Antidepressants Flashcards

1
Q

What are the 4 types of depression?

A
  • major depression
  • bipolar disorder
  • dysthymic disorder
  • depressive disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the features of the syndrome profile of major depression?

A
  • psychomotor retardation
  • fatigue/loss of energy
  • diminished ability to concentrate
  • diminished interest in social activity
  • feelings of guilt and worthlessness
  • insomnia
  • weight loss/decreased appetite
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which neurotransmitters are associated with depression?

A
  • noradrenergic and serotonergic pathways

- serotonin activity decreases during sleep = slow activity during resting//waking phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the brain regions associated with depression?

A
Amygdala
Ventrolateral prefrontal cortex and dorsolateral prefrontal cortex
medial prefrontal cortex
striatal regions
hippocampus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How are the ventrolateral prefrontal cortex and dorsolateral prefrontal cortex associated with depression?

A

Cortical thickness decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the default mode network?

A
  • network of brain regions when the brain is at wakeful rest
  • increased activity in depression
  • important alterations in the left subgenual cingulate area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the significance of the amygdala and hippocampus interactions?

A

Process emotional stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does hyperactivation correlate to?

A

Increased activity in the subgenual cingulate cortex and the medial prefrontal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does decreased activation correlate to?

A

In prefrontal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes rumination?

A

Balance between hyperactivity in the subgenual cingulate cortex and medial prefrontal cortex and decreased activation in the prefrontal cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is rumination?

A

Deep thinking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is serotonin transporter polymorphism?

A

Associated with higher risk major depression after significant life events
- gene-environment interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which drugs are TCAs?

A
  • amitriptyline
  • clomipramine
  • imipramine
  • desipramine
  • nortriptyline
  • protriptyline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the mechanism of TCAs?

A
  • inhibit reuptake of amines
  • have a range of degree of selectivity for amines
  • affinity for histamine, muscarinic alpha-1 and alpha-2 adrenoreceptors
  • overdose = cardiotoxicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the adverse effects of TCAs?

A
  • dry mouth
  • constipation
  • urinary retention
  • weight gain
  • postural hypotension
  • sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the monoamine oxidase inhibitors?

A
  • phenelzine
  • tranylcypromine
  • iproniazid
17
Q

What is the mechanism of monoamine oxidase inhibitors?

A
  • irreversibly inhibit monoamine oxidase
  • non selective - MOAa and b
  • interacts with pethidine (painkiller) and sympathomimetics
  • hepatoxicity
18
Q

What is the cheese effect?

A

Tyramine is found in various cheeses/red wine/beer

  • it is metabolised by monoamine oxidase
  • if MOA is inhibited it gets built up
19
Q

What are monoamine oxidase inhibitors used for?

A

Treatment of atypical depression

e.g with anxiety, phobia and hypochondria

20
Q

What drugs are reversible monoamine oxidase inhibitors?

A

Moclobemide

21
Q

What is the mechanism of reversible monoamine oxidase inhibitors?

A
  • increased selectivity for monoamine oxidase A
  • safer than irreversible as you can switch to another medication almost immediately whereas in irreversible you have to wait
  • higher efficacy than irreversible
22
Q

What are the adverse effects of reversible monoamine oxidase inhibitors?

A
  • nausea
  • agitation
  • confusion
23
Q

Which drugs are selective serotonin reuptake inhibitors?

A
  • citalopram
  • fluoxetine
  • paroxetine
24
Q

What is the mechanism of serotonin reuptake inhibitors?

A
  • increased selectivity for serotonin reuptake
  • no anticholinergic activity
  • no cardiotoxicity = safe in overdose
25
Q

Which serotonin reuptake inhibitor is the most selective?

A

Citalopram

26
Q

What are the adverse effects of serotonin reuptake inhibitors?

A
  • nausea
  • headaches
  • GI problems
  • increased aggression
  • insomnia
  • anxiety
  • sexual dysfunctions
27
Q

Which drugs are serotonin noradrenaline reuptake inhibitors?

A

Venlafaxine

28
Q

Which drugs are noradrenaline reuptake inhibitors?

A

Reboxetine

29
Q

Which drugs are serotonin antagonist and reuptake inhibitors?

A

Trazodone

30
Q

What is the mechanism of serotonin antagonist and reuptake inhibitors?

A

Antagonise 5-HT2 and alpha-2 adrenergic receptors

31
Q

Which drug are noradrenergic and specific serotonergic antidepressants?

A

Mirtazapine

32
Q

What is the mechanism of noradrenergic and specific serotonergic antidepressants?

A

Antagonise 5-H2 receptors and serotonin reuptake inhibition

Fewer unwanted effects than TCAs, MOAs

33
Q

What is the difference between 5-HT1A and 5-HT2 receptors?

A

5-HT1A - serotonin inhibitors

5-HT2 - serotonin excitation