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Antidepressants Flashcards

1
Q

What percentage of people experience discriminations regarding mental health services?

A

79% of people attending specialist mental health services reported experiencing discrimination

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2
Q

What medical condition can mimic depression?

A

Hypo or hyperthyroidism

= may cause fatigue or psychomotor changes or weight and appetite changes

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3
Q

What other medical imbalance can mimic depression?

A

Anemia = may present with fatigue, depression, anorexia, weight loss, mood changes and insomnia

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4
Q

What abnormalities in electrolytes can mimic depression?

A

Sodium imbalance may lead to confusion, weakness and early delirium.

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5
Q

What are some general signs and symptoms of depression?

A
  • Insomnia or excessive sleeping
  • Fatigue/loss of energy
    -Inability to concentrate/make decisions/think
  • Suicidal plans/attempts
  • Withdrawal from social activities
    Physical symptoms
  • Dry mouth
  • Diarrhea
  • Sweating/cramps
  • Weight loss/gain
    Increased/decreased appetite
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6
Q

Who are at higher risk of developing depression?

A
  • Genetics
  • Drug and alcohol abusers
  • Individuals with chronic illness (40%)
  • Abuse victims
  • Males (75% of suicides)
  • Women (2-3 x more likely)
  • Children
  • Elderly people (10-15%)
  • Teens (Suicide is the 2nd leading cause of death in 15-19yr old’s)
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7
Q

Definition of normal depressed mood and grief? (also called reactive depression)

A

A natural reaction to loss and grief.

May involve sadness, lethargy, despair and obsessive thoughts about loss.

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8
Q

Definition of adjustment disorder with depressed mood?

A

Triggered by a life that involves change and adjustment
Individuals feel overwhelmed and ‘out of control’ and find coping difficult
The feel gloomy, angry and unable to cope.

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9
Q

Definition of mild depression (dysthymia)?

A

Similar symptoms to major depression but are less severe.

However in the case of dysthymia symptoms last longer.

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10
Q

Definition of Major Depression (Disorder)?

A

Often causes despair, feelings of hopelessness and helplessness.
Individuals lose interest in life and may become incapable of feeling pleasure

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11
Q

Definition of Bipolar Disorder (Manic-Depression)?

A

This condition involves major episodes of depression alternating with manic (high-energy, wildly unrealistic activity) phase.
Around 2% of Australians experiences bipolar disorder

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12
Q

Definition of Seasonal Affective Disorder (SAD)?

A

A mood disorder that has a seasonal pattern
Thought to be related to variation in light exposure in different seasons
Characterized by mood disturbances (either depression or mania) that begin and end in a particular season.

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13
Q

Definition of Post-Partum Depression?

A

Following childbirth hormonal changes can induce a feeling of transient sadness in 2/3 of women.
However 10-15% become clinically depressed
In around 1/1000 becomes so severely depressed that they must be hospitalized for their own safety and the safety of their baby

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14
Q

Definition of Post-Traumatic Stress Disorder?

A

PTSD is a set of mental health reactions that can develop in people who have experienced/witnessed an event that threatens their life/safety/others around them
It leads to feeling of intense fear, helplessness, horror
Examples could be serious accident, sexual or physical assaults’, war-related events or torture or natural disaster such as bushfires/floods

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15
Q

What system is important for controlling the body’s circadian rhythm?

A

Hypothalamic-Pituitary-Adrenal (HPA) axis.

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16
Q

What neurotransmitter systems impact on hormonal systems to produce major depression?

A

Serotonin and noradrenaline

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17
Q

What genetic factors contribute to depression?

A

Five psychiatric disorders share the same genetic pattern. This pattern interacts with prenatal environmental factors (e.g. mother has infections disease) and postnatal environmental factors (e.g. child maltreatment) produce changes in the brain leading to psychiatric disease vulnerability. This phenomenon is called pleiotropy and involves one gene influencing many unrelated disorders

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18
Q

What drug was created in the 1960s to treat hypertension but was found to deplete monoamines?

A

Reserpine = 15% of these patients became severely depressed

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19
Q

What family did a anti-TB drug which was found to remarkably elevate the patients moods belong to?

A

Monoamine Oxidase Inhibitors = prevent the breakdown of monoamines

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20
Q

What was the hypothesis of depression?

A 
Depression was due to a deficiency in monoamines, in particular, noradrenaline, in the vital brain circuits that control mood. 
This led to the development of the first class of antidepressants.
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21
Q

What was the permissive hypothesis of depression?

A

In the 1990s, serotonin, took center stage in the management of depression because of the connection between these two substances, noradrenaline and serotonin in the brain. It was suggested that the depletion of serotonin in the synapses of the brain circuits that controlled mood prompted the fall in noradrenaline levels

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22
Q

What are five types of antidepressants?

A
  1. Monoamine Oxidase Inhibitors (MAOIs)
  2. Reversible Monoamine Oxidase Inhibitors (RiMAs)
  3. Tricyclic Antidepressants (TCAs)
  4. Selective Serotonin Reuptake Inhibitors (SSRIs)
  5. Serotonin & Noradrenaline Reuptake Inhibitors (SNRIs)
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23
Q

What is the mechanism of action of MAOIs?

A

MAOIs work by inhibiting MAO, an enzyme responsible for degradation of catecholamine neurotransmitters in the neural synapses. This raises the level of excitatory neurotransmitter in the brain and elevates mood.

MAOIs also increase the levels of tyramine in the systemic circulation (not in the brain) which stimulates the release of noradrenaline in the peripheries, causing massive vasoconstriction resulting in hypertensive crisis. Hence, the older MAOI agents are rarely used today for managing depression because of their potential to induce hypertensive crisis.

24
Q

Side effects of MAOIs?

A
  • Drowsiness or insomnia
  • Agitation, fatigue
  • GIT, weight gain
  • Hypotension & dizziness
  • Dry mouth & skin, sexual dysfunction, constipation

Key issue is the potential lethality associated with the interaction with other amines such as Tyramine, found in foods.
Dietary limits are required to avoid increased BP and potential hypertensive crisis.
Dietary restrictions require food that is low in tyramine.
Foods that will result in a reaction are those that have been pickled, fermented, smoked or aged.

25
Q

How do RiMAs work?

A

The blockade of MAO-A blocks serotonin and noradrenaline metabolism and hence it is an effective antidepressant. However, because it is a reversible inhibitor of MAO-A, this drug does not induce hypertensive effects in normal doses.

  • Better tolerated than MAOIs
  • Reduced interaction with tyramine.
  • No dietary restrictions required, unless hypertension evident.
  • As with other anti-depressants, combination overdoses pose a problem
26
Q

Side effects of RiMAs?

A

Insomnia, dizziness and nausea

27
Q

Mechanism of action of TCAs?

A

This group of drug blocks the re-uptake pumps in the noradrenaline and serotonin nerve synapses, thus increasing the concentration of these substances in the synapses.

The increased neurotransmitters in the synapses prolong and intensify the effects of noradrenaline and serotonin, thus improving concentration and elevating mood.

28
Q

Examples of TCAs drugs?

A
  • Clomipramine (Anafranil)
  • Doxepine (Deptranalso available Sinequan)
  • Dothiepin (Dothep)
29
Q

Side effects of TCAs?

A
  • Orthostatic hypotension
  • Blurred vision, worsening of narrow angle glaucoma, photophobia, dry mouth, constipation, urinary retention, sinus tachycardia, mental clouding
  • Sedation
  • Seizures
  • Muscle tremors/twitches
  • Nausea/vomiting
  • Heartburn
  • Weight loss/gain
  • Sexual dysfunction (decreased libido, reduced arousal, impaired orgasm)
30
Q

What TCA antidepressant medications are/is contraindicated in the elderly population due to serious nature of cardiac side effects?

A

Dexepine

Deptran). Sinequan

31
Q

Mechanism of action of SSRIs?

A

Serotonin is an inhibitory neurotransmitter. According to one hypothesis, in response to the inhibitory function of serotonin, the noradrenergic systems (dopamine, noradrenaline) increase the number of receptors (up-regulate), thus increasing the activity of noradrenaline in the neural synapses.

SSRIs are chemically unrelated to any other class of antidepressants.

32
Q

Side effects of SSRIs?

A
  • Excitation
  • Sleep problems
  • Sexual side effects
33
Q

What has a dangerous interaction with SSRIs?

A

St Johns Wort (Hypericum Perforatum)

34
Q

What is known about St Johns Wort? (Hypericum Perforatum)

A
  • declared a noxious weed (seen as a cash crop in aus)
  • found to interact with a no. of neurotransmitter in the brain, inhibits the enzyme monoamine oxidase and increases noradrenaline and serotonin
  • side effects are nausea, rash, fatigue
  • should not be used by women who are pregnant or are breastfeeding, or used together with standard antidepressants
  • appears to be an inducer of metabolic pathway cytochrome
  • may result in a reduction in the plasma concentrations and therapeutic effects of medicines metabolized by these enzymes.
35
Q

What has SSRIs been reported to produce?

A
  • orthostatic hypotension,
  • tachycardia
  • heart block
  • blurred vision
  • dry mouth
  • nausea & vomiting
  • sexual dysfunction.

However, the effects are milder than the TCAs.

36
Q

Mechanism of action for SNRIs?

A

SNRIs inhibits the neuronal re-uptake of serotonin, noradrenaline and dopamine in descending order of potency.
This combination of the effects on the re-uptake mechanisms is responsible for the antidepressant effect of the drug.
This drug is effective in treating patients with generalized anxiety disorder with or without depression.

37
Q

Side effects of SNRIs?

A
  • Dizziness
  • Insomnia
  • Sexual dysfunction
  • Nausea
  • Increased bleeding
38
Q

Mechanism of action of NaSSAs? (Noradrenaline-Serotonin Specific Antidepressants e.g. mirtazapine)

A

Mirtazapine stimulates the release of both noradrenaline and serotonin.
This drug is effective in treating moderate and severe depression, particularly those with anxiety, sleep disturbance and agitation.

39
Q

Side effects of NaSSAs?

A

Fatigue

Weight gain

40
Q

Mechanism of action NARIs? (Reboxetine - Noradrenalin Reuptake Inhibitors)

A

Designed to act selectively on one type of brain chemical – noradrenalin
- less likely to cause sleepiness or drowsiness than some other antidepressants
- more likely to:
− make it difficult for people to sleep
− cause increased sweating after the initial doses
− cause sexual difficulties after the initial doses
− cause difficulty urinating after the initial doses
− cause increased heart rate after the initial doses

41
Q

Mechanism of action NARIs? (Reboxetine - Noradrenalin Reuptake Inhibitors)

A

Designed to act selectively on one type of brain chemical – noradrenalin
- less likely to cause sleepiness or drowsiness than some other antidepressants
- more likely to:
− make it difficult for people to sleep
− cause increased sweating after the initial doses
− cause sexual difficulties after the initial doses
− cause difficulty urinating after the initial doses
− cause increased heart rate after the initial doses

42
Q

Blockade of which one of the following types of receptors causes blurred vision in patients who are taking TCAs?

A

Muscarinic receptors

43
Q

What antidepressant is contraindicated in the elderly due to the serious nature of cardiac side effects?

A

Doxepine (Deptran, Sinequan)

44
Q

Commonly known side effects of the antidepressant Moclobemide?

A

Insomnia & dizziness

45
Q

Tyramine, an amino acid found in various foods is usually broken down by?

A

Monoamine Oxidase

46
Q

Tricyclic antidepressants (TCAs) work by?

A

Blocking re-uptake of serotonin

47
Q

Eating yeast-rich food may cause hypertensive emergency when taking?

A

Monoamine Oxidase Inhibitors (MAIOs)

48
Q

Which antidepressant drug is most effective in alleviating anxiety disorder with or without depression?

A

Venlafaxine (Effexor)

49
Q

Drug metabolizing enzymes found in which medicine reduces the plasma concentration of certain drugs?

A

Hypericum Perforatum (St Johns Wort)

50
Q

What are some risk factors for depression?

A

History of physical and sexual abuse

51
Q

Scenario:
A middle aged women with obesity, her problems started 5 years ago after the death of her partner. She tried alternative therapies first but eventually clinical depression was diagnosed and medical treatment was advised for both her obesity and her depression.
She would have initially suffered from what?

A

Reactive depression

52
Q

Scenario:
A middle aged women with obesity, her problems started 5 years ago after the death of her partner. She tried alternative therapies first but eventually clinical depression was diagnosed and medical treatment was advised for both her obesity and her depression.
If she is prescribed Axokine she could possibly develop?

A

Drug resistance and possible allergic reaction

53
Q

Scenario:
A middle aged women with obesity, her problems started 5 years ago after the death of her partner. She tried alternative therapies first but eventually clinical depression was diagnosed and medical treatment was advised for both her obesity and her depression. Which combination of factor makes her most likely to be predisposed to depression?

A

Female
Personal loss
Hormonal profile

54
Q

Most antidepressants work by?

A

Blocking neurotransmitter reuptake

55
Q

What is a common side effect of SSRIs?

A

Excitation

Sleep issues

56
Q

SSRIs and SNRIs are no more effective than TCAs or MAIOs.

True or False?

A

True

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