Psychopharmacology Flashcards
what is depression
low mood continuing for weeks or months, and interfere with the person’s abilities to function.
what is the main biochemical theory for the cause of depression
monoamine hypothesis of depression
at least 5 symptoms are needed for depression diagnosis. What are the symptoms
Depressed mood or irritability most of the day, nearly every day
Marked loss of interest/pleasure: in all or almost all activities most of the day
Fatigue or loss of energy
Hypersomnia/insomnia
Changes in appetite/weight
Inappropriate guilt and feelings of worthlessness
Suicidal ideation and recurrent thoughts of death, or a suicide attempt or a specific plan for committing suicide
Impaired concentration/decision-making capabilities
Psychomotor agitation or retardation
what are the 5 grades of depression as categorised by NICE
- Sub-threshold
- Mild
- Moderate
- Severe
- Complex
what non-pharmacological treatment is given for mild depression
- Social support
- Guided self-help - leaflets
- Being active
- Psychological therapies - CBT, mindfulness
- General support and advice - financial etc
what nonpharmacological management is used to treat moderate to severe depression
- ECT (electroconvulsive therapy) - acute
- TMS (transcranial magnetic stimulation)
what are the 4 main stages of drug treatment
- symptoms control
- continuation
- relapse prevention
- discontinuation
what are the 5 main classes of antidepressants
- Tricyclic antidepressants (TCAs)
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin noradrenaline reuptake inhibitors (SNRIs)
- Noradrenaline and specific serotoninergic antidepressant (NaSSA)
- Monoamine oxidase inhibitors (MAOIs)
how do TCAs work
Block the reuptake of noradrenaline and serotonin
what are some key side effects of TCAs
GI upsets, dry mouth, blurred vision, constipation, urinary retention, postural hypotension, cardiac arrhythmias, sedation, confusion, memory problems
who cannot receive TCAs
the elderly
how do SSRIs work
Increases the level of serotonin in the synapse by blocking the reuptake pump
what do SSRIs also work for
anxiety disorders
what are common side effects of SSRIs
gastrointestinal effects and anxiety symptoms (initially)
when do you use SSRIs
they are 1st line
fewer side effects
can use with other medications
good safety for overdose
what are common SNRIs side effects
include nausea, headache, dry mouth and sweating
who cannot take SNRIs
people with cardiovascular risk factors
when do you use SNRIs
2nd and 3rd line treatment
better tolerated than TCAs
NOT safe in overdose
how do NaSSAs work
Enhances the action of noradrenaline and serotonin in the synapse
what is the main side effect to consider with NaSSAs
sedation, increased appetite, dizziness and dry mouth
what else can NaSSAs be used to treat
helpful if patients also have sleeping problems
how do MAOIs work
Inhibit (either reversibly or irreversibly) monoamine oxidase enzymes to prevent the breakdown or monoamine neurotransmitters
who gets MAOIs
resistant depression
what MUST be avoided for MAOIs
food and drink that contain tyramine (including alcohol)
what happens if a person on MAOIs has high tyrosine food
very large sudden increase in blood pressure
(hypertensive crisis)
all antidepressants dose low and then increase slowly except which one
MIRTAZAPINE
start at 30mg and then go down to 15mg/d
has less sedative effect at higher dose
what is serotonin syndrome
Due to toxic hyperserotonergic state from hyperstimulation of the brain stem and spinal chord 5-HT1A and 5-HT2 receptors
what is the progression of the signs and symptoms
Restlessness
Sweating
Tremor
Shivering
Muscular rigidity
Confusion
Convulsions
Death
what are the major mediators of the symptoms of anxiety
noradrenaline, serotonin, dopamine, and gamma-aminobutyric acid (GABA).
what is the short term pharmacological management of anxiety
Benzodiazepines
Beta-blockers (e.g. propranolol)
Antihistamines (e.g. hydroxyzine)
Antipsychotics
what is the long term pharmacological management of anxiety
Antidepressants (e.g. SSRIs, TCAs, MAOIs, venlafaxine, mirtazapine)
Buspirone
Pregabalin
how do benzodiazepines work
by enhancing the action of γ-aminobutyric acid (GABA) in the brain (i.e. brains natural calming neurotransmitter)
are benzos used for short or long term treatment and why
short term (up to 4 weeks)
rapid onset
risk of dependence
what are the mild and severe symptoms of benzo withdrawal
Mild – restlessness, tremor, agitation
Severe – depression, convulsions, psychosis
what is the most common form of anxiety disorder
generalised anxiety disorder
what is the first line treatment for GAD
consider a SSRI
Start slowly e.g. paroxetine 5-10mg/d or escitalopram 5mg/d for a week or so, then increasing stepwise over several weeks as tolerated
Allow 8/52 for response
what is the first line pharmaceutical treatment for PTSD
Sertraline 50-200mg/d
Needs long-term treatment as relapse is common
what do you avoid in PTSD
Avoid BDZs as these can be counter-productive and ineffective, except in low dose in the short-term
what pharmaceutical treatment do you give for OCD
Only central serotonin enhancers are effective
what is the first line management for social anxiety
SSRIs (e.g. escitalopram) and venlafaxine are licensed
