Psychopharmacology: antidepressants Flashcards
What are the indications for Electroconvulsive Therapy?
Most effective and most rapid treatment for
SEVERE MAJOR DEPRESSION
ALSO, When medications or psychotherapy:
Have not been effective
Cannot be tolerated
(in life-threatening cases) will not help the patient quickly enough
What is the CGI Improvement/Change (Endpoint) Scale?
It is a 7 point scale that requires the clinician to assess how much the patient’s illness has improved or worsened relative to a baseline state at the beginning of the intervention.
Describe the Permissive Theory of Mood Disorders.
When one neurotransmitter is low, the fluctuation of the other causes mood swings (e.g. “if the serotonin is going down and norepinephrine is going haywire, then the person either goes depressed or manic”)
Define manic episode.
A distinct period of abnormally and persistently elevated, expansive or irritable mood lasting for at least one week or less if a patient must be hospitalized
T or F: To assess the mood of the patient, you need to observe him/her well.
F: To assess the mood, it has to be asked from the patient.
Explain the differences among recovery, relapse, and recurrence of depression
RECOVERY - remission of depression for 4-9 months
RELAPSE - person who is still under the remission stage develops depression again
RECURRENCE - depression occurs after the recovery stage
Which type of drugs is the first choice in psychopharmacology of depression? How long is the drug trial?
Selective Serotonin Reuptake Inhibitors (SSRI)
Each drug trial should last 4-6 weeks
What is double depression?
A depression on top of a dysthymia; when a person recovers from depression, he will still have dysthymia
Enumerate 5 Monoamine Oxidase Inhibitors.
Phenelzine, Tranylcypromine, Isocarboxazid, Selegiline, Moclobemide
The Withdrawal Syndrome of MAOIs consists of which signs and symptoms?
Anxiety, Headache, Chills, Myalgia, Insomnia, Malaise
T or F: A major depressive disorder occurs without a history or mania, mixed, or hypomanic episode.
T
This new antidepressant enhances both serotonergic and adrenergic neurotransmission (Noradrenergic and Specific Serotonergic Antagonist).
Mirtazapine
Define depression remission.
When the px is ASYMPTOMATIC; HAMILTON DEPRESSION (HAM-D) SCALE: <10
Where are presynaptic β2-adrenergic receptors located? What is their function?
in the serotonergic neurons;
regulate the amount of serotonin released
What is the Hamilton Rating Scale for Depression (HAM-D)?
A widely used depression scale with up to 24 items each of which is rated 0 to 4 or 0 to 2, with a total score of 0 to 76. The clinician evaluates the patient’s answers to questions about feelings of guilt, thoughts of suicide, sleep habits, and other symptoms of depression, and the ratings are derived from the clinical interview.
Differentiate MAO-A from MAO-B.
MAO-A is implicated in depression, while
MAO-B is implicated in schizophrenia
T or F: Enuresis is not an indication for antidepressant use.
F
Lithium carbonate inhibits which enzyme?
inositol-1-phosphatase
Serotonin Syndrome consists of which signs and symptoms?
Lethargy, Flushing, Restlessness, Diaphoresis, Mental Confusion, Tremors, Hyperthermia, Hypertonicity, Rhabdomyolysis, Renal Failure, Death
What is Electroconvulsive Therapy?
A medical treatment for severe mental illness that sends mild electric stimuli to the brain through the scalp in order to
INDUCE A CONTROLLED SEIZURE
In Electroconvulsive Therapy, the stimulus is applied on which side of the brain?
The stimulus is applied on non-dominant unilateral side
This mood stabilizer is used as an alternative to valproate and lithium and can be safely combined with antipsychotics
Carbamazepine
What is the Monoamine Hypothesis of Depression?
Depression is due to a deficiency of monoamine neurotransmitters, notably norepinephrine (NE) and serotonin (5-hydroxytryptamine [5HT])
What is the mechanism of Tricyclic/Heterocyclic Antidepressants?
They block the reuptake of both serotonin and norepinephrine.
Explain the Norepinephrine Pathway.
The Locus Coeruleus produces norepinephrine which goes to the cortex, subcortex, mesolimbic area, cerebellum and the spine.
This biogenic amine is most commonly associated with depression. It functions in pain sensitivity and emotions.
Serotonin
T or F: Pregnancy is a contraindication for Electroconvulsive Therapy.
F; ECT has been found safe during all trimesters of pregnancy by the American Psychiatric Association.
This mood stabilizer serves as a prophylaxis for mania and depression in bipolar patients.
Lithium carbonate
Enumerate the Monoamine Neurotransmitters
Norepinephrine, serotonin, dopamine
Gabapentin and lamotrigine are what type of mood stabilizers?
Anticonvulsants; these act on the GABA receptors
