Psychopharmacology - Antidepressants

Question 1

Psychopharmacology involves three main stratagies, what are they?

Answer 1

Indication
Choice of agent and dosage
Management

Question 2

Explain what indication means

Answer 2

What will you use as an indicator of improvement/worsening

e.g establishing a diagnosis and identifying key symptoms that will be used to monitor therapy responsiveness

Question 3

For “choice of agent and dosage” what is key to remember?

Answer 3

Select an agent with acceptable side effect profiles
Use lowest effective dose possible
Keep in mind the delayed response for many psych meds
Keep in mind drug-drug interaction

Question 4

What conditions indicate antidepressant usage will be beneficial?

Answer 4

Uni/bipolar depression
Organic mood disorders
Schizoaffective disorders
Anxiety disorders (including OCD, Panic and PTSD)
Social phobia

Question 5

Does efficacy between different antidepressants vary?

Answer 5

No similar between all

Question 6

If efficacy is similar then how do doctors select which drug to use?

Answer 6

Past history of response
Side effect profile
Co-existing medical conditions

Question 7

There is a delay typically of X to Y weeks after a therapeutic dose is achieved before symptoms improve.

Answer 7

2 to 4 weeks

Question 8

When would you try a different drug/augment current treatment with another drug?

Answer 8

If no improvement with an adequate dose was seen after a trial of at least 2 months

Question 9

How would we use antidepressants as prophylaxis?

Answer 9

Wait til symptoms improve then:

• First episode = continue for 6 months to a year
• Second episode = continue for 2 years
• Third episode = discuss life long

Question 10

List 4 categories of antidepressants

Answer 10

Tricyclics (TCA)
Monoamine Oxidase Inhibitors (MAOIs)
Selective Serotonin Re-uptake Inhibitors (SSRIs)
Serotonin/Noradrenaline re-uptake inhibitors

Question 11

Positives of TCAs?

Answer 11

Very effective drugs