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PHAR2005 > Affective Disorders > Flashcards

Affective Disorders Flashcards

1
Q

Which NTs are involved in the monoamine hypothesis of depression?

A

NA

5HT

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2
Q

What 2 main symptoms must a treatment resolve?

A

Low mood

Reduced psychomotor drive

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3
Q

What does reserpine do and what is its effect?

A

Depletes monoamines

Causes depression

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4
Q

What does iproniazid do and what is its effect?

A

Inhibits nerve terminal MAO-A
Increases cytoplasmic 5HT and NA
NT efflux via reuptake transporter - increases external 5HT and NA
Euphoria/antidepressant effect

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5
Q

What are the 2 types of MAO and what do they metabolise?

A

MAO-A - 5HT and NA

MAO-B - DA

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6
Q

Name an early irreversible non-selective MAOI

A

Phenelzine

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7
Q

Name a new reversible selective MAO-AI

A

Moclobemide

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8
Q

What is the name of the 5HT reuptake transporter?

A

SERT

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9
Q

What is the name of the NA reuptake transporter?

A

NET

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10
Q

What is the general mechanism of tricyclic antidepressants?

A

Inhibit 5HT and NA reuptake

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11
Q

What are the disadvantages of TCAs?

A 
Effect takes 2-3 weeks
Initial sedation - eventually desensitise
Lack of selectivity
Acute cardiotoxicity
Overdose risk
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12
Q

Which receptors do TCAs affect and what are the resulting side effects?

A

Alpha1-adrenoceptor antagonism - postural hypotension
H1-receptor antagonism - sedation
mAChR antagonism - dry mouth, blurred vision

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13
Q

What is the action of SSRIs?

A

Selectively inhibit SERT

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14
Q

What are the disadvantages of SSRIs?

A

Rash
Tremor
Gastrointestinal problems

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15
Q

What are the advantages of SSRIs?

A

No alpha1/H1/mAChR antagonism
No acute cardiotoxicity
Safer in overdose

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16
Q

What are the types of 3rd gen antidepressants, what are their main actions, and name a drug

A

NRIs - selectively inhibit NET - e.g. maprotiline

SNRIs - inhibit SERT and NET - e.g. venlafaxine

17
Q

What is the mechanism of monoamine release negative feedback antagonism?

A

Presynaptic alpha2-adrenoceptors and 5HT1A receptors on soma and terminal - activate Gi/o - inhibit NA and 5HT release
Antagonism of alpha2 and 5HT1A - increases NA and 5HT release - antidepression

18
Q

What is mirtazapine and how does it work?

A

3rd gen tetracyclic
NRI
Alpha2 antagonist - less presynaptic feedback inhibition of NA and 5HT release

19
Q

What is the disadvantage of mirtazapine?

A

H1-receptor antagonist - sedative

20
Q

What is the advantage of mirtazapine?

A

No alpha1/mAChR antagonism

21
Q

What is mianserin and how does it work?

A

3rd gen tetracyclic
Alpha2 antagonist - less presynaptic feedback inhibition of NA and 5HT release
5HT3R antagonist - less presynaptic feedback inhibition of NA and 5HT release and postsynaptic effects

22
Q

What is trazodone and how does it work?

A

Serotonin antagonist and reuptake inhibitor (SARI) - SSRI and 5HT2R antagonist

23
Q

What is the advantage of trazodone?

A

No mAChR antagonism

24
Q

What are the disadvantages of trazodone?

A

H1 antagonist - sedative

Alpha1 antagonist - postural hypotension

25
Q

What is rolipram and how does it work?

A

Phosphodiesterase inhibitor - increases cAMP and PKA - increases NA synthesis and release

26
Q

How does ECT work?

A

Increases CNS sensitivity to 5HT and NA

27
Q

What is the evidence against the monoamine hypothesis of depression?

A

Amphetamine, cocaine, L-DOPA increase NA - no antidepression
Iprindole - tricyclic antidepressant - no effect on 5HT/NA
Levels of 5HT and NA equal in CSF of depressed and non-depressed

28
Q

What is the therapeutic lag hypothesis?

A

Long-term SSRI use - presynaptic 5HT1ARs gradually desensitise - no feedback inhibition of NA and 5HT release - increased postsynaptic firing

29
Q

Describe the types of bipolar depression

A

Type I - mania cycling with major depression - infrequent cycling
Type II - hypomania cycling with major depression - frequent cycling

30
Q

What is the main treatment for bipolar depression and how does it work?

A

Lithium

Mechanism unknown

31
Q

Why can SSRIs not be used for type I bipolar depression?

A

Cause switch to mania

32
Q

Why can an antidepressant alone not be used for type II bipolar depression?

A

Increases suicide risk

PHAR2005 (24 decks)

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