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PCL 200 > Drug for Depression & Anxiety > Flashcards

Drug for Depression & Anxiety Flashcards

1
Q

Locations of the neuron circuitry regulating anxiety and fear

A

subcortical (subconscious)

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2
Q

Fear

A

an emotional state aroused by specific external stimuli that gives rise to defensive and escape behaviours

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3
Q

Anxiety

A

a generalized response to an unknown threat or internal conflict. Some argue that anxiety occurs when a person recognizes that they are not in control of the outcome of a threatening situation

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4
Q

bilateral degeneration of amygdala

A

patient lives without fear

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5
Q

Anxiety Disorders

A

psychiatric conditions characterized by overactivity of the autonomic nervous system, expectation of an impending threat and continuous vigilance of danger (not caused by drug intoxication or withdrawal)

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6
Q

Panic disorder

A

Episodic periods of intense fear and ANS over activation (fast heartbeat, short breath & patients sincerely think they are dying)

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7
Q

Generalized anxiety disorder

A

Persistent state of excessive worry and anxiety serious enough to cause a disruption in normal activities

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8
Q

Anticipatory anxiety

A

A fear of having a panic attack; may lead to agoraphobia

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9
Q

Agoraphobia

A

A fear of being away from home or another protected place

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10
Q

Social anxiety disorder

A

Excessive fear of being exposed to the scrutiny of other people that lead to avoidance of social situations

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11
Q

Post-traumatic stress disorder

A

A reaction to a terrifying event that occurs to or is witnessed by the patient. Characterized by flashbacks, nightmares, anxiety and compulsive thoughts about event

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12
Q

lifetime prevalence of anxiety disorders

A

20 % (most prevalent psychiatric condition)

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13
Q

Biological causes of anxiety disorders

A
  • Females 2x as likely as males to develop an anxiety disorder.
  • but heritability is low compared to other psychiatric conditions (0.3).
  • major factors are environmental & not genetic
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14
Q

Brain regions important in Anxiety

A
  • Amygdala
  • Hypothalamus
  • Anterior pituitary
  • Adrenal gland
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15
Q

Cortisol (stress)

A

causes immune suppression, weight gain & causes some of synapse connections to detach & disappear (especially in hippocampus)

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16
Q

adrenal gland

A

produces adrenaline & cortisol

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17
Q

First-line pharmacotherapy for anxiety disorders

A

SSRIs (selective serotonin reuptake inhibitors)

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18
Q

fMRI

A

functional magnetic resonance imaging
*used to measure changes in blood flow - more neuron activity = more blood

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19
Q

the brain of patients with anxiety disorders show…

A

an over activation of the amygdala

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20
Q

DTI

A

diffusion-tensor imaging

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21
Q

GAD and PD can also be treated with…

A

Benzodiazepines (at low dose)
but have limitations due to tolerance, withdrawal, rebound effect, abuse liability

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22
Q

Disability is measured in:

A

DALY = How many years of healthy life are lost to the disease

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23
Q

Major Depressive Disorder (MDD)

A
  1. Depressed mood most of the day.
    1. Diminished interest or pleasure in all or
      most activities.
    2. Significant unintentional weight loss or
      gain.
    3. Insomnia or sleeping too much.
    4. Agitation or psychomotor retardation
      noticed by others.
    5. Fatigue or loss of energy.
    6. Feelings of worthlessness or excessive
      guilt.
    7. Diminished ability to think or concentrate,
      or indecisiveness.
      1. Recurrent thoughts of death.
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24
Q

MRI

A

used to measure brain volumes and detect lesions and malignancies Volume loss thought to reflect loss of synapses or less neurogenesis in MDD

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25
Q

Heritability of Depression

A

0.3-0.4 = 30-40% of risk is due to genetic factors

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26
Q

Medial prefrontal cortex (of those with depression)

A

Increased functional activity

Lower volume

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27
Q

Lateral prefrontal cortex (of those with depression)

A

Decreased functional activity

Lower volume

28
Q

Striatum (of those with depression)

A

Decreased functional activity

Lower volume

29
Q

Amygdala (of those with depression)

A

Increased functional activity

Same volume

30
Q

Hippocampus (of those with depression)

A

Increased functional activity

Lower volume

31
Q

Low Brain Derived Neurotrophic Factor (BDNF) is caused by

A

Depression
- less dendritic sprouts

32
Q

5 primary Monoamines

A
  1. dopamine (DA)
  2. norepinephrine (NE)
  3. serotonin (5HT)
  4. Melatonin
  5. Histamine
33
Q

Monoamines regulate

A

mood, sleep, appetite, peristalsis, arousal, sexual function, cognition, reward, motivation, aggression – sometimes with opposing effects between dopamine and serotonin.

34
Q

7 Treatments for depression

A
  1. Psychotherapy - cognitive behavioral therapy
  2. Tricyclic antidepressants (TCA’s)
  3. Monoamine oxidase inhibitors (MAOi’s)
  4. Selective Serotonin Reuptake Inhibitors (SSRI’s)
  5. Serotonin/Norepinephrine Reuptake Inhibitors (SNRI’s)
  6. Hallucinogens (ketamine, psilocybin, MDMA)
  7. Electroconvulsive therapy (ECT & TMS)
35
Q

SNRIs

A

Venlafaxine (Effexor)
duloxetine (Cymbalta)
- blocks (antagonizes) both SERT and NET.

36
Q

Bupropion (Wellbutrin)

A

little action at SERT, but blocks DAT and NET. So not an SSRI or a SNRI – in a class of its own.

37
Q

Fluoxetine (Prozac)

A

least selective, first line for adolescents

38
Q

Paroxetine (Paxil)

A

anti-cholinergic effects, most weight gain

39
Q

Citalopram (Celexa)

A

most selective for SERT

40
Q

Sertraline (Zoloft)

A

also antagonist of DAT (dopamine transporter)

41
Q

SERT

A

serotonin transporter

42
Q

NET

A

norepinephrine transporter

43
Q

Monoamine Oxidase Inhibitors

A

removes the neurotransmitters norepinephrine, serotonin and dopamine from the brain.

44
Q

Serendipitous

A

discovery that a drug for tuberculosis patients had antidepressant effects

45
Q

Phenelzine

A

irreversible inhibitor of monoamine oxidase – once it binds the enzyme it permanently inactivates it and there is no more enzyme until the cell makes more
- Highly effective

46
Q

Negative side effects of Phenelzine

A

numerous drug-drug interactions that cause hypertensive crisis (too much adrenaline) & serotonin syndrome (too much serotonin) that can be fatal

47
Q

Tricyclic antidepressants (TCAs) targets

A

primary therapeutic benefit is blocking the reuptake of both serotonin and norepinephrine (inhibit NET and SERT)

48
Q

TCAs are antagonists for

A

5HT2A, 5HT2C, 5HT6, 5HT7 receptors, a1 adrenergic receptor

49
Q

2 Main TCAs

A
  1. imipramine
  2. amitriptyline
50
Q

Half-lives of SSRIs

A

around 24-30 hours, but fluoxetine is 48-96 hours. Active metabolites have half-lives of several days.

51
Q

Discontinuation Syndrome of SSRIs

A

anxiety, insomnia, headache, nausea. Taper off treatment by reducing dose and then taking on alternating days.

52
Q

Symptoms of Serotonin Syndrome

A

Agitation or restlessness, hyper-reflexes, diarrhea, fast heart beat and high blood pressure, hallucinations, increased body temperature, loss of coordination, nausea, vomiting
- Can be fatal –hyperthermia, tachycardia, lactic acidosis from muscle contraction.

53
Q

Causes of Serotonin Syndrome

A

TOO MUCH SYNAPTIC SEROTONIN
- drug-drug interaction of SSRI + MAOI
- SSRIs + dextromethorphan (cough medicine)
- SSRIs + triptans (migraine medicines) or some opioids (analgesics)
- MDMA

54
Q

Dysthymia

A

depressed mood lasting longer but less severe than MDD

55
Q

Postpartum depression

A

caused by sudden drop in estrogen/progesterone

56
Q

Atypical Depression

A

overeating, oversleeping, ability to react positively to positive events, oversensitivity to rejection

57
Q

Neuropathic Pain

A

chronic pain & depression co-morbid

58
Q

8 Related Disorders that also respond to antidepressants

A
  1. Dysthymia
  2. Postpartum depression
  3. Atypical depression
  4. Seasonal Affective Disorder
  5. Anxiety Disorders
  6. OCD
  7. Neuropathic Pain
  8. Bulimia
59
Q

4 Hallucinogens that are used as rapid antidepressant

A
  1. Ketamine
  2. Psilocybin
  3. LSD
  4. MDMA
60
Q

antagonist of NMDA type of glutamate receptors - increases spine density within 1 hour of treatment. Given intravenously every 1-4 weeks

A

Ketamine

61
Q

converted to psilocin in the body - agonist of 5HT2A serotonin receptor

A

Psilocybin

62
Q

agonist of 5HT2A serotonin receptor

A

LSD (derived from ergot mold)

63
Q

amphetamine like drug that is selective for SERT - reverse transports serotonin

A

MDMA

64
Q

______act as catalyst for treating depression

A

Hallucinogens

65
Q

The first antidepressant

A

Imipramine (first designed as an antipsychotic)

66
Q

neurogenesis

A

generation of new neurons

67
Q

Most commonly used tricyclic antidepressant

A

amitriptline

PCL 200 (11 decks)

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