Pharmacology of Antidepressant drugs

Question 1

What are the two types of depression?

Answer 1

Unipolar - mood swings in one direction. 75% environmental, 25% genetic

Bipolar - oscillation between depression and mania

Question 2

Name 3 emotional symptoms of depression:

Answer 2

Apathy, pessimism, negativity

• low self-esteem, feeling guilty
• loss of motivation
• indecisiveness

Question 3

Name 3 biological symptoms of depression:

Answer 3

Reduced activity
Loss of libido
Sleep disturbance
loss of appetite

Question 4

What is the Monoamine theory?

Answer 4

Depression is caused by reduced activity of NAergic/Serotonergic systems
- Monoamines lead to a beneficial transcription response and so inhibit neural apoptosis and increase neurogenesis.

Question 5

What is the Neuroendocrine theory?

Answer 5

NAergic and 5-HT neurons input to the hypothalamus, which releases CRH

• CRH acts on pituitary to cause release of ACTH
• This causes cortisol release from adrenal cortex
• Cortisol leads to decreased neurogenesis and increased neural apoptosis which leads to depressive symptoms

Question 6

Name some treatments for Depression

Answer 6

• CBT
• SSRIs - Citalopram
• TCAs - Amitryptiline
• MAOIs - Phenylzine
• SNRIs
• Monoamine receptor agonists
• Reversible MAOIs - Moclobemide

Question 7

What is the drug and food interaction with MAOIs?

Answer 7

Tyramine in cheese and wine is an indirect sympathomimetic and increases NA release by displacing it in vesicles
- If MAO is blocked, NA will accumulate and cause headaches, haemorrhage etc.

Question 8

Why are SSRIs the first line treatment?

Answer 8

They have much fewer side effects than other drugs- e.g. they dont cause postural hypotension and other muscarinic effects.