalopram?

Answer 7

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness

Question 8

What is the drug target of citalopram?

Answer 8

Serotonin transporter

Question 9

What are the main side effects of citalopram?

Answer 9

1. GI effects (nausea, diarrhoea)
2. Sexual dysfunction
3. Anxiety
4. Insomnia

Question 10

What does citalopram antagonise?

Answer 10

Mild antagonism of muscarinic and histamine (H1) receptors

Question 11

What is citalopram metabolized by?

Answer 11

CYP2C19

Question 12

How do you decrease citalopram?

Answer 12

Must be gradually decreased on discontinuation

Question 13

What is the primary mechanism of action for fluoxetine?

Answer 13

• Inhibition of serotonin reuptake results in an accumulation of serotonin
• Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.

Question 14

What is the drug target for fluoxetine?

Answer 14

Serotonin transporter

Question 15

What are the main side effects of fluoxetine?

Answer 15

1. GI effects (nausea, diarrhoea)
2. sexual dysfunction
3. anxiety
4. insomnia

Question 16

What is fluoxetine an antagonist of?

Answer 16

Mild antagonism of 5HT2A and 5HT2C receptors

Question 17

What does fluoxetine inhibit?

Answer 17

1. Complete inhibition of CYP2D6

2. Significant inhibition of CYP2C19 (caution with warfarin)

Question 18

What is the primary mechanism of action for venlafaxine?

Answer 18

• Venlafaxine is a more potent inhibitor of serotonin reuptake than norepinephrine reuptake
• Noradrenaline in the central nervous system is implicated in the regulation of emotions and cognition.

Question 19

What is the drug target of venlafaxine?

Answer 19

• Serotonin transporter

- Noradrenaline transporter

Question 20

What is the main side effects of venlafaxine

Answer 20

1. GI effects (nausea, diarrhoea)
2. sexual dysfunction
3. anxiety
4. insomnia
5. hypertension (at higher doses)

Question 21

How you decrease venlafaxine?

Answer 21

Must be gradually decreased on discontinuation

Question 22

What is the primary mechanism of action for mirtazapine?

Answer 22

1. Antagonises central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine.
2. Antagonises central 5HT2 receptors, which leaves 5HT1 receptors unopposed causing anti-depressant effects.

Question 23

What the drug target of mirtazapine?

Answer 23

• Alpha-2 receptor

- 5-HT2 receptor

Question 24

What is the main side effect if mirtazapine?

Answer 24

1. Weight gain

2. sedation

Question 25

How does mirtazapine affect sexual dysfunction and sleep?

Answer 25

• Low probability of sexual dysfunction

- May exacerbate REM sleep behaviour disorder