Pharmacological Treatments of Affective and Anxiety Disorders Flashcards
(37 cards)
What are some conditions that can be treated by antidepressants?
Unipolar and bipolar depression
Organic mood disorders
Schizoaffective disorder
Anxiety disorders (OCD, social phobia, PTSD)
Premenstrual dysphoric disorder
Personality disorders
How do antidepressants work?
Increase levels of serotonin and noradrenaline in the brain
Increasing these neurotransmitters changes receptors in the brain which is why there isnt an immediate response
How long is the delay before symptoms improve when taking antidepressants?
Lecture slides say 2-4 weeks
Heard 7-14 days in the tutorial though
What are some common side effects associated with tricyclic antidepressants?
Antihistaminic:
Weight Gain
Sleepiness
Anticholinergic:
Dry Mouth
Blurred Vision
How do TCA’s work?
Work by increasing serotonin, dopamine and noradrenaline
What are some of the negatives of TCA’s?
Lethal in overdose (even a weeks supply can cause death)
Cause QT lengthening even at therapeutic level
High side effect profile
Would you prescribe a secondary or a tertiary TCA if you had the choice? Why?
Secondary
The added side chains in tertiary tend to be more reactive and result in greater side effects
How do monoamine oxidase inhibitors work?
Bind irreversibly to monoamine oxidase which prevents the inactivation of amines such as norepinephrine, dopamine and serotonin
Increases their synaptic levels
When do monoamine oxidase inhibitors tend to get prescribed?
Treatment resistant depression
What are some of the side effects of monoamine oxidase inhibitors?
- Orthostatic hypotension (sudden drop in blood pressure when you stand from a seated position)
- Weight gain
- Dry mouth
- Sedation
- Sexual dysfunction
- Sleep disturbance
What is the cheese reaction?
When monoamine oxidase inhibitors are taken with tyramine rich foods or sympathomimetics they can cause hypertensive crisis
Cheese, red wine, processed meats all rich in tyramine
What brings about serotonin syndrome? What is serotonin syndrome characterized by?
Caused by taking monoamine oxidase inhibitors with meds that increase serotonin or have sympathomimetic actions
Characterized by abdominal pain, diarrhoea, sweats, tachycardia, HTN, myoclonus, irratibility, delerium. Can lead to cardiovascular shock and death
How do selective serotonin reuptake inhibitors (SSRI’s) work? What symptoms are they most suited to?
Block the presynaptic reuptake of serotonin
Treat both anxiety and depressive symptoms
What are some of the side effects of SSRI’s?
GI upset Sexual dysfunction anxiety, nervousness insomnia, restlessness fatigue or sedation nausea
If you stop taking SSRI’s abruptly what are you at risk of?
Discontinuation syndrome
Agitation, nausea, disequilibrium and dysphria
If a patient starts taking SSRI’s what may be seen in the first week or so? What symptoms might you expect?
Activation syndrome
Nausea, anxiety, panic and agitation
Should only last 2-10 days
What are some examples of SSRI’s?
Sertraline
Fluoxetine (Prozac)
How do SNRI’s work? (serotonin / noradrenaline reuptake inhibitors)
Inhibit both serotonin and noradrenaline uptake but without the antihistaminic / antiadrenergic and anticholinergic side effects of TCA’s
When are serotonin / noradrenaline reuptake inhibitors used?
Used for depression, anxiety and potentially neuropathic pain
What are the conditions that may require treatment with mood stabilizers?
Bipolar disorder
Cyclothymia
Schizoaffective disorders
What are the main classes of mood stabilizers?
Lithium
Anticonvulsants
Antipsychotics
What is the only medication shown to drop suicide rates in bipolar affective disorder?
Lithium
Drops suicide rates by about 15 percent
Prior long term response or family member with good response predicts good response
What is lithium used for?
prophylaxis of both mania and depressive episodes in bipolar affective disorder
In order to prescribe lithium what tests are needed?
Baseline U&E and TSH
Pregnancy tests (Ebsteins anomaly)
