Depression drugs

Question 1

Features of depression?

Answer 1

low mood, low energy, loss of libido, sleep disturbance.

Question 2

What is unipolar depression?

Answer 2

Mood swings into depressive moods only

Question 3

What is bipolar depression?

Answer 3

mood swings between depressed and manic (enthusiastic, exuberant)

Question 4

Monoamine theory of depression?

Answer 4

low levels of monoamines : 5HT. NA and dopamine in the brain induces depression

Question 5

What is the neuroendocrine theory of depression?

Answer 5

Hyperactive Hypothalamic pituitary axis leads to excess cortisol. Low activity of hippocampus induces depression.

Question 6

what is the neuroplasticity /neurogenesis theory of depression?

Answer 6

neuronal loss and decreased activity in hippocampus causes less ‘happy’ signals to be sent

Question 7

Main theory?

Answer 7

Monoamine

Question 8

Two main treatments of depression?

Answer 8

CBT and antidepressants

Question 9

What is CBT

Answer 9

Cognitive behavioural therapy - helming depressed people think about their thoughts in more manageable positive ways, changing the way people think.

Question 10

Three types of ADs?

Answer 10

MAOIs, TCAs and SSRIs

Question 11

How do MAOIs work?

Answer 11

prevent MAO breaking down Was- NA and 5HT, therefore higher level in synaptic cleft.

Question 12

Problems with MAOIs?

Answer 12

Sympathomimetics cause an increased release of NA- excess will not be broken down as MAOs are inactivated and this causes TOO much NA- causes headaches, intracranial haemorrhage and hypertension.

Question 13

Side effects of MAOIs?

Answer 13

Headaches, hypertension, tremors, convulsions, dry mouth, antimuscarinic effects .

Question 14

Mechanism of TCAs?

Answer 14

Block re uptake of NA and 5HT by re uptake transporters.

Question 15

Problems with TCAs?

Answer 15

Anti cholinergic and anti muscarinic effects- dry mouth , constipation, drowsiness, have other drug interactions. narrow therapeutic window, OD is toxic, and cause respiratory depression.

Question 16

Side effects of TCAs?

Answer 16

Anti muscarinic and anti cholinergic - drowsiness, constipation and blurred vision. Block K channels - respiratory depression and exaggerate heart problems.

Question 17

Mechanism of SSRIs?

Answer 17

Block uptake of 5HT channels, inhibit the 5HT neurone causing increased 5HT release- increases 5HT in synaptic cleft, ‘normalising the post synaptic neuron to a normal working level.

Question 18

Problems with SSRIs?

Answer 18

Take 2-3 weeks to work, linked to violence in U18s, can’t be used with TCAs or MAOIs

Question 19

Side effects of SSRI’S?

Answer 19

insomnia, sexual dysfunction, nausea.

Question 20

Benefits of SSRIs?

Answer 20

broader therapeutic profile- treats GAD, anxiety and OCD too.

Question 21

Other antidepressants?

Answer 21

mirtazapine - alpha 2 antagonist

Question 22

How do alpha 2 antagonists treat depression?

Answer 22

Alpha 2 receptors are on the pre synaptic neurone- once activated by NA they stop the release of further NA and 5HT, antagonists stop this negative stimulus, increasing NA and 5HT release from pre synaptic neurone.

Question 23

Main issues with ADs?

Answer 23

Can become addictive, insomnia, toxic in OD, delayed response, unresponsive in some, have pharmacogenetics interactions within the body.