Session 3b - Pharmacology of Depression

Question 1

What percentage of people who are suffering depression fail to respond to the drug of 1st choice?

Answer 1

30%

Question 2

Anti- Depressants are advised (under NICE guidelines) to only be used in moderate-severe cases alongside psychological therapies.
What is the advised to patients in the mild-moderate category?

Answer 2

Initially, use websites such as:
Livinglifetothefull.com
as well as seeing a healthcare worker.

Question 3

Antidepressants act to increase concentrations of which neurotransmitters?

Answer 3

Serotonin

Noradrenaline

Question 4

SSRIs (selective serotonin re-uptake inhibitors) act to block the re-uptake of serotonin into pre-synaptic neurones there by increasing the amount of serotonin in synaptic cleft.
Can you name an example of an SSRI’s
What are some common side effects with these drugs?

Answer 4

Citalopram - main one
Fluoxetine
Sertraline

Common side effects include: Nausea, sexual dysfunction, weight loss/gain, hypotension

Question 5

Tricyclic Anti-depressants (TCAs) work by blocking the re-uptake of noradrenaline and serotonin into the pre-synaptic neurone (similar to that of SNRIs).
Can you name an example of a TCA?
What are some common side effects with these drugs?

Answer 5

Lofepramine
Amitriptyline
Clomipramine

Common side effects include: Cadio-toxic, arrhythmia’s, and heart block, dry mouth, blurred vision and urinary retention/constipation.

Question 6

MAOIs (MonoAmine Oxidase inhibitors) act by irreversibly inhibiting the enzyme MAO, which is used to break down NA and serotonin. By preventing the function of this enzyme, these two neurotransmitters are increased in the brain.
Can you name an example of an MAOi?
What are some common side effects with these drugs?

Answer 6

Phenelzine
Trancypromine

Common side effects include: Hypotension and/or Dizziness

Question 7

SNRIs (Serotonin and noradrenaline re-uptake inhibitors) are used to treat depression.
Can you name an example of an SNRI?
What are some common side effects with these drugs?

Answer 7

Venlafaxine
Duloxetine

Common side effects include: nausea, constipation and hypertension

Question 8

NaSSA (Noradrenaline and Specific Serotonergic Agent). work via two processes, what are they?
Name an NaSSA.

Answer 8

1. A presynaptic alpha 2 adrenoreceptor antagonist; thereby increasing NA neurotransmitter.
2. Block alpha 2 adrenergic presynaptic receptors on serotonin neurones thereby increasing serotonin neurotransmission.

Mirtazepine

Question 9

What are the common side effects of most anti depressants?

Answer 9

They are anticholinergic, sedative (reduce anxiety), hypotension, nausea, sexual dysfunction, weight gain and cardiac problems.

Question 10

If a patient is suffering from depression, but also from cardiac disease. What type of anti-depressants should be a)avoided and b)used for a first choice

Answer 10

a) Tricyclics

b) SSRIs due to their anti-arrhythmic potential

Question 11

What advice would someone taking anti-depressive medication, but has hepatic impairment think about.
Which anti-depressant should be used?

Answer 11

Use low starting dose
Leave longer intervals between doses
SSRI - Citalopram and Paroxeitene is probably safest

Question 12

What advice would someone taking anti-depressive medication, but has renal impairment think about.

Answer 12

Patients with renal impairment have reduced capacity to excrete drugs and their metabolites.
Start with low doses and increase slowly.

Question 13

What are some of the prescribing issues with administering anti-depressants?

Answer 13

Allow for 6 weeks with good compliance before considering changing doses.
Change to another antidepressant if adverse effects are intolerable.
Take into account there conditions (pregnancy, liver function, epilepsy etc..)

Question 14

Which anti-depressant is used usually as a first choice?

Answer 14

SSRI’s (e.g. Citalopram)