L3- Antidepressants (general)

Question 1

Monamine Hypothesis:

• (1) was found to precipitate depression (include use, MOA)
• (2) was found to help relieve depressive symptoms (include use, MOA)

Answer 1

1- Reserpine: for HTN, depleted Dopa, 5-HT, NE

2- Iproniazid, Isoniazid: for TB, MAOI

Question 2

define the Monoamine Hypothesis

Answer 2

• monoamine depletion => depression

- monoamine preservation => mood elevation

Question 3

describe the particular weakness in the Monoamine Hypothesis

Answer 3

• pharmacological actions of tricyclics and MAOIs are immediate
• clinical effects of these drugs take weeks

-this suggest that the drugs trigger long-term changes

Question 4

describe the main mechanism of depression in relation to the monoamine hypothesis (what defect is depression linked to, not based on monoamine levels)

Answer 4

• may be linked to deficiency in signal transduction

- this can lead to deficient response of target neurons to neurotransmission –> depression

Question 5

list the antidepressant drugs

Answer 5

• SSRIs
• SNRIs
• TCAs
• MAOIs
• 5-HT2 antagonists/reuptake inhibitors
• NE and Dopa reuptake inhibitors
• Antagonists to α2, 5-HT2, 5-HT3 receptors

Question 6

Antidepressant effects:

• (1) time for any improvement in Sxs
• (2) time for substantial benefits
• all mechanisms of the drug enhance (3)
• (4) are the most common MOAs

Answer 6

1- 2-4 wks
2- 6-8 wks

3- monoamine neurotransmission (via one or multiple MOAs)
4- SERT inhibition, NET inhibition, or both

Question 7

1st line antidepressant for depression

Answer 7

SSRIs

Question 8

2nd line antidepressant for depression

Answer 8

SNRIs

Question 9

Abrupt stoppage of taking antidepressants can lead to (1), most often with (2) drugs.

Answer 9

1- antidepressant discontinuation syndrome (many Sxs on another card)

2- SSRIs (b/c most prescribed)

Question 10

list the symptoms of Antidepressant Discontinuation Syndrome

Answer 10

• anxiety, irritability, tearfulness
• insomnia
• dizziness, HA
• lethargy
• flu-like Sxs
• electric shock sensations
• n/v/d

Question 11

Antidepressant discontinuation syndrome is more common in drugs with (short/long) half-lives with like (2) drugs. (3/4)- name the opposite.

Answer 11

1/2- short; Paroxetine (SSRI), Venalfaxine (SNRI) [can occur after missing one dose]

3/4- long, Fluoxetine (SSRI) [able to miss a few doses]

Question 12

_____ is an adjunct that may be added to an established antidepressant regimen

Answer 12

atypical antipsychotics

Question 13

1st line antidepressant for anxiety disorders (GAD, SAD, PTSD, PD, OCD)

Answer 13

SSRIs

Question 14

_____ can also be used in smoking cessation

Answer 14

Buproprion (NDRI)

Question 15

_____ can also be beneficial for women with PMDD

Answer 15

(premenstrual dysphoric disorder)

SSRIs

Question 16

_____ antidepressants can also be used for chronic pain

Answer 16

TCAs, SNRIs- for neuropathic pain

Note- SSRIs are not effective here

Question 17

Antidepressants are useful in treating (anorexia/bulimia)

Answer 17

bulimia, not anorexia

Question 18

before prescribing an antidepressant, all patients must be screened for….

Answer 18

manic episodes in order to r/o bipolar disorder –> otherwise antidepressants may precipitate a manic episode