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physiology and pharma > L11 - depression and antidepressants > Flashcards

L11 - depression and antidepressants Flashcards

1
Q

define depression

A

chronic, constant, non specific, life limiting sadness

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2
Q

how is depression diagnosed

A

no single objective test, use

DSM-IV (diagnostic statistical manual)
and
ICD-10 (international classification of diseases)

based on interview by doctor

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3
Q

describe how the DSM-IV diagnoses depression

A

5 or more of the following symptoms present in the same 2 week period that exhibit a change from normal fucntioning:

at least one of the following

  1. depressed mood
  2. diminished interest or loss of pleasure

remaining from

  1. significant weight loss
  2. insomnia
  3. agitation
  4. fatigue
  5. feelings of worthlessness
  6. diminished ability to think / concentrate
  7. recurrent suicidal thoughts
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4
Q

why is depression difficult to diagnose

A

wide variety of symptoms can be reported

difficult to differentiate normal mood changes from depression

depression doesnt present 24/7, might have good days

no single objective test to diagnose

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5
Q

list causes for depression

A

genetic
environmental
age

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6
Q

expand on genetic causes for depression

A

40-50% of MZ twins will suffer from depression if their twin does

depression affects 2x as many females as males

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7
Q

list some physiological symptoms of depression

A

insomnia
fatigue
reduction in self hygiene

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8
Q

expand on environmental causes of depression

A
  1. could be life events, eg loss of loved one, job, social isolation
  2. could also be due to co-morbidities, such as
    - terminal / chronic illness
    - drug abuse
    - anxiety
    - neurological disease / illnesses
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9
Q

expand on age as a cause for depression

A

age for depression onset is decreasing, why?

  • life more stressful?
  • better at diagnosis?
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10
Q

what are the two types of depression

A

unipolar -> mood swings in one direction - of sadness

bipolar -> mood fluctuations between depression and mania

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11
Q

does bipolar or unipolar depression have a stronger genetic influence?

A

bipolar

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12
Q

what are the types of unipolar depression and explain them

A
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13
Q

describe symptoms of mania (bipolar depression)

A

present for at least 1 week and impair individuals normal life

  • erratic impulsive behaviours
  • rapid speech
  • poor desicions based on unrealistic thoughts
  • short attention span
  • reduced sleep / tiredness
  • racing thoughts
  • elevated / irritable mood
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14
Q

list the types of bipolar disorder and briefly describe them

A
  1. cyclothymic disorder (most mild) -> slight depressive states followed by moderate manic states
  2. bipolar 2 disorder -> small manic states and comparably larger, major depressive states
  3. bipolar 1 disorder -> severe manic states followed by severe depressive states

individuals with bipolar 1 can also experience mixed affective episodes -> concurrent episodes of mania and depression (highest risk of suicide)

all types cyclic, depressive follows manic

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15
Q

what are the 3 theories of depression

A
  1. monoamine theory
  2. neuroendocrine theory
  3. neuroplasticity theory
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16
Q

what is the monoamine theory of depression

A

serotonin levels are responsible for depression

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17
Q

what is the evidence for the monoamine theory of depressoon

A
  1. reserpine blocks VMAT2 blocking the uptake of 5-HT into vesicles - and so decreasing [5-HT] in synaptic cleft from reduced exocytosis
    The use of reserpine induces depression
  2. antidepressants increase serotonin (and sometimes other amines) in the brain reversing depression symptoms
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18
Q

what limits the monoamine theory for depression

A

although increasing 5-HT can improve symptoms there is no definitive evidence that 5-HT is deficient in depressed individuals

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19
Q

describe the neuroendocrine theory of depression

A
  1. NA and 5-HT neurones input to hypothalamus which causes release of CRH (corticotrophin releasing hormone)
  2. CRH acts on pituitary inducing release of ACTH (adrenocorticotrophic hormone)
  3. ACTH causes cortisol release from adrenal cortex in response to increased [ACTH] in blood
  4. Cortisol associated with stress
20
Q

describe neuroplasticity (neurodegeneration) theory of depression

A

Evidence of neuronal loss and decreased neuronal activity in hippocampus ad prefrontal cortex

Anti-depressants and ECT (electroconvulsive therapy) promote neurogenesis in these regions

21
Q

list the treatments for unipolar depression

A

SSRIs / SNRIs

MAOIs and TCAs (older)

CBT (first line)

ECT (severe)

22
Q

list treatments for bipolar depression

A 
CBT
Lithium 
anticonvulsants 
antipsychotics 
ECT (severe cases)
23
Q

describe mechanism of SSRIs

A
  1. block SERT - reduces 5-HT uptake
  2. increased [5-HT] in cleft
  3. increased activation of 5-HT receptors
24
Q

give examples of SSRIs

A

sertraline

fluoxetine

25
Q

describe mechanism of SNRI

serotonin and noradrenaline reuptake inhibitors

A
  1. block SERT and NET
  2. increase [5-HT] and [NA] in cleft
  3. increase NA and 5-HT receptor activation

NA significant for energy levels

26
Q

give example of SNRI

A

duloxetine

27
Q

describe TCA mechanism

A
  1. block NET>SERT, also block histamine and muscarinic receptors
  2. increase [NA] and [5-HT] in cleft increasing receptor activation
28
Q

give examples of TCAs

A

amitryptyline

imipramine

29
Q

describe mechanism of MAOIs

A
  1. block metabolism of 5-HT, NA,DA in synapse
  2. increases the [NT] in the synapse to be released by exocytosis
  3. increased [NT] in synapse and increased receptor activation
30
Q

give example of a MAOI

A

selegiline

31
Q

why are TCAs and MAOIs less used for the treatment of depression now?

A

they have more off target effects and so possibility for more side effects

32
Q

describe the mechanism for lithium in bipolar depression treatment

A

mechanism not entirely understood but believed to be due to:

  • Li and Na have same no. of valence electrons so may be able to mimic the role of Na in signal transduction, but at a slower reduced effect due to it being smaller and less electronegative ( so it slows down the transmission and treats manic stages)
  • seems to also increase 5HT synthesis but decrease NA release
33
Q

why is amitriptyline especially useful in some cases of depression

A

amitryptyline low dose is used to treat pain but also inhibits NET and SERT, so would be a good option for individuals experiencing depression due to chronic pain as it treats both

34
Q

side effects of lithium treatment

A
  1. nephrotic toxicity
  2. teratogenic -> can cause birth defects if taken by pregnant women
  3. induces hyperthyroidism
  4. dehydration
  5. too much can lead to overdose -> is it sensible to give depressed patients a substance that can cause overdose?

many other side effects

35
Q

what can be given alongside lithium treatment to prevent hyperthyroidism

A

thyroxine

35
Q

what can be given alongside lithium treatment to prevent hyperthyroidism

A

thyroxine (hormone containing iodine)

36
Q

describe anticonvulsants for bipolar depression treatment

A
37
Q

what is the most suitable treatmnet for pregnant women with bipolar depression

A

antipsychotics

38
Q

what is the most suitable treatmnet for pregnant women with bipolar depression

A

antipsychotics

39
Q

why arent typical antipsychotics used in bipolar depression tretament?

A

they are more anti-manic than mood stabilising, they may worsen depressive episodes

40
Q

what is the commonly prescribed antispsychotic for bipolar depression

A

olanzapine (atypical)

41
Q

what is a problem with bipolar disorder diagnosis

A

often misdiagnosed as depression, and antidepressants prescribed

these can worsen manic episodes (due to increased NA,DA, 5-HT)

42
Q

explain CBT

A

aims to change thinking processes and perspectives to have a more positive, open mindset

first line treatment before drugs

43
Q

explain ECT

A

inducing epileptic seizures in cases where symptoms are most severe

44
Q

describe pathology of depression (changes to brain)

A

enlarged ventricles

shrunken pre frontal cortex and hippocampus

physiology and pharma (18 decks)

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