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Behavioral Science > Treatment for Depression > Flashcards

Treatment for Depression Flashcards

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1
Q

Altering the function of this NT will form core symptoms of depression

A

SEROTONIN!

…and/or dopamine, NE

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2
Q

What AA is serotonin synthesized from?

A

tryptophan

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3
Q

What metabolizes brain serotonin?

A

monoamine oxidase - A (MOA-A) into 5H1AA…released into synaptic cleft and taken back up by serotonin transporter (SERT)

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4
Q

Significance of SERT

A

located on chromosome 17, long and short 44 base pair insertion/deletion = short/long…THOSE WHO HAVE HOMOZYGOUS SHORT (ss), are more likely to experience depression with repeated stress

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5
Q

What can tryptophan depletion do to antidepressants?

A

Can transiently reverse antidepressant response causing a short lived reutrn of depressive symptoms

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6
Q

What part of brain is involved in the process of working memory to regulate behavior and attention?

A

prefrontal cortex

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7
Q

How does NE modulate amygdala?

A

strengthens memory consolidation and fear conditioning

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8
Q

How do beta-blockers (like propranolol) affect emotion?

A

If beta-blocker can cross BBB, you can block emotional reactivity to an emotionally charged stimuli (modulated by NE) (ex: abnormal rxn to something that should make you really happy)

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9
Q

Dopamine (also very involved in mood disorders) modulates neural activation in what areas?

A

motor function (nigrostriatal), reward/motivation (mesolimbic), memory/attention (mesocortical), pleasure/substance abuse

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10
Q

What do you do to dopamine to make a good antidepressant?

A

enhance dopamine transmission

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11
Q

What hormonal disorder is greatly associated with depression?

A

hypothyroidism

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12
Q

What are symptoms commonly associated with hypothyroidism?

A

fatigue, memory impairment, irratibility, decreased libido, psychosis, delirium, suicidality

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13
Q

IMPORTANT: Atrophy of what part of brain is GREATLY established as a marker for depression?

A

atrophy of…..drumrolll…HIPPOCAMPUS

correlates with duration of depression, data suggests that if we restore normal hippocampal volume we can induce remission of depression

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14
Q

What is an anti-depressant?

A

antidepressants are a HETEROgenous group of medications. Each antidepressant, to some extent via some means, increases one or more NTs including SEROTONIN, NE, and/or DOPAMINE.

since depression varies from person to person, different antidepressants are indicated with different clniical data

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15
Q

Is one antidepressant better?

A

No, all antidepressants are equally effective, but they aren’t all equally effective in a single person…side effects may be more pronounced from one person to another

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16
Q

Different groups of antidepressants?

A
  • SSRIs (selective srotonin reuptake inhibitors)
  • NDRIs (NE-Dopa Reuptake inhibitors)
  • SARIs (Serotonin antagonism and reuptake inhibitors)
  • SNRIs (Serotonin-NE reuptake inhibitors
  • a2 antagonists
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17
Q

How do SSRIs work?

A

inhibits the reuptake of serotonin and potentiate serotonin neurotransmission

18
Q

What are some side effects of SSRIs?

A

Since SSRIs increase serotonin to in non-specific ways (unintended consequences)….

anxiety, restlessness, nausea, diarrhea, headache, tremor, dry mouth restlessness, increased perspiration….SEXUAL DYSFUNCTION

19
Q

What is SSRI discontinuation?

A

Occurs when an SSRI with a half life of 24 hrs or less is stopped abruptly. UNPLEASANT (nausea, irritabilitly, tearfulness)…make sure to tell patients to keep up with medications and not to stop without guidance from a physician

20
Q

Fluoxetine (Prozac)

A

the ONE SSRI with a LONG HALF LIFE (2-3 days or 8 days)…revolutionized since it was safer

21
Q

Sertraline (Zoloft)

A

has weak DOPAMINERGIC activity (may be useful after brain injury), risk of discontinuation

22
Q

Paroxetine (Paxil)

A

Somewhat sedating, significant 2D6 inhibition, weak NE uptake inhibitor, muscarinic anticholinergic side effects (dry mouth, constipation, blurry vision)

23
Q

Citalopram (Celexa)

A

Fewer drug interactions, so use if someone is on ALOT of medications, similar profile to Lexapro

24
Q

Fluvoxamine (Luvox)

A

not used as much clinically, primarily used to treat OCD

25
Q

Serotonin syndrome (important!)

A

characterized by fever, delirium, HTN, hypotension, neuromuscular excitability but is uncommon.

risk increases when using more than one serotonergic drug, can result in death

aka “red man” syndrome

26
Q

Buproprion (Wellbutrin)

A

possibly works via dopa/NE inhibition. MAJOR SIDE EFFECT: SEIZURRRRRRE RISSSSSSSSKKKKKKKKKKKKKKK. , contraindicated in eating disorders

WELLBUTRIN. SEIZURES. WELLBUTRIN. SEIZURES. WELLBUTRIN. SEIZURES. WELLBUTRIN. SEIZURES

27
Q

Venlafaxine (Effexor)

A

NE/serotonin reuptake inhibition.

DOSE RELATED INCREASE IN BP…DON’T GIVE TO SOMEONE WITH POORLY CONTROLLED HTN

“bad EFFEXOR on your BLOOD PRESSURE”

28
Q

Desvenlafaxine (Pristiq)

A

Greater NE reuptake than venlafaxine, more potent NE effect

29
Q

Duloxetine (Cymbalta)

A

Far less likely than effexor to cause dose related HTN, also indicated for diabetic neuropathic pain and other pain symptoms

30
Q

Mirtazapine (Remeron)

A

unique action, antagonist at central PRESYNAPTIC a2 autoreceptors….

BIGGEST SIDE EFFECTS: SLEEP AND GAIN WEIGHT, very sedating

31
Q

Trazodone

A

PRIAPRISM!!!!!!!!!!!!!! LONG ERECTION

“are you trazoDONE yet?!

“NO, I’M STILL HARD WTF!”

32
Q

Dose range of TCAs

A

150 - 300 mg range

33
Q

Side effects of TCA

A

anticholinergic: dry mouth, urine retention, constipation, blurred vision

alpha adrenergic block: orthostatic hypotension

antihistamine: sedation, increased appetite, weight gain

34
Q

TCA overdose

A

VERY LETHAL (2-3g can be lethal!)

35
Q

Monoamine Oxidase Inhibitors (MAOIs)

A

inhibits enzyme that metbaolizes NE, serotonin, dop, and tyramine

36
Q

Pregnant woman and anti-depressants

A

Antidepressants carry risk in pregnancy but also untreated depression carries risk in pregnancy (more depressed if yo baby was an accident)…so risk and benefit analysis

37
Q

What is the risk in 1st trimester use of PAROXETINE? important!!

A

CONGENITAL CARDIAC ABNORMALITIES

38
Q

What is a notable “black box” warning that antidepressants carry?

A

Possible increase of suicidal thinking an dbehavior in children and adolescents during first few months of treatment

39
Q

How does electroconvulsive therapty work? (ECT)

A

induces bilateral, generalized tonic-clonic seizure lasting 30-90 seconds…shown to be effective…reserve it for most sick patients…affects every major NT system

40
Q

What are indications for ECT?

A

MAJOR depressive disorder, manic episodes, schizophrenia

41
Q

ECT and CHRONIC schizophrenia

A

DOES NOT RESPOND TO ECT

Behavioral Science (6 decks)

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