PHARM - Drugs Used to Treat Depression and Bipolar Disorders - Week 9

Question 1

What are affective disorders?

Answer 1

Those which influence affect or mood

Question 2

What happens with mood swings?

Answer 2

Extreme elation and hyperexcitability to extreme melancholia and withdrawal

Question 3

Do unipolar/major depression have manic episodes?

Answer 3

No

Question 4

What are the two kinds of unipolar/major depression? Are their causes known?

Answer 4

Reactive - known cause

Endogenous - no known/apparent cause

Question 5

What are the two kinds of mood disorders?

Answer 5

Unipolar

Bipolar

Question 6

What are three neurotransmitters implicated in mood?

Answer 6

Noradrenaline
Serotonin
Dopamine

Question 7

What are mood disorders characterised by?

Answer 7

Longlasting changes to mood

Question 8

What are 6 symptoms of depression?

Answer 8

Intense sadness/despair
Diminished interest/pleasure in daily life
Loss of concentration
Sleep disturbance
Anorexia
Disruption to normal rhythm

Question 9

List three psychological risk factors for mood disorders.

Answer 9

Early parental loss
Childhood abuse
Stressful life events

Question 10

List three biological risk factors for mood disorders.

Answer 10

Hormonal
Genetic
Biochemical (monoamines)

Question 11

Describe the monoamine theory of depression.

Answer 11

Drugs that interfere with monoaminergic transmission influence mood.
Depletion results in depression.

Question 12

Do drugs that elevate mood make good antidepressants? Explain (3).

Answer 12

No as they can cause dependence (dopamine related) and toxicity

Question 13

How long do antidepressants take to have effect?

Answer 13

2-6 weeks

Question 14

Describe the action of cocaine on a neuron.

Answer 14

It blocks the uptake of noradrenaline by the neuron.

Question 15

Describe the action of amphetamine on a neuron.

Answer 15

Forces the release of noradrenaline

Question 16

List two 1st generation unipolar antidepressant drugs.

Answer 16

Tricyclic antidepressants

Monoamine oxidase inhibitor

Question 17

List two 2nd generation unipolar antidepressant drugs.

Answer 17

Selective serotonin uptake inhibitors

Selective serotonin/noradrenaline uptake inhibitors

Question 18

List two 3rd generation unipolar antidepressant drugs.

Answer 18

Novel monoaminergic drugs
Non-monoaminergic drugs
(these are known as atypical antidepressants)

Question 19

List two bipolar antidepressant drugs.

Answer 19

Lithium

Some anti-epileptics

Question 20

What generation of unpolar antidepressant drugs led to the monoamine theory of depression?

Answer 20

1st generation - MAOi and TCAs

Question 21

What effect do MAOi and TCAs have? Describe each.

Answer 21

They prolong the action of NA
MAOi decreases NA metabolism
TCA blocks neuronal uptake of NA

Question 22

Which MAO do MAOi inhibit?

Answer 22

Both MAO A and MAO B

Question 23

Inhibition of which MAO is related to antidepressant activity and side effects?

Answer 23

Inhibition of MAO A

Question 24

What is the mechanism of action of MAOi? What effect does it have on monoamine concentrations in the cytoplasm?

Answer 24

It is similar in structure to MAO substrates

It increases monoamine concentration in the cytoplasm

Question 25

What is the mechanism of action for tricyclic antidepressants?

Answer 25

Blocks re-uptake of NA and 5HT into nerve terminal

Question 26

In addition to their mechanism of action, what else to TCAs allow for?

Answer 26

Downregulation of post-synaptic receptors

Question 27

List 6 side effects of TCAs. Is an overdose dangerous?

Answer 27

``` Sedation Anti-cholinergic side effects Decreased blood pressure Increased weight gain Cardiac effects Seizures Dangerous in overdoses ```

Question 28

Describe how quickly the pharmacological effects of TCAs manifest vs how long it takes to have an antidepressant effect. Give a reason for this disrepancy (2).

Answer 28

Takes weeks to develop despite pharmacological effects manifesting in hours. Adaptive changes in neuronal function likely underlie antidepressant activity like changes in receptor sensitivity and density. Increased levels of transmitter can downregulate receptor number/function.

Question 29

Do TCAs have a wide or narrow therapeutic window? | Is their efficacy good or limited?

Answer 29

Narrow | Limited efficacy

Question 30

Do TCAs have a long or short half-life? Can it accumulate?

Answer 30

Long | Gradual accumulation is possible

Question 31

Describe the mechanism of action for selective serotonin reuptake inhibitors (SSRI). Does it have any effect on NA or DA?

Answer 31

It is selective for 5HT uptake - exact mechanisms unknown | Has weak inhibition of NA/DA uptake

Question 32

How are SSRIs administered?

Answer 32

Orally

Question 33

What do SSRIs interact with directly?

Answer 33

hSERT

Question 34

List 5 adverse effects of SSRIs. List one advantage it has. Does it have many or few drug interactions (mention 1st gen antidepressants)?

Answer 34

``` Nausea Insomnia Agitation Weight change Loss of libido Advantage - much safer in overdose Numerous drug interactions, including with MAOi and TCAs ```

Question 35

Are 3rd gen atypical antidepressants TCAs?

Answer 35

Are non TCAs

Question 36

Are 3rd gen atypical antidepressants short or long acting?

Answer 36

Short acting

Question 37

Do 3rd gen atypical antidepressants have a common mechanism of action?

Answer 37

No

Question 38

Which has more adverse effects, TCAs or 3rd gen atypical antidepressants?

Answer 38

TCAs | 3rd gen has fewer

Question 39

How do some common 3rd gen atypical antidepressants work (4)?

Answer 39

Block a2 adrenoceptors, histamine and serotonin receptors. | No effect on uptake.

Question 40

What is the drug of choice for acute manic illness (a bipolar depression)? What is its mechanism of action?

Answer 40

Lithium | Mechanism unclear

Question 41

Why must plasma levels be monitored when administering lithium?

Answer 41

It becomes toxic quickly and the therapeutic range is very low and close to toxic levels.

Question 42

In what form is lithium administered?

Answer 42

Lithium carbonate

Question 43

List 5 side effects of lithium.

Answer 43

Nausea Tremor Impaired renal (polyuria), thyroid, and neurological function