Antidepressants

Question 1

Depression types

Answer 1

Unipolar

Bipolar

Question 2

Unipolar depression can be divided into

Answer 2

Reactive depression (~75%)
Endogenous depression (~25%)

Question 3

What are the factors of reactive depression ?

Answer 3

Associated with circumstance (e.g. stress)

Non-familial

Question 4

What are the factors of endogenous depression?

Answer 4

Unrelated to external pressure

Familial

Question 5

Biological symptoms of depression.

Answer 5

Cognitive deficits
Loss of sex drive
Sleep disturbance
Loss of appetite

Question 6

Depression can be treatable through surge affecting which pathways?

Answer 6

Serotonergic and noradrenergic

Question 7

Where is 5-HT released from?

Answer 7

Dorsal rapid

Question 8

What are the main 5-HT receptors?

Answer 8

5-HT1A
5-HT2A
5-HT2c
5-HT3

Question 9

Location and function of 5-HT1A receptor

Answer 9

Presynaltic Gi/o

Decrease 5-HT release

Question 10

Other location of 5-HT1A and function receptors?

Answer 10

Postsynaptic Gi/o

Decrease depression & decrease anxiety

Question 11

Location and function of 5-HTA2A receptor

Answer 11

Gq

Increase anxiety

Question 12

Location and function of 5-HTA2c receptor

Answer 12

Gq

Increase depression, anxiety, stress & appetite

Question 13

Location and function of 5-HTA3 receptor

Answer 13

Ligand-gated cation channel

Increase nausea

Question 14

How long does it take for antidepressants to generate a therapeutic effect?

Answer 14

~ 2 weeks

Question 15

Antidepressant classes

Answer 15

Selective serotonin reuptake inhibitors (SSRIs)

Tricyclic antidepressants (TCAs)

Serotonin / Noradrenaline reuptake inhibitors (SNRIs)

Monoamine receptor antagonists

Monoamine oxidase inhibitors

Question 16

Function of SSRIs

Answer 16

Increase amount on serotonin in synaptic cleft

Increase activity through post synaptic receptors

Question 17

All SSSRIs have a half life of?

Answer 17

Long- 18 hours

Question 18

Administration of SSRIs

Answer 18

Oral tablets once daily

Question 19

Side effects of SSRIs on CNS

Answer 19

Sleep disturbance, weight gain, sexual dysfunction, agitation / anxiety

Question 20

SSRIs side effects on GI

Answer 20

diarrhoea & nausea

Question 21

SSRIs side effect on CVS

Answer 21

Bleeding disorders

Question 22

What happens when SSRIs is taking in overdose

Answer 22

Serotonin syndrome

Question 23

Fluoxetine

Answer 23

Specific SSRI
“Prozac”
Long duration (t 1/2 up to 96h)

Question 24

Citalopram

Answer 24

Specific SSRI

Milder side effects (anti cholinergic)

Question 25

Escitalopram

Answer 25

Specific SSRI Racemic form of citalopram No anti cholinergic

Question 26

Paroxetine

Answer 26

Specific SSRI “Seroxat” Withdrawal symptoms Anti cholinergic effect

Question 27

SSRIs with anti cholinergic effect

Answer 27

Citalopram | Paroxetine

Question 28

MOA of TCA & SNRIs

Answer 28

Serotonin cleared from synapse by 5-HT & Noradrenaline re-uptake transporters Subsequent breakdown by intracellular monoamine oxidase A (5-HT & NA) and catechol-O-methyltransferase (NA only)

Question 29

Venlafaxine

Answer 29

SNRI inhibitor (Serotonin & Noradrenaline Reuptake Inhibitors ) Weak, non selective Weak receptor blocking

Question 30

Side effects of SNRIs

Answer 30

``` Similar to SSRIs + Dry mouth Dizziness Arrhythmia Seizure Overdose risk of serotonin syndrome ```

Question 31

Most famous tricyclic antidepressant (TCA)

Answer 31

Amitryptline

Question 32

Use of TCA

Answer 32

neuropathic pain with lower dose antagonists at α1, mACh, Histamine H1 (similar side effects to antipsychotics)

Question 33

Side effects of TCA

Answer 33

Anticholinergic effects Sedation Postural hypotension Impotence

Question 34

Cautions with TCA

Answer 34

Significant overdose risk Drug interactions with other CNS depressant and hepatic metabolism CV disorders

Question 35

Most common noradrenaline selective reuptake inhibitor

Answer 35

Bupropion

Question 36

Bupropion

Answer 36

NA- selective reuptake inhibitor | antidepressant & anxiolytic. Also inhibits DA uptake, some 5-HT uptake. Mostly used for smoking cessation

Question 37

Side effects of bupropion (or any NA-selective reuptake inhibitor)

Answer 37

General sympathomimetic & CNS stimulant side effects (e.g. dry mouth, insomnia, dizziness, tachycardia, constipation)

Question 38

Most common monoamine receptor antagonist(MOA)

Answer 38

Mirtazepine

Question 39

Mirtazepine

Answer 39

MOA antagonist Antagonist adrenergic a2 5-HT2A,C & 5-HT3 No serious drug interactions. Faster onset

Question 40

MOA inhibitors mechanism of action

Answer 40

* Monoamines cleared from synapse by 5-HT & NA re-uptake transporters * Subsequent breakdown by intracellular monoamine oxidase A, and catechol-O-methyltransferase (NA only) * Some MAOIs nonselective; also inhibit MAO-B

Question 41

Side effects for MAO

Answer 41

Serious; SSRI side effects plus “cheese reaction” (tyramine), anticholinergic side effects, arrhythmias

Question 42

MAOIs must not be given concurrently with other antidepressants at least?

Answer 42

2 week gap between medication changed

Question 43

All antidepressant classes have similar effectiveness; usually side effects determine preference. In which order?

Answer 43

SSRIs > SNRIs > TCAs

Question 44

How do we treat bipolar disorder?

Answer 44

Generally stabilise mania, less so depression Conventional antidepressants controversial for bipolar disorder; usually given with additional anti-mania drug

Question 45

What is used as anti-mania drug?

Answer 45

Lithium

Question 46

moa of lithium to as anti-mania

Answer 46

Enters cells selectively via certain Na+ channels (e.g. brain, kidneys) Accumulation: not pumped out by Na+/K+ exchanger.

Question 47

Other bipolar disorder drugs are?

Answer 47

Anticonvulsants Atypical antipsychotics (May be prescribed in conjunction with antidepressants, usually SSRI (e.g. fluoxetine)