Pharmacology of Antidepressants Flashcards
which drugs have the most effect in moderate depression
most of the drugs have a similar effect
which drugs are most effective in severe depression
TCAs
what are teh 3 cardinal symptoms of depression
anergia, low mood and anhedonia
outline the criteria for mild, moderate and severe depression
do AD work immediately?
no, take around 2-6 weeks
how long do depressive symptoms need to be present for for crtieria?
most of teh day for the past 2 weeks
are dosing adjustments amde for older patients?
yes, they dont need as large as an adult dose
usually start on half the adult dose
what happens if you start a patient on an AD and see no change?
assess after 4-6 weeks
increase dose and review in 2 weeks
if after 6 weeks at max/max tolerated dose there is still non/inadequate response - switch drug
if eg fluxoetine doesnt work cn you switch to citalopram?
no, must swittch AD class
how long after resolutionof symptoms must AD be continued for, and after recurrence
6-12 months
12-24 if recurrence
what happens if you stop AD too soon?
50% relapse
in which circumstances would AD be continued indefinitely?
3rd relapse, or very severe
what is the monoamine hypothesis
suggests that depression results from functionally deficient monoaminergic transmission in the CNS. although this is too simple to fully explain depression, pharmacological theory is based on increasing the monoaminergic transmission
endocrinology and depression
dexamethasone suppression test is abnormal in 1/3 patients - abnormally weak response of plasma cortisol to exogenous steroid
this may reflect monomaine transmission in the hypothalamus
what is the first derivative of serotonin
tyrptophan
what is noradrenaline made from
what is the role of monoamine oxidase enzyme
removes the neurotransmitters norpinehrine, serotonin and dopamine from the brain by reabsorbing them from teh synpatic clefr and breaking them down
mechanism of action of SSRIs
selectively inhibit the reuptake of serotonin from the synaptic cleft
which drug is used first line in depression
usually SSRI, individuals respond differently to different drugs
when are SSRIs taken
morning, reduce insomnia