Pharmacological/ biological treatments

Question 1

Monoamine oxidase (MAO) inhibitors

Answer 1

1. first drug used to treatment for depression

2. inhibits reuptake of serotonin, norepinephrine and dopamine

Question 2

The next generation of drugs (2nd) were the

Answer 2

tricyclic antidepressants - inhibited reuptake of 5HT and norepinepherine

Question 3

SSRI include

Answer 3

Prozac, Zoloft, paxil, et al

Question 4

SNRI is a med

Answer 4

this slide would be empty, had I not written this sentence

Question 5

What percentage of patients do not show improvement with initial anti-depressant med rx?

Answer 5

20-40%

Question 6

Ketamine is a what?

Answer 6

NMDA glutamate antagonist

Question 7

Re ketamine, functional imaging studies suggest depressed pts have

Answer 7

increased levels of glutamate

Question 8

Two hours after single administration of ketamine…

Answer 8

70% improved, 30% remission - remember that repeated administration of ketamine causes sxs of schizo

Question 9

Current research on NMDA

Answer 9

Current research focused on developing drug that affects specific parts of NMDA receptors and does not produce schizo sxs

Question 10

ECT

Answer 10

1. usually unilateral to the right hemis while patient is anesthetized, paralyzed and on a respirator
2. usually given 3 X’s per week for total 6-12 times
3. proven effective for depression in double blind studies
   - relapse common, however
4. typically used for severe depression when other treatments are not effective
5. produces temporary amnesia which dissipates over a few days
   - permanent memory impairment can occur with excessive use
   - studies show no permanent memory impairment as presently used
   - however, pts who have received ECT often report alteration in cognitive functioning: e.g. “fogginess”

Question 11

Transcranial magnetic stimulation

Answer 11

1. applies a localized magnetic field to brain by passing an electrical current thru coil of wire placed on scalp
2. most studies show response rate less than 30% and relapse is common
   - But see case study

Question 12

Deep brain stimulation of subgenual ACC

Answer 12

(probably don’t need to know this) 1. 6 months post implant 60% improved, 35% remission

Question 13

Vegas nerve stimulation

Answer 13

apparently, don’t need to know more

Question 14

Lithium

Answer 14

1. effectively treats mania in bipolar disorder
   - depression usually does not occur if mania effectively treated
2. 70 – 80% of bipolar patients respond to lithium within 1-2 weeks
3. low therapeutic index
   - toxic reactions include nausea, diarrhea, motor incoordination, confusion
   - liver damage with prolonged use
4. pharmacological effects are not fully understood

Question 15

Anti-convulsants

Answer 15

1. also effective in treatment of bipolar

2. Tegretol (Carbamazepine) and Depakote (Valporic acid / Valporate)

Question 16

Treatment list

Answer 16

1. Monoamine oxidase inhibitors (MAO)
2. Tricyclic antidepressants
3. SSRI
4. SNRI
5. Ketamine
6. ECT
7. Transcranial magnetic stimulation
8. Deep brain stimulation of subgenual ACC
9. Vegas nerve stimulation
10. Lithium
11. Anti-convulsants