Neurobiology of Disease 4 Flashcards
Define ‘depression’. (1)
Persistent feelings of sadness, hopelessness, or loss of interest in life which can last for weeks or months.
DSM-V criteria is used to diagnose depression. Patients must have experienced at least 5 out of 9 symptoms in the same 2 weeks.
Name the two symptoms (one of which must feature). (2)
Then name the other seven symptoms. (7)
- Depressed mood
- Loss of interest or pleasure
- Change in weight/appetite
- Insomnia or hypersomnia
- Psychomotor retardation or agitation
- Loss of energy or fatigue
- Feelings of worthlessness or guilt
- Impaired concentration or indecisiveness
- Suicidal ideation or suicide attempt
Which mental health condition is being described? (1)
‘A mental health condition that affects moods, which can swing from one extreme to another.’
Bipolar disorder
Name the two extreme moods which are experienced in bipolar disorder. (2)
How long do these ‘moods’ typically last? (1)
- Depression
- Mania
Each mood can last for several weeks at a time
Bipolar disorder used to be known by what other name? (1)
Manic depression
Give a definition of mania, including how long it must have lasted for and how often symptoms are present. (3)
Abnormally and persistently elevated/irritable mood
lasting at least a week
and present most of the day nearly every day.
According do the DSM-V at least 3 symptoms have to be present to be diagnosed with mania.
What are the seven possible symptoms? (7)
- Inflated self-esteem and grandiosity
- Decreased need for sleep
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility
- Increase in goal-directed activity
- Excessive involvement in activities with high potential for painful consequences
Briefly describe the monoamine hypothesis of depression and mania. (2)
Depression is due to a functional deficit of monoamine neurotransmitters
mania is due to a functional excess.
Name three monoamine neurotransmitters. (3)
Noradrenaline
Dopamine
Serotonin
Give two pieces of pharmacological evidence that support the monoamine hypothesis of depression. (2)
- Drugs that increase monoamine neurotransmission improve mood
- Drugs that reduce monoamine neurotransmission lower mood
One piece of evidence that supports the monoamine hypothesis of depression is that drugs that increase monoamine neurotransmission improve mood.
Give two examples of this. (2)
Tricyclic antidepressants block monoamine reuptake and improve mood.
Monoamine oxidase inhibitors inhibit monoamine metabolism and improve mood.
One piece of evidence that supports the monoamine hypothesis of depression is that drugs that reduce monoamine neurotransmission lower mood.
Give an example of this. (1)
Reserpine, a-methyltyrosine, and methyldopa all inhibit monoamine synthesis or storage
and all lower mood.
Briefly describe four shortcomings in the monoamine hypothesis of depression. (4)
- Doesn’t clarify the pathophysiology of depression
- Drugs like cocaine and amphetamine enhance monoamine neurotransmission but aren’t antidepressant
- Some clinically effective antidepressants don’t affect monoamines
- Doesn’t explain the delayed therapeutic onset or treatment resistance (30% of people don’t respond)
Briefly describe the issue of delayed therapeutic onset with antidepressants. (3)
ie, what don’t we understand as scientists, why is it confusing?
SSRIs elevate synaptic 5HT within hours
Side effects also appear within hours
However antidepressant effects take about 3 weeks to occur
Name a neuroendocrine pathway which may be implicated in depression. (1)
HPA axis
Complete the passage relating to the HPA axis in depression. (6)
Depressed patients display HPA axis …………………
There is increased …………………. in saliva, plasma, and urine.
Increased ……………………… in CSF and limbic brain regions.
Increased size and activity of …………………………….. and ………………………..
And impaired …………………………….. mechanisms.
Hyperactivation
Cortisol
Corticotropin releasing hormone
Pituitary gland
Adrenal glands
Negative feedback
How might antidepressant drugs affect the HPA axis to treat depression? (1)
Enhance negative feedback to reduce HPA axis hyperactivity.
How is the volume of the hippocampus affected in depression? (1)
Reduced by about 10%
The volume of the hippocampus is reduced in depression.
Briefly name and describe two mechanisms by which this may occur. (4)
NEUROPLASTICITY HYPOTHESIS:
- Atrophy of mature neurones (shortened dendrites and/or decreased spinal density)
NEUROGENESIS HYPOTHESIS:
- Decreased adult neurogenesis (fewer new neurones and neural precursors)
Describe a piece of evidence supporting the neuroplasticity hypothesis of depression. (1)
Ketamine (a rapid onset antidepressant) increases number and function of dendritic spines in the PFC
Describe a piece of evidence supporting the neurogenesis hypothesis of depression. (1)
Many antidepressants are known to increase adult neurogenesis.
Name a molecule which may be involved in pathology and treatment responses, according to the neuroplasticity and neurogenesis hypothesis of depression. (1)
BDNF
Briefly describe four pieces of evidence supporting the theory that inflammation may be involved in depression. (4)
- Patients with depression have increased inflammatory markers (cytokines, chemokines, acute-phase proteins)
- Preclinical studies show that inflammatory markers induce depressive symptoms
- Inflammation can precipitate depression in hepatitis or cancer patients treated with INFa or IL-2
- Systemic diseases with an inflammatory component increase risk of depression (eg. RA or IBD)
Suggest a non-pharmacological treatment for depression. (1)
What is the aim of this treatment? (1)
Cognitive behavioural therapy (CBT)
Aims to stop negative cycle that influences behaviour and emotion.
Briefly describe the negative cycle of thoughts and behaviours associated with depression. (4)
- Low mood
- Altered physical functioning (eg. sleep, appetite)
- Altered behaviours (eg. withdrawal, work absence)
- Negative thoughts about self
- Back to low mood
Give three general mechanisms that pharmacological management of depression aims to work via. (3)
- Inhibit reuptake of monoamine neurotransmitters
- Block presynaptic receptors that inhibit monoamine release
- Inhibit monoamine oxidase
Give a reason which monoamine inhibitors aren’t really used to treat depression anymore. (1)
Give two examples of MAOIs which have been used in the past. (2)
Can have serious side effects (including food interactions)
Phenelzine
Tranylcypromine
Give five possible classes of drugs which may be effective in depression (not MAOIs). (5)
SSRI
Tricyclic antidepressants
SNRI
Noradrenaline reuptake inhibitor
Mirtazapine
Describe two theories behind why antidepressants, such as SSRIs, have a delayed therapeutic effect. (7)
- Inhibition of SERT leads to increased 5HT
- More 5HT binds presynaptic autoreceptors
- Inhibition of 5HT release
- Over time, presynaptic receptors desensitise
- Therapeutic effects can then be felt
- Also, antidepressants work by altering gene expression and synaptic plasticity
- And these effects take time to kick in
How do SSRIs alter monoamine neurotransmission? (2)
Increase synaptic serotonin
By inhibiting SERT transporter and reuptake
Give four examples of SSRIs that can be used to treat depression. (4)
- Citalopram
- Fluoxetine
- Paroxetine
- Sertraline
Give two reasons why SSRIs are the first line treatment for depression. (2)
- Favourable side-effect profile
- Less toxic in overdose
Give two examples of tricyclic antidepressants (TCA) which can be used to treat depression. (2)
Amitriptyline
Imipramine
Describe how tricyclic antidepressants alter monoamine neurotransmission. (2)
- Increase synaptic 5HT and NA
- By inhibiting reuptake
Give three side effects that are seen with tricyclic antidepressants. (3)
- Sedative
- Anticholinergic (dry mouth, blurred vision)
- Cardiovascular (can be fatal in overdose)
Why can tricyclic antidepressants have sedative effects? (1)
Because they can act as H1 antagonists
Give two examples of SNRIs which can be used to treat depression. (2)
Venlafaxine
Duloxetine
Describe how SNRIs alter monoamine neurotransmission. (2)
Increase synaptic 5HT and NA
by inhibiting reuptake
Given that SNRIs may be more effective than SSRIs in treating depression, why aren’t SNRIs used as the first line treatment? (1)
They can increase blood pressure
Name a noradrenaline reuptake inhibitor which can be used to treat depression. (1)
Reboxetine
How is mirtazapine thought to enhance NA and 5HT neurotransmission? (1)
By blocking presynaptic a2 and 5HT2 autoreceptors (which would normally inhibit NA and 5HT release)
Give a side effect often seen when using mirtazapine to treat depression. (1)
Sedative
(However this may be helpful if the patient is experiencing sleeping difficulties)
Give three possible next generation treatments for depression. (3)
- Ketamine
- Vagal nerve stimulation
- Psychedelics
What receptors are targeted by ketamine, as used to treat depression? (1)
Glutamate NMDA receptor antagonist
Give an advantage and a disadvantage of using ketamine to treat depression. (2)
ADVANTAGE:
- Rapid-onset activity which may last for several weeks
DISADVANTAGE:
- Cannot be given in an outpatient setting (given as low-dose infusion)
Give two potential mechanisms that ketamine may use to help treat depression. (2)
*Not NMDA antagonist
- mTOR signalling (mechanistic targeting of rapamycin)
- BDNF
When might vagal nerve stimulation be useful in treating depression? (1)
For treatment-resistant depression which has not responded to drugs.
Psychedelics used to treat depression often target what receptor (and how)? (2)
5HT2A receptor
Agonists
Give an example of a psychedelic why may be effective in treating depression. (1)
Psilocybin COMP360
(Currently in phase III clinical trials)
Describe one confounding factor to take into account when using and evaluating the use of psychedelic drugs to treat depression. (2)
Patients must receive psychotherapeutic input while receiving the drug.
Are the positive effects due to drug or psychotherapeutic input?
Suggest three possible pharmacological therapies to treat mania in bipolar disorder. (3)
- Lithium
- Antipsychotics
- Anticonvulsants
What is the exact cellular mechanism by which lithium alters neurotransmission in the treatment of bipolar disorder? (1)
Unknown
Give three effects of lithium on neurotransmission in the treatment of bipolar disorder. (3)
- Reduces excitatory DA neurotransmission
- Reduces excitatory glutamate neurotransmission
- Increases inhibitory GABA neurotransmission
Give a major drawback with using lithium to treat bipolar disorder. (1)
Has a very narrow therapeutic window so careful monitoring is essential.
What is the therapeutic window (blood concentration) for lithium when treating bipolar disorder? (1)
0.5-1.0mmol/L
Give ten possible effects that can be seen with blood concentrations of lithium over 1.0mmol/L. (10)
- Severe diarrhoea
- Vomiting or anorexia
- Muscle twitching
- Dehydration
- Drowsiness
- Confusion
- Muscle weakness
- Slurred speech
- Vertigo
- Blurred vision
Give six possible effects that can be seen with blood concentrations of lithium over 2.0mmol/L. (6)
- Convulsions
- Renal failure
- Electrolyte imbalance
- Hypotension
- Clouding of consciousness
- Coma and death
Name four antipsychotics that could be used to treat bipolar disorder. (4)
- Olanzapine
- Quetiapine
- Risperidone
- Cariprazine
How do antipsychotics affect monoamine transmission? (2)
Reduce monoamine activity
by antagonising D2 and 5HT2A receptors
Give a particularly troubling side effect of antipsychotic drugs, as used to treat bipolar disorder. (1)
Weight gain
Give three examples of anticonvulsants which could be used to treat bipolar disorder. (3)
- Valproate
- Carbamazepine
- Lamotrigine
Describe a caution that must be taken into account when using valproate to treat bipolar disorder. (2)
It increases risk of birth defects and developmental disorders
so must be avoided in pregnancy.
When serotonin was first discovered in blood serum (by Maurice Rapport and Irvine Page), what was its effects shown to be on tissue? (1)
Increase tension and contract arteries
Name the molecular structure of serotonin. (1)
5-hydroxytryptamine (5-HT)
Give the two components of the molecular structure of serotonin. (2)
Indole ring
Amine group
Monoamine neurotransmitters can be further classified into groups based on their molecular structures. For example, dopamine and noradrenaline are both monoamines and catecholamines.
What further category is serotonin classified into? (1)
Indolamines
Serotonin can be classified as an indolamine neurotransmitter.
Give another example of an indolamine. (1)
Melatonin
Suggest a category of drugs of abuse which have a similar structure to indolamine neurotransmitters. (1)
Hallucinogenic or psychedelic drugs
There are two groups of serotonergic neurones in the brain.
Name the two general locations where their cell bodies are located. (2)
Rostral (and median) raphe nuclei
Caudal raphe nuclei
The rostral (and median) raphe nuclei contain serotonergic neurones.
Give four areas of the CNS where these neurones project to. (4)
- Forebrain
- Thalamus
- Hippocampus
- Cerebellum