Treatment for Depression Flashcards
Altering the function of this NT will form core symptoms of depression
SEROTONIN!
…and/or dopamine, NE
What AA is serotonin synthesized from?
tryptophan
What metabolizes brain serotonin?
monoamine oxidase - A (MOA-A) into 5H1AA…released into synaptic cleft and taken back up by serotonin transporter (SERT)
Significance of SERT
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
What can tryptophan depletion do to antidepressants?
Can transiently reverse antidepressant response causing a short lived reutrn of depressive symptoms
What part of brain is involved in the process of working memory to regulate behavior and attention?
prefrontal cortex
How does NE modulate amygdala?
strengthens memory consolidation and fear conditioning
How do beta-blockers (like propranolol) affect emotion?
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)
Dopamine (also very involved in mood disorders) modulates neural activation in what areas?
motor function (nigrostriatal), reward/motivation (mesolimbic), memory/attention (mesocortical), pleasure/substance abuse
What do you do to dopamine to make a good antidepressant?
enhance dopamine transmission
What hormonal disorder is greatly associated with depression?
hypothyroidism
What are symptoms commonly associated with hypothyroidism?
fatigue, memory impairment, irratibility, decreased libido, psychosis, delirium, suicidality
IMPORTANT: Atrophy of what part of brain is GREATLY established as a marker for depression?
atrophy of…..drumrolll…HIPPOCAMPUS
correlates with duration of depression, data suggests that if we restore normal hippocampal volume we can induce remission of depression
What is an anti-depressant?
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
Is one antidepressant better?
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
Different groups of antidepressants?
- SSRIs (selective srotonin reuptake inhibitors)
- NDRIs (NE-Dopa Reuptake inhibitors)
- SARIs (Serotonin antagonism and reuptake inhibitors)
- SNRIs (Serotonin-NE reuptake inhibitors
- a2 antagonists
How do SSRIs work?
inhibits the reuptake of serotonin and potentiate serotonin neurotransmission
What are some side effects of SSRIs?
Since SSRIs increase serotonin to in non-specific ways (unintended consequences)….
anxiety, restlessness, nausea, diarrhea, headache, tremor, dry mouth restlessness, increased perspiration….SEXUAL DYSFUNCTION
What is SSRI discontinuation?
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
Fluoxetine (Prozac)
the ONE SSRI with a LONG HALF LIFE (2-3 days or 8 days)…revolutionized since it was safer
Sertraline (Zoloft)
has weak DOPAMINERGIC activity (may be useful after brain injury), risk of discontinuation
Paroxetine (Paxil)
Somewhat sedating, significant 2D6 inhibition, weak NE uptake inhibitor, muscarinic anticholinergic side effects (dry mouth, constipation, blurry vision)
Citalopram (Celexa)
Fewer drug interactions, so use if someone is on ALOT of medications, similar profile to Lexapro
Fluvoxamine (Luvox)
not used as much clinically, primarily used to treat OCD
