Pharmacology Of Depression

Question 1

What is the primary mechanism of action of Sertraline?

Answer 1

Inhibition of serotonin reuptake resulting 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 is the primary drug target of Sertraline?

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 else does Sertraline inhibit?

Answer 4

Mild inhibition of dopamine receptor
At high doses - partial inhibition of CYP2D6

Question 5

What is the primary mechanism of action of Citalopram?

Answer 5

Inhibition of serotonin reuptake resulting in an accumulation of serotonin

Question 6

What is the primary drug target of Citalopram?

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 other effects does Citalopram have?

Answer 8

Mild antagonism of muscarinic and histamine (H1) receptors

Question 9

What is Citalopram metabolised by?

Answer 9

CYP2C19

Question 10

What is the primary mechanism of action of Fluoxetine?

Answer 10

Inhibition of serotonin reuptake resulting in an accumulation of serotonin

Question 11

What is the primary drug target of Fluoxetine?

Answer 11

Serotonin transporter

Question 12

What are the main side effects of Fluoxetine?

Answer 12

Nausea, diarrhoea
Sexual dysfunction
Anxiety
Insomnia

Question 13

What other effects does Fluoxetine have?

Answer 13

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

Question 14

What is the primary mechanism of action of Venlaflaxine?

Answer 14

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 15

What are the primary drug targets of Venlafaxine?

Answer 15

Serotonin transporter
Noradrenaline transporter

Question 16

What are the main side effects of Venlafaxine?

Answer 16

Nausea, diarrhoea
Sexual dysfunction
Anxiety
Insomnia
Hypertension (at higher doses)

Question 17

What is the primary mechanism of action of Mirtazapine?

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 primary drug targets of Mirtazapine (for depression)?

Answer 18

Alpha-2-receptor
5-HT2 receptor

Question 19

What are the main side effects of Mirtazapine?

Answer 19

Weight gain
Sedation

Question 20

What may Mirtazapine exacerbate if present?

Answer 20

REM sleep behaviour disorder

Question 21

Which drugs must be gradually decreased on discontinuation and why?

Answer 21

Sertraline
Citalopram
Venlafaxine

Caution is required when switching from one antidepressant to another due to the risk of drug interactions, serotonin syndrome, withdrawal symptoms, or relapse
Washout is required before starting a new drug

Question 22

What are the other drug targets for Mirtazapine?

Answer 22

Histamine (H1) receptor - sedation
5HT3 receptor - anti-emetic