Pharmacology Of Depression

Question 1

Sertraline mechanism of action

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

Drug target of sertraline

Answer 2

Seratonin transporter

Question 3

Sertraline main side effects

Answer 3

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

Question 4

Extra info on Sertraline

Answer 4

Mild inhibition of dopamine transporter

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

In 2020 – Sertraline was the 16th most commonly prescribed drug in West London area

Question 5

Citalopram mechanism of action

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

Citalopram target

Answer 6

Seratonin transporter

Question 7

Side effects of Citalopram

Answer 7

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

Question 8

Extra info on sitalopram

Answer 8

Mild antagonism of muscarinic and histamine (H1) receptors

Must be gradually decreased on discontinuation. Metabolized by CYP2C19.

In 2020 – Citalopram was the 27th most commonly prescribed drug in West London area

Question 9

Fluoxetine mechanism of action

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

Target of fluoxetine

Answer 10

Seratonin transporter

Question 11

Side effects of fluoxetine

Answer 11

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

Question 12

Extra info on fluoxetine

Answer 12

Mild antagonism of 5HT2A and 5HT2C receptors

Complete inhibition of CYP2D6 and significant inhibition of CYP2C19 (caution with warfarin).

In 2020 – Fluoxetine was the 68th most commonly prescribed drug in West London area

Question 13

Velafaxine mechanism of action

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

Drug target of venlafaxine

Answer 14

Serotonin transporter

Noradrenaline transporter

Question 15

Side effects of venlafaxine

Answer 15

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

Question 16

Venlafaxine extra info

Answer 16

Must be gradually decreased on discontinuation

In 2020 – Venlafaxine was the 83rd most commonly prescribed drug in West London area

Question 17

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

Mirtazapine drug target

Answer 18

Alpha-2 receptor

5-HT2 receptor

H1 receptor

5HT3 receptor

Question 19

Side effects of mirtazapine

Answer 19

Weight gain and sedation

Question 20

Extra info on mertazapine

Answer 20

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

In 2020 – Mirtazapine was the 30th most commonly prescribed drug in West London area