Drug treatment for Depression

Question 1

Depressed mood most of the time or persists for a long time

Answer 1

Mood disorder

Question 2

Causes of Major Depressive Disorder

Answer 2

Endogenous (no apparent external cause)
Reactive (identifiable external cause)

Question 3

Biochemical basis of Depression

Answer 3

Neurotrophic Hypothesis & Monoamine Hypothesis

Question 4

Explain the Neurotrophic Hypothesis

Answer 4

stress and pain are associated with a drop in BDNF levels

Essentially, lower BDNF = depression

Question 5

What is BDNF (Brain Derived Neurotrophic Factor)

Answer 5

responsible for nerve growth factor and emotional regulation

Question 6

Two evidences that support the Neurotrophic hypothesis

Answer 6

Direct infusion of BDNF into the brain of rodents has antidepressant effects

Antidepressants are associated with an increase in BDNF

Question 7

Explain the Monoamine Hypothesis

Answer 7

Deficit in function or amount of biogenic amines

Question 8

Evidences of Monoamine Hypothesis

Answer 8

Reserpine treatment is associated w/ depression

All available antidepressants appear to have significant effects of the monoamine system

Administration of NE synthesis inhibitor is associated with relapse

Question 9

MOA of TCAs (Amitryptiline, Desipramine, Imipramine, Clomipramine, Nortryptiline, Protryptiline, Doxepin, Lofepramine)

Answer 9

Blocks the neuronal reuptake of NE and 5HT

All are equally effective in relieving depression, although some patients respond better to one drug than to another

Question 10

Side effects of TCAs (Amitryptiline, Desipramine, Imipramine, Clomipramine, Nortryptiline, Protryptiline, Doxepin, Lofepramine)

Answer 10

Antihistamine (Sedation)

A-1 adrenoreceptor blocker

Antimuscarinic

Acute poisoning (manifests as suicidal ideation) - generally recommended that no more than a week’s supply should be given at any time to acutely depressed patient

Cardiac arrhythmias

Weight gain (most common)

Confusion, impaired memory and cognition

Lower the seizure threshold

Question 11

Examples of TCAs

Answer 11

AMITRYPTILINE
DESIPRAMINE
IMIPRAMINE
CLOMIPRAMINE
NORTRYPTILINE
PROTRYPTILINE
DOXEPIN
LOFEPRAMINE

Question 12

MOA of TeCAs (Amoxapine, Quetiapine, Mianserin, Mirtazapine, Maprotiline, Setiptiline)

Answer 12

blocks neuronal reuptake of NE and 5HT

Alternative for patients who are unresponsive to other antidepressants

Question 13

Examples of TeCAs

Answer 13

Amoxapine & Quetiapine - four rings are not fused together

Mianserin - First second generation, lacks cardiotoxic and anticholinergic S/E,
sedative, postural hypotension, weight gain, and causes blood dyscrasias

Mirtazapine - derivative of Mianserin that lacks blood dyscrasias and adverse effects,
(Noradrenergic & Specific Serotonergic
Antidepressant)

Maprotiline & Setiptiline - both are NaSSA

Question 14

MOA of SSRIs (Fluoxetine, Paroxetine, Fluvoxamine, Sertraline, Citalopram, Escitalopram, Vilazodone, Vortioxetine)

Answer 14

Selectively block the neuronal reuptake of serotonin and have much less effect on the reuptake of NE

Question 15

SSRIs are

Answer 15

the most widely used drugs of depression an certain anxiety disorders

as effective as TCAs - fewer autonomic side effects and less sedation

safer than TCAs - less likely to cause arrhythmia and seizures

Question 16

Examples of SSRIs

Answer 16

FLUOXETINE
PAROXETINE
FLUVOXAMINE
SERTRALINE
CITALOPRAM
ESCITALOPRAM
VILAZODONE
VORTIOXETINE

Question 17

Side effects of SSRIs

Answer 17

N&V
Diarrhea/constipation
Tremor
Dizziness
Sexual dysfunction
HA

Question 18

MOA of SNRIs (Duloxetine, Venlafaxine, Desvenlafaxine, Milnacipran)

Answer 18

Block the neuronal reuptake of serotonin and norepinephrine

Question 19

SNRIs tend

Answer 19

to be favored over the TCAs in the treatment of MDD

Question 20

Examples of SNRIs

Answer 20

DULOXETINE
VENLAFAXINE
DESVENLAFAXINE
MILNACIPRAN

Question 21

MOA of NaRIs (Reboxetine, Atomoxetine, Viloxazine)

Answer 21

Block the neuronal reuptake of norepinephrine

*Also indicated for ADHD

Question 22

Examples of NaRIs

Answer 22

REBOXETINE
ATOMOXETINE
VILOXAZINE

Question 23

MOA of Unicyclic Antidepressant (Bupropion)

Answer 23

Block the neuronal reuptake of NE and DA

*Adjunct therapy for patients who are attempting to quit smoking cigarettes

Question 24

MOA of MAOIs (Moclobemide, Selegiline, Rasagiline, Tranylcypromine, Isocarboxazid, Phenelzine)

Answer 24

Inhibits Monoamine Oxidase thereby increasing biogenic amines

Question 25

Substrates of MAO - A

Answer 25

Norepinephrine, Epinephrine, Serotonin

Question 26

Substrates of MAO - B

Answer 26

Dopamine, Tyramine

Question 27

Examples of MAOIs

Answer 27

MOCLOBEMIDE - reversible inhibitor of MAO-A SELEGILINE & RASAGILINE - irreversible inhibitor of MAO-B Non selective MAOIs: TRANYLCYPROMINE ISOCARBOXAZID PHENELZINE

Question 28

Examples of serious interactions of MAOIs

Answer 28

MAOIs + Tyramine-rich food MAOIs + Adrenergic Drugs MAOIs + Serotonergic Drugs

Question 29

MOA of Serotonin Receptor Modulators (Trazodone, Nefazodone)

Answer 29

Mild inhibition of serotonin reuptake

Question 30

Examples of 5HT receptor Modulators

Answer 30

TRAZODONE NEFAZODONE Neither drugs is effective for severely depressed people Trazodone is strongly sedative which can improve sleep of depressed patients

Question 31

Isolated from Hypericum officinalis/ perforatum Contains HYPERICIN and FLAVONES

Answer 31

St. John's Wort

Question 32

MOA of St. John's Wort

Answer 32

Blocks neuronal reuptake of 5HT Have fewer side effects than other antidepressants but is not as effective as prescription antidepressants

Question 33

Adverse effects of Antidepressants

Answer 33

Some potential adverse effects are common to all antidepressants, most of their adverse effects are specific to subclass of agents and to their pharmacodynamic effects FDA warning applied to all antidepressants is the risk of increased suicidality in patients younger than 25. Association with suicidal ideation and gestures but not completed suicide