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Neurology > Depression Drugs > Flashcards

Depression Drugs Flashcards

1
Q

What scoring system is used in Depression to measure severity?

A

Patient Health Questionnaire -9 (PHQ-9 Score)

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1
Q

What PHQ-9 score is indicative of a “less severe” depression?

A

<16
More severe ≥16

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2
Q

What is the first line Tx for Depressed Patients?

A

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.

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3
Q

What are some mechanisms of managing more severe depression?

A

A combination of individual CBT and Antidepressant.
- SSRI
- SNRI
- Or another antidepressant if indicated based on previous clinical and treatment history.

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4
Q

What Clinical uses do Antidepressant drugs have?

A
  • Moderate to severe depression
  • Dysthymia (persistant depressive disorder)
  • Generalised anxiety disorder
  • Panic disorder, OCD, PTSD
  • Bulimia Nervosa
  • Neuropathic pain
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5
Q

What are the 2 major Classifications of Antidepressant Drugs?

A

Monoamine Oxidase inhibitors (MOAIs)

Monoamine Re-uptake Inhibitors (MORIs)
- Tricyclics
- SSRIs
- SNRIs (noradrenaline re-uptake inhibitors)

Also Atypical Drugs (Post synaptic receptor effects)

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6
Q

What are the Monoamine Neurotransmitters?

A
  • Noradrenaline
  • 5-HT (serotonin)
  • Dopamine
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7
Q

What is the Serotonin (5-HT) pathway involved in?

A

Mood, Sleep, Feeding, Behaviour and sensory perception.

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8
Q

What receptor does Serotonin work on at the synapse?

A

5-HT1-7 receptor

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9
Q

What is the Noradrenaline projection pathway involved in?

A

Arousal and emotion.

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10
Q

Where is serotonin primarily synthesised?

A

Serotonin is primarily synthesised in the raphe nuclei of the brainstem, particularly in the dorsal and median raphe nuclei.

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11
Q

How is serotonin synthesised?

A

Serotonin is synthesised from the amino acid tryptophan through a series of enzymatic reactions involving tryptophan hydroxylase and aromatic L-amino acid decarboxylase.

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12
Q

How is serotonin regulated in the synaptic cleft?

A

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).

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13
Q

What are the major projections of the serotonergic pathways?

A

Pathways to the limbic system, frontal cortex, hypothalamus, and spinal cord.

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14
Q

What is the Noradrenaline Pathway?

A

AKA noradrenergic pathway, is a neural pathway within the central nervous system (CNS) involved in regulating arousal, attention, mood, and stress responses.

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15
Q

Where is noradrenaline primarily synthesized?

A

Noradrenaline is primarily synthesized in the locus coeruleus, a nucleus located in the pons of the brainstem.

16
Q

How is noradrenaline synthesized?

A

Noradrenaline is synthesized from the amino acid tyrosine through a series of enzymatic reactions involving tyrosine hydroxylase and dopamine beta-hydroxylase.

17
Q

How is Noradrenaline Re-uptaken in to the presynaptic neurone?

A

via noradrenaline transporters (NET)

18
Q

What are examples of some Monoamine Oxidase Inhibitors?

A

Phenelzine (Irreversible)
Moclobemide (Reversible)

19
Q

What are some side effects of MAOIs?

A
  • “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.

20
Q

What are examples of Tricyclic Antidepressants?

A
  • Imiparamine
  • Amitriptyline
  • Dosulepin
21
Q

How do Tricyclic Antidepressants work?

A

Block the reuptake of Monoamines (Serotonin/5-HT and Noradrenaline) into the presynaptic terminals.

22
Q

What are some Side-effects of Tricyclic antidepressants?

A
  • Cardiovascular reactions (Arrhythmias, Tachycardia)
    Cardiotoxic in overdose.
  • Weight gain
  • Sedation
  • Anticholinergic - Blurred vision, dry mouth, constipation, urinary retention.

Potentially Fatal in Overdose!

23
Q

What are examples of SSRI’s?

A
  • Fluoxetine
  • Citalopram / Escitalopram
  • Sertraline
24
Q

How do SSRI’s cause there therapeutic effect?

A

Selectively inhibit reuptake of Serotonin (5-HT) from the synaptic cleft.

25
Q

What are some common side effects of SSRI’s?

A
  • Nausea and Headache
  • Worsened Anxiety
  • Sweating / Vivid dreams
  • Sexual Dysfunction
  • Hyponatraemia (in Elderly)
    Discontinuation effects.
26
Q

What type of Antidepressant is Venlaflaxine?

A

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)

27
Q

When can Reboxetine be used?

A

It is more selective for NA and may help patients who complain of reduced energy or fatigue.

28
Q

When can Mirtazepine be used?

A

May act on both the presynaptic adrenoceptors and post-synaptic 5-HT receptors. It still increased central NA and 5HT without antimuscarinic effects.

29
Q

Which Antidepressant has become helpful for helping in smoking cessation?

A

Bupropion

30
Q

What are examples of SNRIs?

A

Duloxetine
Venlafaxine

Neurology (13 decks)

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