Exam 4: Li Flashcards
What are the types of depression and %?
- Reactive (60%)
- MDD (25%)
- Bipolar affective (15%)
What are the physiological symptoms of depression?
decreased sleep, appetite changes, fatique, constipation, headaches, palpitations, menstrual irregularities
What are the psychological symptoms of depression?
dysphoric mood, worthlessness, excessive guilt, lost of interest/ pleasure in all or most activities
what are the cognitive symptoms of depression?
decreased concentration and SI
what are the types medications that cause drug-induced depression?
- antihypertensive and cardiovascular (BBs)
- sedative-hypnotics
- anti-inflammatory and analgesics
- steroids
- anti-parkinson, neuroleptics
What are the four major hypotheses for depression?
- biogenic amine
- neuroendocrine
- neurotrophic
- integration
what is the biogenic amine hypothesis of depression?
- depletion of NE and 5HT from vesicles
- polymorphisms in SERT promoter
- alterations in 5HT1A/2C & a2 receptors
what is the neuroendocrine hypothesis of depression?
- changes in HPA axis
–> ACTH promoting release of cortisol from adrenal
What is the neurotrophic hypothesis of depression?
- the BDNF is critical in ( neural plasticity, resilience, and neurogenesis)
what is the integration hypothesis of depression?
- HPA and steroid abnormalities regulate BDNF levels
- hippocampus cells activated by cortisol decreasing BDNF
- activation of MOA receptors increase BDNF
–> chronic activation leads to down regulation of HPA axis
What are the main classes of drugs for depression?
- MOAIs
- SSRIs
- SNRIs
- TCAs
- 5HT antagonists
- tetracyclic and unicyclic antidepressants
Why does therapy for antidepressants take 4-8 weeks?
NO one really knows
- maybe due to the drug causing the neurotransmitter in the intrasynaptic space to increase
What is the mechanism of MOAIs?
- NE and 5HT normally degraded by MAO
- more NE and 5HT is released from vesicles into the Synapse
what drugs are tertiary amines?
imipramine, amitriptyline, trimipramine, doxepin
what is the mechanism of SSRIs?
- 5HT transporters pumps are blocked
- 5HT stays insynapse longer and remain active longer
what drugs are SSRI & 5HT1A partial agonists?
Vilazodone and vortioxetine
What drugs are NSRIs?
reboxetine and atomoxetine
what are some rapidly acting antidepressants?
NMDA antagonists
- ketamine-subanesthetic doses
- scopolamine
- lanicemine
- GLYX-13 partial NMDA antagonist
What is the new medication that helps with postpartum depression?
Zulresso (Brexonolone)
what is the MOA of Zulresso
resensitizes GABA-A receptors
What AD/pain medications work within the brain for perception?
opioids, A2 agonist, TCAs, SSRIs, SNRIs
what AD/pain meds work within the descending modulation in regards to modulation?
TCAs, SSRIs, SNRIs
what AD/pain meds with within the dorsal ganglion root for transmission?
LAs, a2 agonists
what AD/pain meds work within the peripheral nerve for transmission?
LAs, Opioids
what AD/pain meds work within the peripheral nociceptors for transduction?
LAs, capsaicin, anticonvulsants, NSAIDs, ASA, APAP, nitrate
where is the pain and where is the trauma for pain transmission?
pain in head and trauma in peripheral nociceptors and peripheral nerves
