Pharmacology of Depression

Question 1

what is the target for sertraline?

Answer 1

serotonin transporter

mild dopamine transporter

Question 2

what is the MOA of sertraline?

Answer 2

inhibition of serotonin reuptake = serotonin accumulates

Question 3

what are the main side effects of sertraline?

Answer 3

GI effects - nausea, diarrhoea
sexual dysfunction
anxiety
insomnia

Question 4

what other receptor does sertraline act on?

Answer 4

inhibits dopamine transporter mildly

Question 5

what is the MOA of citalopram?

Answer 5

inhibition of serotonin reuptake = serotonin accumulation

Question 6

what is the target for citalopram?

Answer 6

serotonin transporter

Question 7

what are the common side effects for citalopram?

Answer 7

GI effects - diarrhoea, nausea
insomnia
anxiety

Question 8

what other receptors does citalopram work on?

Answer 8

antagonist of muscarinic and H1 receptors

Question 9

what is the MOA for fluoxetine?

Answer 9

inhibition of serotonin reuptake = accumulation of serotonin

Question 10

what is the role of serotonin in the CNS?

Answer 10

regulation of mood, personality and wakefulness

Question 11

what are the common side effects of fluoxetine?

Answer 11

GI effects - nausea, diarrhoea
sexual dysfunction
anxiety
insomnia

Question 12

what cautions must be taken with fluoxetine?

Answer 12

warfarin

complete inhibition of CYP2D6 and partial inhibition of CYP2C19

Question 13

what is the MOA of venlafaxine?

Answer 13

inhibition of serotonin reuptake, and a bit of noradrenaline

Question 14

what is the role of noradrenaline in the CNS?

Answer 14

regulation of emotions and cognition

Question 15

what is the target for venlafaxine?

Answer 15

noradrenaline and serotonin transporter

Question 16

what are the common side effects of venlafaxine?

Answer 16

GI effects - nausea, diarrhoea
sexual dysfunction
anxiety
insomnia
hypertension at high doses

Question 17

what is the MOA of mirtazapine?

Answer 17

antagonises central presynaptic alpha-2-adrenergic receptor – increased release of serotonin and noradrenaline
antagonises central 5HT2 receptor leaving 5HT1 open to serotonin and anti-depressant effects

Question 18

what is the target for mitrazapine?

Answer 18

alpha-2 receptor

5-HT2 receptor

Question 19

what are the common side effects of mirtazapine?

Answer 19

weight gain, sedation

Question 20

what disorder should be taken into account for mirtazapine?

Answer 20

may exacerbate REM sleep behaviour disorder - helps REM sleep and consistency of sleep

Question 21

why must sertraline and venlafaxine be weaned off slowly?

Answer 21

potential for rebound depression, serotonin syndrome

Question 22

what receptor does mirtazapine have the highest affinity for?

Answer 22

H1 receptor - causing sedation at low doses

Question 23

how are the effects of mirtazapine binding to H1 offset at higher doses?

Answer 23

sedation effects are overcome by increased noradrenergic transmission

Question 24

first line treatment for depression

Answer 24

SSRI

Question 25

what do you have to do before switching from SSRI to any other

Answer 25

trial at least 2 SSRIs

Question 26

what to try if SSRI failure or bad SEs (2nd line)

Answer 26

SNRI

mitrazapine