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Health.2 > Antidepressants > Flashcards

Antidepressants Flashcards

1
Q

2 things which impact depression mood?

A

normal high/low mood but

  • duration
  • intensity of feeling
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2
Q

diagnostic features of depression (symptoms)

A

persistent sadness/low mood
and/or

marked loss of interests or pleasure

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3
Q

associated symptoms of the 2 major symptoms of depression?

A 
physical
- Altered sleep
- change in appetite and/or 
weight
- fatigue/loss of energy
- agitation/slowing of movements
- poor concentration or indecisiveness

psychological

  • feelings of worthlessness or excessive or inappropriate guilt
  • suicidal thoughts or acts.
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4
Q

diagnosis of depression

A

Subthreshold depressive
symptoms: < five symptoms of
depression.

• Mild: >five symptoms and result 
in only minor functional 
impairment. 
• Moderate: between ‘mild’ 
and ‘severe’.
• Severe: Most 
symptoms present; markedly 
interfere with functioning.
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5
Q 
Not solely based on 
symptom counting but 
on
• Severity
• Persistence
• Presence of other 
symptoms
• Functional and social 
impairment
A
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6
Q

aetiology and neurobiology of depression

what are the risk factors for vulnerability to depression?
3

A

biological vulnerability:
-genes, brain abnormalities, disordered biochem

psychological:
- Abuse, Neglect, Parental discord, poor attachment, Neuroticism

social:
- Unemployment, poverty, homelessness, chronic illness, poor relationships

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7
Q

the 3 risk factors of vulnerability to depression may lead to what which could lead to depression?

not always

A 
- Stress
Bereavement
Trauma
Onset of 
illness
Chronic stress
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8
Q

3 hypothesis of neurobiology of depression.

not been validated

A

Monoamine hypothesis– low
monoamines (Serotonin & Nor Adrenaline)

(HPA) axes hyperactivity –
repeated Stress ->increased cortisol levels, & CRF -> reduced hippocampus (volume) & neurogenesis.

Brain areas implicated indepression - : prefrontal cortex (PFC), anterior cingulate cortex (ACC), primary and secondary
somatosensory cortex, insular cortex, posterior cerebellum,
amygdala, hippocampus, thalamus, nucleus accumbens

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9
Q

do most antidepressants work?

A

inc/reduce levels of NTs: serotonin…

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10
Q

normally what is the action of NTs e.g. serotonin?

A

normal neurotransmission.

  • elect activity passed through neuron
  • NT release from pre synaptic vesicles?
  • NT come into synaptic cleft (jnction between 2 neurons)
  • act on post synaptic receptors

and activity from this to post synaptic neuron

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11
Q

what happens to NT when activity done i.e. reached synaptic cleft and postsynaptic neuron?

A

NTs e.g. serotonin are metabolised by enzymes in synaptic cleft/ in pre synaptic neurone

or

taken back into pre synaptic neurone by reuptake transporter. metab/stored back into cell

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12
Q

name of the enzymes that break down NTs once used?

A

monoamine (5HT and NA) enzymes !!!!

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13
Q

treatment of depression?

A 
• Medical: antidepressants 
• Adjuvant medication
• Psychological  therapies 
• Electroconvulsive therapy (ECT)
• Vagal Nerve Stimulation*
• Transcranial Magnetic Stimulation (TMS)*
• Deep brain stimulation*
* Experimental and yet to be recommended by NICE
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14
Q

Examples of Adjuvant medication to antidepressants?

A

Lithium, Antipsychotic medication,

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15
Q

nature of intervention for step 1 focus: All known and suspected
presentations of depression

A

Assessment, support, psycho-education, active

monitoring & referral for assessment & interventions

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16
Q

nature of intervention for step 2 focus: Persistent subthreshold
depressive symptoms; mild to moderate
depression

A

Low-intensity psychosocial interventions,
psychological interventions, medication and
referral for assessment & interventions

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17
Q

nature of intervention for step 3 focus: Persistent subthreshold
symptoms or mild to moderate
(inadequate response to initial intervn)
moderate and severe depression

A

Medication, high-intensity psychological
interventions, combined treatments,
collaborative care, and referral for further
assessment and interventions

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18
Q

nature of intervention for step 4 focus: Severe and complex
depression; risk to life; severe
self-neglect

A

Medication, high-intensity psychological
interventions, ECT, crisis service,
combined treatments, MDT & inpatient
care

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19
Q

first line pharm treatment of depression?

give example and mechanism of action

A

SSRIs (specific 5HT or NA reuptake inhibitors)
e.g. Citalopram

block presynaptic uptake rec = increases serotonin/ NAd

no anticholinergic effects

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20
Q

what are tricyclic antidepressants?

A

non-specific in uptake of serotonin/ NAd

amplify 5HT and NA

anticholinergic and other SE. e.g. cardiac therefore not first line

affect other recpetors

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21
Q

what are dual 5HT/NA reuptake inhib antidepressants?

and give example

A

SNRIs e.g. venlafaxine

block both serotonin and NAd.
amplify 5HT AND NA

no anticholinergic effects

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22
Q

why are dual 5HT/NA reuptake inhib antidepressants reserved for 2nd/3rd line treatment?

A

very powerful and have SEs such as cradiac. caution w patients w heart problems

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23
Q

what do atypical antidepressants do?

A

increase serotonin and NAd by diff mechanism

free of major tricyclic SEs

24
Q

mechanism of atypical antidepressants?

and give an example drug for each mechanism

A
  • stimulate 5HT1A rec (buspirone)

- or disinhibition of NA/5HT by blockade of inhibitory receptors e.g. mirtazapine

25
Q

what do MAOIs depressants do?

A

block MAO receptors so less break down of NTs and more available in synaptic cleft for NTransmission

25
Q

what do MAOIs depressants do?

A

block MAO receptors so less break down of NTs and more available in synaptic cleft for NTransmission

26
Q

two types of MAOIs: selective and reversible

how do they differ?

A

selective

  • amplify 5HT, NA
  • dietary SEs (wine and cheese)

reversible

  • amplify 5HT, NA
  • no dietary SEs
27
Q

two types of MAOIs: selective (reversible) and (non-selective) irreversible
give example of each

A

selective:
- clorgyline
reversible:
- moclobemide

non-selective… irreversible

  • phenelzine
  • tranylcypromine
28
Q

7 types/examples of SSRIs?

A
  1. Fluoxetine
  2. Citalopram
  3. Escitalopram
  4. Sertraline
  5. Paroxetine
  6. Fluvoxamine
  7. Vortioxetine
29
Q

mechanism of action of SSRIs

A

Blockade of reuptake

of 5HT

30
Q

SSRIs licensed uses?

A 
Depression
Generalized anxiety 
disorder
Social phobia
OCD
Eating disorders
31
Q

adverse/ side effects of SSRIs?

A 
Nausea, Vomiting, 
Dyspepsia, 
diarrhoea, 
sweating, agitation, 
headache, insomnia
Sexual dysfunction
Hyponatremia (elderly!!)
Cutaneous bleeding 
disorders

GI SEs

32
Q

7 types/ examples of Tricyclic Antidepressants (TCAs)?

A
  1. Amitriptyline
  2. Clomipramine
  3. Dosulpein
  4. Imipramine
  5. Lofepramine
  6. Nortriptyline
  7. Doxepin
33
Q

mechanism of action of TCAs?

A

Non-selective inhibitors of amine

(5HT, NA) transporters

34
Q

TCAs licensed uses?

A

Depression
Nocturnal enuresis
OCD
Cataplexy

35
Q

adverse/ side effects of TCAs?

A 
Dry mouth, blurred 
vision, constipation, 
urinary retention.
Postural hypotension
Sedation
Poor dental health
Tachycardia / 
arryhtymia

heart SEs

36
Q

non selective MAOIs particularly useful in?

A

atypical depression

37
Q

how do the side effects differ for the two types of MAOIs?

A

MAO-A selective, reversible:
- transient, stop when treatment stops

non-selective, irreversible:
- irreversible SEs

actual SEs are the same

38
Q

side effects of any MAOIs?

A 
post hypotension
dry mouht 
blurred vision
urinary retention 
(atropine like effects)

weight gain
restlessness
insomnia
(CNS stimulation)

39
Q

SNRIs 2 examples

A

Venlafaxine

Duloxetine

40
Q

mechanism of action of SNRIs

A

Serotonin- norepinephrine
reuptake inhibitor

similar to tricyclic

41
Q

SNRIs licensed uses?

A

Depression
Generalized
Anxiety disorder

42
Q

SNRIs adverse effects?

A 
Nausea, dry mouth, 
constipation, 
increased BP.
Somnolence, 
sweating, sexual 
dysfunction, 
headaches
43
Q

mechanism of action of the newest antidepressant: Agomelatine?

A

Agonist at melatonin
receptor and
antagonist at 5HT2c
receptor

only licensed for depression

44
Q

Adverse effects of Agomelatine?

A

Nausea, dizziness,
headaches,
somnolence, changes
in Liver function tests

45
Q

Mirtazapine SE that is good for people with what specific symptom of depression?

A

known to cause sedation good if have insomnia

46
Q

Mechanism of action of Mirtazepine?

A

antagonist at central
pre-synaptic alpha(2)
-receptors. Increases
both 5HT and NA

47
Q

Mechanism of action of Reboxetine?

A

Specific Noradrenergic

reuptake inhibitors

48
Q

Mirtazepine adverse effects?

A

Increased appetite,
weight gain,
drowsiness, oedema,
headache, dizziness

49
Q

Reboxetine adverse effects?

A

Insomnia, sweating,
dizziness, dry mouth,
constipation, urinary
hesitancy, headache.

50
Q

summary: treatment of Recent onset mild depression?

A

active monitoring, guided self help, CBT or exercise

51
Q

summary: treatment of Moderate to severe depression?

A

Antidepressants (SSRIs)

52
Q

summary: treatment For refractory depression?

A

antidep (SSRIs)

and add Lithium, or antipsychotic or another antidepressant

53
Q

onset of action of antidepressants and what to warn patients about?

A

Onset of action 10-14 days, warn about withdrawal symptoms

54
Q

duration of treatment with antidep?

A

After recovery from 1st episode treatment continued for 6-9 months, if 2 or more episode, continue treatment for 2 years

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