Neuroanatomy-Antidepressants

Question 0

Tricyclics antidepressants (TCAs)

Answer 0

2nd generation
Inhibit NE, serotonin, and Da transporters
2-3 week time before benefit
Inhibition of p450, reduces hypertensive actions, reduced seizure threshold, additive sedation with alcohol and depressants
Enhances anticholinergics - elderly are impacted greatly
H1-R blockage causes sedation.
Anticholinergic effects (M-R blockage) -> dry mouth, blurred vision, sexual dysfunction, delirium, glaucoma
Vascular: alpha 1 blockage, orthostatic hypotension
Cardiac: t wave flattening, inversion myocardial depression arrhythmias

Overdose may result in: hypotension, grand mal seizures, hyperpyrexia, arrhythmias, renal failure, shock. -> physostigmine antidote.

Other uses: narcolepsy, OCD, chronic pain (migraine), panic disorder, PTSD, enuresis (can’t control urination), ADHD, eating disorders
Secondary amines: generally NE > serotonin
Tertiary amines: generally equal

Question 1

MAOIs

Answer 1

1st gen
Increase mono amines in synapse
Now used as a later (second or third line) treatment
Takes 2-3 weeks to be effective
Tranylcypromine - irreversible inhibitor of maoi-a and b.

Question 2

Heterocyclics

Answer 2

Like TCAs, with extra ring
Amoxipine - nonselective
Maprotiline - NE selective
Trazodone - serotonin selective, sedating, no anticholinergic effects so useful for elderly
Bupropion (widely used) - DA selective, helps with additions as a result. No sexual side effects.

Question 3

SSRIs

Answer 3

Safer and used frequently!
Fluoxetine is most prescribed antidepressant
No cholinergic effects, also no histamine, alpha adrenrgic effects either

Don’t give to someone on MAOIs. Will result in serotonin syndrome. Altered mental state, fever, agitation, tremor.

Question 4

Fluoxetine (Prozac)

Answer 4

SSRI
Used for major depression, OCD, bulimia, Pms, panic disorder

Side effects: headache, anxiety, insomnia, drowsiness, tremor, restlessness, sexual dysfunction (temporary usually)

Question 5

Sertaline (Zoloft)

Answer 5

Ssri
Major depression
OCD
Panic disorder

Side effects: nausea, dyspepsia, dizziness, insomnia, sexual dysfunction

Question 6

Paroxetine (Paxil)

Answer 6

SSRI
Major depression
OCD
Panic disorder

Side effects: n,d, insomnia, head ache, sexual dysfunction

Question 7

SNRIs

Answer 7

Basically TCAs without all the side effects

Citalopram (celexa): race mic mixture. ^ 40 mg per day can cause heart issues.
Escitalopram (lexapro): s-enantomer of citalopram. 100x more potent.

Others:
Venlafaxine
Duloxetine

Question 8

Lithium

Answer 8

Acute mania, prophylaxis

Side effects: 
Memory
Weight gain
Tremor
Poluria
Drowsiness
Hypothyroidism
Cardiac effects

Question 9

Other mood stabilizers

Answer 9

Anticonvulsants:
Valproate
Carbamazepine
Lamontrignine

Antipsychotics:
Haloperidol