Pharmacological treatments of depression and anxiety

Question 1

what is the clinical note about alpha adrenoreceptor antagonist in the treatment of anxiety?

Answer 1

do not withdraw abruptly to avoid side effects

Question 2

what are the four symptoms of GAD

Answer 2

insomina
muscle tension with headache
backache
autonomic physical symptoms

Question 3

two treatment options for GAD

Answer 3

1. psychological (CBT)

2. SSRIs- sertraline first line

Question 4

which medicine is only used in short term use for GAD during crisis?

Answer 4

benzodiazepine

Question 5

what is benzodiazepine used for?

Answer 5

muscle relaxation
insomnia 
epilepsy 
pre medication (surgery) 
anxiety 
alcohol withdrawal

Question 6

what are the effects of anti depressants on the HPA axis?

Answer 6

increases negative feedback and decreases HPA axis hyperactivity (decreases cortisol levels)

Question 7

what are the HPA hyperactivities expressed by depressed patients?

Answer 7

increased cortisol in plasma, urine and saliva
increase CRH in CSF and limbic regions
increased size of pituitary and adrenal glands
impaired negative feedback

Question 8

why is the monoamine hypothesis inadequate?

Answer 8

doesnt explain…
why antidepressants take 2-3 weeks to work
why it can treat other conditions (phobia)
pathophysiology of depression
full explanation of therapeutic actions of antidepressants

Question 9

what do you need to consider before prescribing a pharmacological treatment?

Answer 9

toxicity in OD
side effects / adverse effects
cost
interactions with other treatments

Question 10

what is the difference in treating <18 year olds with moderate/ severe depression?

Answer 10

<18 you must start with psychological therapy before trying combined therapy (with fluoxetine)
-> consider alt psych and switch to sertraline or citalopram if side effects
>18 combined therapy

Question 11

what is NICE’s guidelines in drug treatment in mild depression

Answer 11

only in certain cases like if history of moderate/ severe depression

Question 12

what is the importance of diagnosing bipolar disorder?

Answer 12

must be confirmed by mental health professional as treatment varies and usually misdiagnosed

Question 13

when is the first episode of bipolar observed? what age does it peak

Answer 13

before 30, peak 15-19