Pharmacology of anti-depressant drugs and mood stabilisers

Question 1

Name a MOAi

Answer 1

Iproniazid

Question 2

What do appetitive/ approach systems do?

Answer 2

Function to mediate seeking and approach behaviours (including pleasure)

Question 3

What do aversive/defensive systems do?

Answer 3

Function to promote survival in the event of threat (fear/pain)

Question 4

What is the dorsal striatum responsible for?

Answer 4

Movement

Question 5

What is the amygdala responsible for?

Answer 5

Conditioning/learning

Question 6

What is the anterior cingulate responsible for?

Answer 6

The anterior cingulate cortex is responsible for reward anticipation, decision making, emotion, impulse control and empathy

Question 7

What is the orbitofrontal cortex responsible for?

Answer 7

The orbitofrontal cortex is responsible for cognitive processing of decision making

Question 8

Drug used to treat premature ejaculation

Answer 8

SSRI

Question 9

How do SSRIs work?

Answer 9

Prevent the reupake of 5-HT

-increase synaptic 5-HT within hours

Question 10

How long does it take to feel the effects of anti-depressant medications?

Answer 10

2-3 weeks

Question 11

What are 5-HT1A receptors

Answer 11

These are auto-receptors found throughout the CNS

• they are inhibitory and more receptors means greater inhibition
• they may provide a plausible mechanism to explain the delayed effects of most anti-depressants

Question 12

Name 2 SSRIs which inhibit CYP450

Answer 12

Fluoxetine
Paroxetine

( anti=psychotics which do this: phenytoin, carbamazepine)

Question 13

One of the first antidepressant drugs was which category of drug?

Answer 13

TCA

-imipramine

Question 14

Name an anti-psychotic which may act as an anti-depressant at a low dose

Answer 14

Flupentixol

Question 15

Dopamine receptors involved in anti-depressants

Answer 15

D2 receptors

Question 16

Main inhibitory neurotransmitter in the brain

Answer 16

GABA

• in the developing brain, its actions are primary excitatory

Question 17

What does GABA binding cause?

Answer 17

GABA binding causes opening of ion channels - either Cl- ions into the cell or K+ ions out of the cell

-this leads to a negative change in the transmembrane potential –> hyperpolarisation

Question 18

What are ‘mood stabilisers’

Answer 18

Most mood stabilisers are anti-convulsant drugs

-the majority of mood stabilisers are more effective at reducing manic episodes than depressive episodes

Question 19

List some anti-convulsant drugs

Answer 19

• carbamazepine
• valproate, sodium valproate
• lamotrigine

Question 20

“atypical” or “second generation” drugs

Answer 20

• olanzapine
• risperidone
• aripiprazole
• quetiapine

Question 21

How does lamotrigine work?

Answer 21

Blocking Na+ channels

-overall effect is to reduce excitability and cell firing (potentially useful if you have over-excitable neurons

Question 22

One of the oldest mood stabilisers

Exact mechanism unknown:
-Inhibition of 5-­‐HT autoreceptors
-Increase in anti-­‐apoptotic factor Bcl-­‐2
-Inhibition of glycogen synthase kinase-­‐3 (GSK-­‐3)
-Depletion of inositol
Upregulation of glutamate re-­‐uptake

Answer 22

Lithium

Question 23

IMPORTANT: Anti-psychotic mechanism of action

Answer 23

The true antipsychotic efficacy is related to their affinity of the D2 RECEPTOR

Question 24

IMPORTANT: What is the desired effect of anti-psychotics

Answer 24

Desired effect is DA blockade in the MESOLIMBIC CIRCUITS

Question 25

IMPORTANT: adverse effects of anti-psychotics?

Answer 25

Adverse effects (e.g. movement disorders, hyperprolactinaemia) are due to DA BLOCKADE in the NIGROSTRIATAL and TUBERO-INFUNDIBULAR PATHWAYS