Lecture 11 - Antidepressants Flashcards
Drugs used as antidepressants
amitriptyline imipramine fluoxetine paroxetine sertraline mirtazapine buprorion venlafaxine phenelzine
List 3 types of depressive disorders
1 - reactive (secondary depression)
2 - bipolar disorder
3 - major depression
Describe:
1 - reactive (secondary depression)
- temporary rxn to real stimuli such as grief or illness
- treatment is largely by psychotherapy
Describe:
2 - bipolar disorder
-recurrent major depressive episodes with intervening manic, hypomanic, or mixed episodes
Describe:
3 - major depression
-one or more major depressive episodes free of manic, mixed or hypomanic episodes
Lifetime prevalence in males?
9.6%
Lifetime prevalence in females?
20.4%
____% of the population are at risk of experience a major depressive episode at any given time
3-5
Onset?
most frequently 25-44 years of age
____ % have a single episode
30-50
recurrent episodes in ____%
50-70
If a first degree relative has depression, how much more likely are you to get depression?
1.5-3 times more likely
Risk of major depression determined by inheritance = ?
39%
Risk of major depression determined by environment = ?
61%
List the 4 types of symptoms of major depression
1-emotional
2-physical
3-cognitive
4-psychomotor
Describe:
1-emotional
- diminished ability to experience pleasure
- loss of interest in usual activities
- pessimistic outlook
- anxiety (90%)
Describe:
2-physical
- chronic fatigue
- terminal insomnia
- appetite disturbances
Describe:
3-cognitive
- poor concentration
- slow thinking
- poor short-term memory
Describe:
4-psychomotor
- slowed physical movements and speech
- agitation
Diagnosis for depression?
have to have at least 5 symptoms of these over a period of 2 weeks to be diagnosed with depression
List 2 non-pharmacologic therapies for major depression
- psychotherapy
- ECT (electroconvulsive therapy)
Describe pharmacologic therapy for major depression
- 50-60% of Pts responsive
- newer drugs well-tolerated and present little risk for OD
- all drugs have similar efficacy
Describe the amine hypothesis
depression is related to reduced synaptic levels of NE and 5-HT
What supports the amine hypothesis?
1) 1950’s - Reserpine was proven to reduce NE and 5-HT metabolism and caused depression in 15% of patients
2) Most antidepressant drugs appear to work by enhancing synaptic monoamines (by blocking reuptake)
How long is the therapeutic lag for antidepressants?
1-4 weeks
Antidepressants have ___-term synaptic effects that influence synaptic strength
long
Describe Phase 1 amine enhancement
short-term (min-hrs)
uptake inhibition
Describe Phase 2 amine enhancement
long-term (weeks) effects of phase 1 enhancement - produces further enhanced amine levels to reach therapeutic significance