Mood Disorders and Antidepressant Drugs

Question 1

what is used to classify mental health conditions

Answer 1

DSM5

Question 2

depressive disorders

Answer 2

disruptive mood dysregulation disorder
major depressive disorder - single+recurrent
premenstrual dysphoric disorder
substance/medication induced depressive disorder
depressive disorder due to another medical condition
other specified depressive disorder
unspecified depressive disorder

Question 3

is bipolar disorder classified as a depressive disorder on DSM5

Answer 3

no

Question 4

bipolar disorder

Answer 4

alternation of depressive episodes and mania

Question 5

depression symtoms

Answer 5

psychomotor retardation
fatigue or energy loss
decr concentration
decr interest in social activity
agitation
depressed mood
guilt and worthlessness
suicidal ideation
insomnia or hypersomnia
weight loss and decr appetite
lack of interest
anhedonia

Question 6

anhedonia

Answer 6

decr ability to experience pleasure

Question 7

does depression have a possible genetic link

Answer 7

yes

Question 8

which NT systems are associated with mood disorders

Answer 8

noradrenergic
seratonergic
possibly dopaminergic

Question 9

brain regions associated with depression

Answer 9

amygdala
prefrontal cortex
striatum
hippocampus

Question 10

how does metabolism and glucose consumption in the brain change with depression

Answer 10

decrease

Question 11

which region of the brain has the most significant loss of grey matter volume and white matter volume in depression

Answer 11

grey - subgenual anterior cingulate cortex
white - hippocampus

Question 12

how is cortex size effected by depression

Answer 12

decreased thickness

Question 13

default mode network

Answer 13

network of brain regions active when brain is at wakeful rest

Question 14

what is believed to cause pattern of negative and self reference thoughts in depression

Answer 14

increased connectivity within and of DMN

Question 15

what type of NT signalling can be impaired by stress

Answer 15

glutamatergic

Question 16

which brain areas are hyperactive in depression

Answer 16

hippocampus
amygdala
subgenual cingulate cortex
medial prefrontal cortex

Question 17

what is the effect of hypoactivity in the venterolateral and dorsolateral prefrontal cortices

Answer 17

impaired cognitive control on other brain regions leading to rumination

Question 18

classes of antidepressants

Answer 18

tricyclic
reversible+irreversible MOA inhibitors
SSRIs
serotonin noradrenaline reuptake inhibitors SNRIs
noradrenaline reuptake inhibitors NARIs
noradrenergic and specific serotonergic antidepressants NaSSA
serotonin antagonist and reuptake inhibitor SARI
agomelatine

Question 19

tricyclic antidepressant mechanism and targets

Answer 19

inhibit amine reuptake
H1 histamine, muscarinic, alpha1+2 adrenergic, 5HT

Question 20

what effects are caused by tricyclic antidepressant overdose

Answer 20

cardiotoxicity

Question 21

tricyclic antidepressant adverse effects

Answer 21

dry mouth
blurred vision
constipation
urinary retention
narrow angle glaucoma
fatigue
sedation
weight gain
postural hypotension
dizziness
loss of libido
arrhythmia

Question 22

monoamine oxidase inhibitor mechanism and targets

Answer 22

irreversibly inhibit monoamine oxidase
MOAa and MOAb

Question 23

what type of depression are monoamine oxidase inhibitors used to treat

Answer 23

atypical - with anxiety, phobia, hypochondria

Question 24

monoamine oxidase inhibitor interactions

Answer 24

tyramine containing food - mature cheese, pickled fish+meat, red wine, beer, broad beans, marmite
pethidine
sympathomimetic compounds

Question 25

what happens when a pt on MAO inhibitors eats tyrosine containing foods

Answer 25

pt cant inactivate tyramine -> tyramine accumulates and replaces noradrenaline -> hypotension

Question 26

MAO inhibitor adverse effects

Answer 26

hepatotoxicity

Question 27

SSRI mechanism

Answer 27

inhibit serotonin reuptake

Question 28

SSRI overdose effects

Answer 28

benign

Question 29

are reversible or irreversible MAO inhibitors safer

Answer 29

reversible

Question 30

reversible MAO inhibitor adverse effects

Answer 30

nausea agitation confusion

Question 31

are reversible MAOs selective for MAOa or MAOb

Answer 31

MAOa

Question 32

which receptors do NaSSAs and SARIs antagonise

Answer 32

NaSSA - 5HT2 + alpha2 adrenergic SARI - 5HT2 + serotonin reuptake inhibition

Question 33

agomelatine MOA

Answer 33

agonist at MT1 and MT2 melatonin receptors and 5HT2c receptors

Question 34

what drug type are clomipramine, imipramine, desipramine, amitriptyline, nortriptyline, and protriptyline

Answer 34

tricyclic antedepressants

Question 35

what class of drug are phenelzine and tranylcypromine

Answer 35

irreversible MOA inhibitors

Question 36

what drug class are citalopram, fluoxetine, and paroxetine

Answer 36

SSRIs

Question 37

what drug class is moclobemide

Answer 37

reversible MAO inhibitor

Question 38

what drug type are venlafaxine and duloxetine

Answer 38

SNRIs

Question 39

what drug type is reboxetine

Answer 39

NARI

Question 40

what drug type of mirtazapine

Answer 40

NaSSA

Question 41

what drug type is trazodone

Answer 41

SARI

Question 42

how long is the delay of action between starting an antidepressant and mood improvement

Answer 42

2-3 weeks

Question 43

what causes delayed action onset of antedepressants

Answer 43

regulatory adaptations of neurones and autoreceptors to compensate for drug effects occur once receptors desensitised

Question 44

why must antidepressants be discontinued very gradually

Answer 44

avoid antidepressant drug discontinuation syndrome

Question 45

antidepressant drug discontinuation syndrome symptoms

Answer 45

insomnia anxiety nausea headaches electric shock sensations agitation mood swings diarrhoea abdo cramps

Question 46

what is a bipolar mixed episode

Answer 46

symptoms of mania and depression that occur at the same time or in rapid sequence without recovery in between

Question 47

mood stabilisers

Answer 47

lithium carbamazepine sodium valproate

Question 48

when is lithium used

Answer 48

bipolar maintenance acute mania drug resistant depression

Question 49

function of which organs mist be tested before and during lithium treatment

Answer 49

thyroid kidney

Question 50

lithium adverse effects

Answer 50

thirst nausea fine tremor polyuria weight gain oedema acne

Question 51

what can antidepressant drugs used in bipolar adversely lead to

Answer 51

manic episodes mixed affective states rapid cycling

Question 52

3 phases of depression treatment

Answer 52

acute - 6-12wks continuation - 6mo after full symptoms control maintenance

Question 53

drug resistant depression

Answer 53

lack of clinical response after at least 2 different antidepressants have been prescribes

Question 54

non pharmacological mood disorder treatments

Answer 54

electroconvulsive therapy CBT vagal nerve stimulation deep brain stimulation transcranial direct current and magnetic stimulation

Question 55

what type of depression is esketamine used for

Answer 55

treatment resistant

Question 56

esketamine MOA

Answer 56

NMDA glutamate receptor antagonist

Question 57

what type of depression is brexanolone used for

Answer 57

PPD

Question 58

brexanolone MOA

Answer 58

positive modulator of GABAa receptors

Question 59

how is brexanolone administered

Answer 59

IV