Lecture 18: treatments of depression Flashcards

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1
Q

Is electroconvulsive therapy effective? List one advantage and one disadvantage.

A

Yes, it is effective
- induce seizure in temporal lobe
- advantage: relief occurs very quickly, which is very good when a person is experiencing suicidal thoughts
- disadvantage: risk of memory loss

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2
Q

Why are electroconvulsive therapy and ketamine NOT first choices in the treatment of depression?

A

ECT:
- very invasive, risk of memory loss
Ketamine:
- easy to be abused, very difficult to be approved
- very expensive, often insurance won’t cover it

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3
Q

How is ketamine’s mechanism of action different from SSRIs mechanism of action

A

Ketamine:
- glutamate antagonist
- increases release* of glutamate from pre-synaptic neuron

SSRIs:
- serotonin reuptake inhibitors
- prevent serotonin from returning to the pre-synaptic neuron

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4
Q

What is the key advantage of ketamine treatment?

A
  1. works extremely fast
  2. amount you need to experience relief goes down over time, which prevents tolerance and dependence/abuse
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5
Q

How do SSRIs and SSNRIs work?

A
  • selectively block/inhibit the reuptake of serotonin / serotonin and norepinephrine
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6
Q

What are the advantages of SSRI’s over MAOi or tricyclics?

A
  • SSRI’s have very few side effects and are very safe (low therapeutic index)
  • MAOis are less effective than SSRIS and have side effects on your diet
  • tricyclics are effective for melancholic features (rather than atypical), but have much more side effects than SSRIs (heart failure) and higher therapeutic index
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7
Q

How do MAOis work? Why do they interfere with your diet?

A
  • MAOis = monoamine oxidase inhibitors
  • monoamine oxidase is an enzyme that breaks down monoamines such as DA, NE, and 5-HT
  • by inhibiting the enzyme, MAOis prevent the breakdown of monoamines in the neuron
  • MAO is also present in other places in the body
  • its used to digest food
  • when you’re inhibiting it, it can’t digest food as well, which can cause toxic reactions to certain foods
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8
Q

Tricyclics have lower therapeutic index than SSRIs making them less safe. What does it mean to have a lower therapeutic index?

A

therapeutic index is the ratio of the dose of a drug needed to be effective compared to the dose that is toxic. A lower therapeutic index means that a small difference in dosage can be dangerous, which makes tricyclics less safe.

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9
Q

By now, you know what SSRis do, using the same approach, what do you think NDRIs do?

A
  • Norepinephrine & dopamine re-uptake inhibitors
  • they inhibit the reuptake of NE and DA NTs
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10
Q

What are the 3 hypotheses of depression?

A
  • diathesis-stress
  • monoamine hypothesis (NTs)
  • allergies
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11
Q

Last week we talked about different hypothesis of depression. Which of those hypotheses are supported by the fact that tricyclics are an effective treatment of depression? Explain your answer

A
  • allergies
  • tricyclics have 2 parts
    –> 1st – identical to SSNRIs – block reuptake of 5-HT & NE
    –> 2nd – block receptors of acetylcholine and histamine
  • histamine = allergies
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