Depression Drugs Flashcards
What scoring system is used in Depression to measure severity?
Patient Health Questionnaire -9 (PHQ-9 Score)
What PHQ-9 score is indicative of a “less severe” depression?
<16
More severe ≥16
What is the first line Tx for Depressed Patients?
Trying to give the least invasive so sometimes would only recommend CBT unless the patients preference was to try Pharmacological Therapy.
SSRIs in that case.
What are some mechanisms of managing more severe depression?
A combination of individual CBT and Antidepressant.
- SSRI
- SNRI
- Or another antidepressant if indicated based on previous clinical and treatment history.
What Clinical uses do Antidepressant drugs have?
- Moderate to severe depression
- Dysthymia (persistant depressive disorder)
- Generalised anxiety disorder
- Panic disorder, OCD, PTSD
- Bulimia Nervosa
- Neuropathic pain
What are the 2 major Classifications of Antidepressant Drugs?
Monoamine Oxidase inhibitors (MOAIs)
Monoamine Re-uptake Inhibitors (MORIs)
- Tricyclics
- SSRIs
- SNRIs (noradrenaline re-uptake inhibitors)
Also Atypical Drugs (Post synaptic receptor effects)
What are the Monoamine Neurotransmitters?
- Noradrenaline
- 5-HT (serotonin)
- Dopamine
What is the Serotonin (5-HT) pathway involved in?
Mood, Sleep, Feeding, Behaviour and sensory perception.
What receptor does Serotonin work on at the synapse?
5-HT1-7 receptor
What is the Noradrenaline projection pathway involved in?
Arousal and emotion.
Where is serotonin primarily synthesised?
Serotonin is primarily synthesised in the raphe nuclei of the brainstem, particularly in the dorsal and median raphe nuclei.
How is serotonin synthesised?
Serotonin is synthesised from the amino acid tryptophan through a series of enzymatic reactions involving tryptophan hydroxylase and aromatic L-amino acid decarboxylase.
How is serotonin regulated in the synaptic cleft?
Serotonin is regulated in the synaptic cleft through a process called reuptake, where it is taken back up into the presynaptic neuron via serotonin transporters (SERT).
What are the major projections of the serotonergic pathways?
Pathways to the limbic system, frontal cortex, hypothalamus, and spinal cord.
What is the Noradrenaline Pathway?
AKA noradrenergic pathway, is a neural pathway within the central nervous system (CNS) involved in regulating arousal, attention, mood, and stress responses.
Where is noradrenaline primarily synthesized?
Noradrenaline is primarily synthesized in the locus coeruleus, a nucleus located in the pons of the brainstem.
How is noradrenaline synthesized?
Noradrenaline is synthesized from the amino acid tyrosine through a series of enzymatic reactions involving tyrosine hydroxylase and dopamine beta-hydroxylase.
How is Noradrenaline Re-uptaken in to the presynaptic neurone?
via noradrenaline transporters (NET)
What are examples of some Monoamine Oxidase Inhibitors?
Phenelzine (Irreversible)
Moclobemide (Reversible)
What are some side effects of MAOIs?
- “Cheese Reaction”/ Hypertensive crisis (prevents breakdown of dietary tyramine)
- Insomnia
- Postural HyperT
- Peripheral Oedema
consuming foods or beverages high in tyramine, a compound found in aged cheeses, can lead to a potentially dangerous increase in blood pressure, known as a hypertensive crisis, when combined with MAOIs.
What are examples of Tricyclic Antidepressants?
- Imiparamine
- Amitriptyline
- Dosulepin
How do Tricyclic Antidepressants work?
Block the reuptake of Monoamines (Serotonin/5-HT and Noradrenaline) into the presynaptic terminals.
What are some Side-effects of Tricyclic antidepressants?
- Cardiovascular reactions (Arrhythmias, Tachycardia)
Cardiotoxic in overdose. - Weight gain
- Sedation
- Anticholinergic - Blurred vision, dry mouth, constipation, urinary retention.
Potentially Fatal in Overdose!
What are examples of SSRI’s?
- Fluoxetine
- Citalopram / Escitalopram
- Sertraline
How do SSRI’s cause there therapeutic effect?
Selectively inhibit reuptake of Serotonin (5-HT) from the synaptic cleft.
What are some common side effects of SSRI’s?
- Nausea and Headache
- Worsened Anxiety
- Sweating / Vivid dreams
- Sexual Dysfunction
- Hyponatraemia (in Elderly)
Discontinuation effects.
What type of Antidepressant is Venlaflaxine?
It’s an SNRI
A dual re-uptake inhibitor of 5-HT and NA.
(similar effects as Tricyclic Antidepressants but without the same side effects)
When can Reboxetine be used?
It is more selective for NA and may help patients who complain of reduced energy or fatigue.
When can Mirtazepine be used?
May act on both the presynaptic adrenoceptors and post-synaptic 5-HT receptors. It still increased central NA and 5HT without antimuscarinic effects.
Which Antidepressant has become helpful for helping in smoking cessation?
Bupropion
What are examples of SNRIs?
Duloxetine
Venlafaxine
