Pharmacology of Depression

Question 1

How does sertraline work?

Answer 1

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.

Question 2

What drug target does sertraline act on?

Answer 2

Serotonin transporter

Question 3

What are the main side effects of sertraline?

Answer 3

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia

Question 4

What are 2 facts about sertraline?

Answer 4

1. Mild inhibition of dopamine transporter

2. Must be gradually decreased on discontinuation. Partial inhibition of CYP2D6 at high doses (150 mg).

Question 5

How does citalopram work?

Answer 5

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.

Question 6

What drug target does citalopram act on?

Answer 6

Serotonin transporter

Question 7

What are the main side effects of citalopram?

Answer 7

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia

Question 8

What are 2 facts about citalopram?

Answer 8

Mild antagonism of muscarinic and histamine (H1) receptors. Must be gradually decreased on discontinuation. Metabolized by CYP2C19.

Question 9

How does fluoxetine work?

Answer 9

Inhibition of serotonin reuptake results in an accumulation of serotonin. Serotonin in the central nervous system plays a role in the regulation of mood, personality, and wakefulness.

Question 10

What does fluoxetine act on?

Answer 10

Serotonin transporter

Question 11

What are side effects of fluoxetine?

Answer 11

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia

Question 12

What are 2 facts about fluoxetine?

Answer 12

Mild antagonism of 5HT2A and 5HT2C receptors. Complete inhibition of CYP2D6 and significant inhibition of CYP2C19 (caution with warfarin).

Question 13

How does venlafaxine work?

Answer 13

Venlafaxine is a more potent inhibitor of serotonin reuptake than norepinephrine reuptake. Noradrenaline in the central nervous system is implicated in the regulation of emotions and cognition.

Question 14

What does venlafaxine act on?

Answer 14

Serotonin transporter and Noradrenaline transporter.

Question 15

What are the side effects of venlafaxine?

Answer 15

GI effects (nausea, diarrhoea), sexual dysfunction, anxiety, insomnia, hypertension (at higher doses)

Question 16

What is an important fact about venlafaxine?

Answer 16

Must be gradually decreased on discontinuation

Question 17

How does mirtazapine work?

Answer 17

Antagonises central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine. Antagonises central 5HT2 receptors, which leaves 5HT1 receptors unopposed causing anti-depressant effects.

Question 18

What are the drug targets of mirtazapine?

Answer 18

Alpha-2 receptor and 5-HT2 receptor

Question 19

What are the side effects of mirtazapine?

Answer 19

Weight gain, sedation

Question 20

What is an important fact about mirtazapine?

Answer 20

Low probability of sexual dysfunction. May exacerbate REM sleep behaviour disorder.