(Exam 3) Antidepressants Flashcards
purpose of ADs?
alleviate distress of clinical depression, relieve anxiety; improve quality of life; repair neuronal damage
adverse side effects of ADs
sexual dysfunction, weight gain, cog effects, suicidal ideation
what type(s) of depression do ADs work best for?
moderate-severe
symptoms of MDD
affective disorder with alteration of emotion/mood, anhedonia, insomnia, fatigue, no energy, feelings of worthlessness, excessive guilt, thoughts of death or suicide
severe depression symptoms
psychosis, loss of touch with reality
what is dysthymia
relatively mild but persistent symptoms
what is the classic theory of MDD?
deficiency in 5-HT, NE, and DA; restoration to normal mood state involved increasing NT activity (2 weeks longer for effect); delay in clinical effect due to changes in Rs
neurogenic theory?
neurons are able to repair or remodel themselves; brain is capable of neurogenesis
what does MDD do to neurons?
MDD damages neurons + decreases neurogenesis
what does BDNF stand for
brain derived neurotrophic factor
pathophysiology of MDD
depression is consequence of environmental + cellular stress
what does stress do to the brain?
stress damages the brain and weakens its ability to recover
what do ADs do to neurons?
AD drugs may repair neurons + increase neurogenesis; promote neuronal survival
what is the immediate effect of ADs?
modulate synaptic levels
what is the ultimate target for ADs?
intracellular molecules for maintenance of neuronal health and plasticity
short term MOA of ADs
increase 5-HT and NE
long term MOA of ADs
decrease in R function but increase in BDNF
what does an increase in BDNF cause?
increase in neuro- and synaptic protection/function
MDD effects on hippocampus
chronic stress=decreased BDNF (causes atrophy/death of neurons)
what does TCA stand for
tricyclic antidepressant
what does MAOI stand for
monoamine oxidase inhibitor
what does SSRI stand for
selective serotonin reuptake inhibitor
what does SNRI stand for
selective norepinephrine reuptake inhibitor
what is the monoamine hypothesis of mania and depression?
depression is a deficiency of DA, NE, and 5-HT; mania is excess
which ADs are classified as first-gen?
TCAs, MAOIs
why are TCAs called tricyclic?
they have a 3 ring molecular core
MOA of TCAs
block presynaptic NE and 5-HT reuptake; block H and Ach Rs
TCAs account for what 2 pharmacological actions?
therapeutic and side effects
what are the 3 clinical limitations to TCAs?
slow onset, significant side effects, and overdose = cardiotoxic and potentially fatal
what are efficacy problems with MAOIs?
use limited by interactions
what kinds of interactions occur with MAOIs?
adrenaline-like drugs (nasal sprays, asthma, cold meds); foods with tyramine (high-protein foods: cheeses, pickled + fermented liquids, foods, sauces)
are MAOIs as safe as SSRIs?
yes
MAOIs may work in pts who respond poorly to what?
TCAs and/or SSRIs
MAOIs are tx for what disorders?
MDD, BPD, dysthymia, panic, and phobia
what do SSRIs do?
block presynaptic transporter for 5-HT reuptake
what are concerns with SSRI therapy?
Tx-resistant patient and serotonin syndrome
when does serotonin syndrome occur?
after high doses or polypharmacy
what are symptoms of serotonin syndrome?
altered cognition, behavioral alterations, autonomic, neuromuscular impairment
when does serotonin syndrome resolve?
within 24-48 hours
what happens if you increase activity at 5-HT1?
antidepressant + anxiolytic effects
what happens if you increase activity at 5-HT2?
insomnia, anxiety, agitation, sexual dysfunction
what happens if you increase activity at 5-HT3?
nausea
what happens if you increase activity at 5-HT2 and 5-HT3?
adverse effects
if you take an SSRI, what happens at 5-HT Rs? Which ones?
increased activity at all R types
what are the side effects of SSRIs?
sedation, cog impairment, weight gain, sexual dysfunction, sleep disturbance, suicidal ideation in children + adolescents
what do dual-action ADs do?
inhibit presynaptic reuptake of 5-HT and NE
what did the STAR D study test?
the effectiveness of AD tx for MDD
what did the STAR D study find?
no AD superior to others
what were the specific results of STAR D?
2/3 of pts were able to achieve remission if they didn’t withdraw
