Mood Disorders and Antidepressant Drugs Flashcards
what is used to classify mental health conditions
DSM5
depressive disorders
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
is bipolar disorder classified as a depressive disorder on DSM5
no
bipolar disorder
alternation of depressive episodes and mania
depression symtoms
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
anhedonia
decr ability to experience pleasure
does depression have a possible genetic link
yes
which NT systems are associated with mood disorders
noradrenergic
seratonergic
possibly dopaminergic
brain regions associated with depression
amygdala
prefrontal cortex
striatum
hippocampus
how does metabolism and glucose consumption in the brain change with depression
decrease
which region of the brain has the most significant loss of grey matter volume and white matter volume in depression
grey - subgenual anterior cingulate cortex
white - hippocampus
how is cortex size effected by depression
decreased thickness
default mode network
network of brain regions active when brain is at wakeful rest
what is believed to cause pattern of negative and self reference thoughts in depression
increased connectivity within and of DMN
what type of NT signalling can be impaired by stress
glutamatergic
which brain areas are hyperactive in depression
hippocampus
amygdala
subgenual cingulate cortex
medial prefrontal cortex
what is the effect of hypoactivity in the venterolateral and dorsolateral prefrontal cortices
impaired cognitive control on other brain regions leading to rumination
classes of antidepressants
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
tricyclic antidepressant mechanism and targets
inhibit amine reuptake
H1 histamine, muscarinic, alpha1+2 adrenergic, 5HT
what effects are caused by tricyclic antidepressant overdose
cardiotoxicity
tricyclic antidepressant adverse effects
dry mouth
blurred vision
constipation
urinary retention
narrow angle glaucoma
fatigue
sedation
weight gain
postural hypotension
dizziness
loss of libido
arrhythmia
monoamine oxidase inhibitor mechanism and targets
irreversibly inhibit monoamine oxidase
MOAa and MOAb
what type of depression are monoamine oxidase inhibitors used to treat
atypical - with anxiety, phobia, hypochondria
monoamine oxidase inhibitor interactions
tyramine containing food - mature cheese, pickled fish+meat, red wine, beer, broad beans, marmite
pethidine
sympathomimetic compounds
what happens when a pt on MAO inhibitors eats tyrosine containing foods
pt cant inactivate tyramine -> tyramine accumulates and replaces noradrenaline -> hypotension
MAO inhibitor adverse effects
hepatotoxicity
SSRI mechanism
inhibit serotonin reuptake
SSRI overdose effects
benign
are reversible or irreversible MAO inhibitors safer
reversible
reversible MAO inhibitor adverse effects
nausea
agitation
confusion
are reversible MAOs selective for MAOa or MAOb
MAOa
which receptors do NaSSAs and SARIs antagonise
NaSSA - 5HT2 + alpha2 adrenergic
SARI - 5HT2 + serotonin reuptake inhibition
agomelatine MOA
agonist at MT1 and MT2 melatonin receptors and 5HT2c receptors
what drug type are clomipramine, imipramine, desipramine, amitriptyline, nortriptyline, and protriptyline
tricyclic antedepressants
what class of drug are phenelzine and tranylcypromine
irreversible MOA inhibitors
what drug class are citalopram, fluoxetine, and paroxetine
SSRIs
what drug class is moclobemide
reversible MAO inhibitor
what drug type are venlafaxine and duloxetine
SNRIs
what drug type is reboxetine
NARI
what drug type of mirtazapine
NaSSA
what drug type is trazodone
SARI
how long is the delay of action between starting an antidepressant and mood improvement
2-3 weeks
what causes delayed action onset of antedepressants
regulatory adaptations of neurones and autoreceptors to compensate for drug
effects occur once receptors desensitised
why must antidepressants be discontinued very gradually
avoid antidepressant drug discontinuation syndrome
antidepressant drug discontinuation syndrome symptoms
insomnia
anxiety
nausea
headaches
electric shock sensations
agitation
mood swings
diarrhoea
abdo cramps
what is a bipolar mixed episode
symptoms of mania and depression that occur at the same time or in rapid sequence without recovery in between
mood stabilisers
lithium
carbamazepine
sodium valproate
when is lithium used
bipolar maintenance
acute mania
drug resistant depression
function of which organs mist be tested before and during lithium treatment
thyroid
kidney
lithium adverse effects
thirst
nausea
fine tremor
polyuria
weight gain
oedema
acne
what can antidepressant drugs used in bipolar adversely lead to
manic episodes
mixed affective states
rapid cycling
3 phases of depression treatment
acute - 6-12wks
continuation - 6mo after full symptoms control
maintenance
drug resistant depression
lack of clinical response after at least 2 different antidepressants have been prescribes
non pharmacological mood disorder treatments
electroconvulsive therapy
CBT
vagal nerve stimulation
deep brain stimulation
transcranial direct current and magnetic stimulation
what type of depression is esketamine used for
treatment resistant
esketamine MOA
NMDA glutamate receptor antagonist
what type of depression is brexanolone used for
PPD
brexanolone MOA
positive modulator of GABAa receptors
how is brexanolone administered
IV
