Antidepressants

Question 1

What is the monoamine hypothesis of depression?

Answer 1

Proposes that depression is due to a functional deficit of monoamine neurotransmitters like norepinephrine and serotonin at certain sites in the brain

Question 2

Name the major classes of antidepressant drugs.

Answer 2

Tricyclic antidepressants (TCA) SSRIs SNRIs NRIs NDRIs MAO inhibitors Atypical antidepressants

Question 3

What are SSRIs used for?

Answer 3

First-line treatment for depression and anxiety disorders

Question 4

Name some common SSRIs.

Answer 4

Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Escitalopram

Question 5

What is the therapeutic lag for antidepressants?

Answer 5

2-4 weeks before a measurable therapeutic response is evident

Question 6

Describe the neurotrophic hypothesis of depression.

Answer 6

Depression results from decreased neurotrophic support leading to neuronal atrophy decreased hippocampal neurogenesis and loss of glia

Question 7

What is the role of BDNF in depression?

Answer 7

Brain-Derived Neurotrophic Factor (BDNF) is decreased in depression contributing to neuronal atrophy and reduced neurogenesis

Question 8

List adverse effects common to SSRIs.

Answer 8

GI symptoms headache insomnia anxiety sexual dysfunction increased risk of GI bleeding serotonin syndrome discontinuation syndrome

Question 9

What is serotonin syndrome?

Answer 9

A potentially life-threatening condition due to excessive serotonin causing symptoms like agitation confusion rapid heart rate and high blood pressure

Question 10

What is the role of MAO inhibitors in treating depression?

Answer 10

Inhibit monoamine oxidase preventing the breakdown of monoamine neurotransmitters thus increasing their availability

Question 11

Name some adverse effects of tricyclic antidepressants (TCAs).

Answer 11

Sedation weight gain dry mouth constipation urinary retention blurred vision tachycardia orthostatic hypotension

Question 12

What is the role of norepinephrine reuptake inhibitors (NRIs)?

Answer 12

Increase norepinephrine levels by inhibiting its reuptake thus enhancing mood

Question 13

What is the mechanism of action of SNRIs?

Answer 13

Inhibit the reuptake of both serotonin and norepinephrine

Question 14

What is an important pharmacokinetic consideration for fluoxetine?

Answer 14

Fluoxetine has the longest half-life among SSRIs and must be discontinued 4 weeks before starting an MAOI

Question 15

What is the role of neuroendocrine interactions in depression?

Answer 15

Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis and the role of stress response can contribute to depression

Question 16

Name some drugs classified as atypical antidepressants.

Answer 16

Bupropion trazodone nefazodone mirtazapine mianserin agomelatine vortioxetine

Question 17

What is the significance of active metabolites in antidepressants?

Answer 17

Active metabolites can affect the duration of drug action and influence switching from one medication to another

Question 18

What is the role of glutamate in depression?

Answer 18

The glutamate hypothesis suggests that rapid actions of drugs like ketamine may be due to their effects on glutamate neurotransmission

Question 19

Name the primary cellular targets for tricyclic antidepressants (TCAs).

Answer 19

Inhibit the reuptake of norepinephrine and serotonin

Question 20

What is the main mechanism of action for SSRIs?

Answer 20

Selective inhibition of serotonin reuptake

Question 21

Describe the pharmacokinetics of most SSRIs.

Answer 21

Good absorption significant liver metabolism (CYP450) and variable half-lives

Question 22

What is a common adverse effect specific to paroxetine?

Answer 22

Increased risk of teratogenic effects (cardiac) in the first trimester of pregnancy

Question 23

What are the therapeutic uses of SNRIs beyond depression?

Answer 23

Used for generalized anxiety disorder (GAD) panic disorder (PD) social anxiety disorder and chronic pain conditions

Question 24

Describe the “switch” phenomenon in bipolar disorder treatment with antidepressants.

Answer 24

Antidepressants can induce a switch from a depressed episode to a manic or hypomanic episode in bipolar patients

Question 25

What is the relationship between dietary sodium and lithium pharmacokinetics?

Answer 25

Alterations in dietary sodium can affect lithium levels as sodium depletion increases lithium reabsorption

Question 26

How does exercise affect lithium levels?

Answer 26

Exercise can alter sodium levels impacting lithium reabsorption and potentially causing toxicity or subtherapeutic levels

Question 27

What are the signs of lithium toxicity?

Answer 27

Nausea vomiting diarrhea tremor confusion seizures and potentially coma

Question 28

Why is lithium contraindicated in patients with renal impairment?

Answer 28

Reduced renal function can lead to lithium accumulation and toxicity

Question 29

What is the role of bupropion in depression treatment?

Answer 29

Acts as a norepinephrine-dopamine reuptake inhibitor (NDRI) and is also used for smoking cessation

Question 30

What is the importance of CYP450 interactions in antidepressant pharmacology?

Answer 30

Many antidepressants are metabolized by CYP450 enzymes and drug interactions can affect their levels and efficacy

Question 31

What is the mechanism of action of monoamine oxidase inhibitors (MAOIs)?

Answer 31

Inhibit the enzyme monoamine oxidase increasing levels of neurotransmitters like serotonin and norepinephrine

Question 32

What is the role of serotonin in the neurobiology of depression?

Answer 32

Serotonin deficits are associated with mood disorders and enhancing its levels can improve depressive symptoms

Question 33

What is the importance of neurogenesis in treating depression?

Answer 33

Increased neurogenesis particularly in the hippocampus is thought to correlate with the therapeutic effects of antidepressants

Question 34

How does fluvoxamine differ from other SSRIs in terms of enzyme inhibition?

Answer 34

Fluvoxamine is a potent inhibitor of CYP3A4

Question 35

What is the role of psychotropic medication in treating severe depression with suicidal risk?

Answer 35

Medications like ECT are used when rapid response is needed and delay in antidepressant effects is hazardous

Question 36

Describe the discontinuation syndrome associated with antidepressants.

Answer 36

Symptoms can include flu-like symptoms insomnia nausea imbalance sensory disturbances and hyperarousal

Question 37

What is the primary use of mirtazapine in depression treatment?

Answer 37

An atypical antidepressant with noradrenergic and specific serotonergic activity

Question 38

How do MAOIs interact with dietary tyramine?

Answer 38

MAOIs can cause hypertensive crisis when taken with tyramine-rich foods due to increased levels of tyramine

Question 39

What are the most common adverse effects of lithium?

Answer 39

Tremor hypothyroidism weight gain renal dysfunction and polyuria

Question 40

What is the clinical use of agomelatine?

Answer 40

Atypical antidepressant that acts as a melatonin receptor agonist and 5-HT2C antagonist

Question 41

What is the main therapeutic action of tricyclic antidepressants?

Answer 41

Inhibit the reuptake of norepinephrine and serotonin enhancing mood

Question 42

What is the pharmacological action of vortioxetine?

Answer 42

Atypical antidepressant that modulates serotonin receptor activity and inhibits serotonin reuptake

Question 43

How does nefazodone differ from trazodone?

Answer 43

Both are atypical antidepressants but nefazodone has a higher risk of hepatotoxicity

Question 44

What are the effects of antidepressants on anxiety during early treatment?

Answer 44

May increase anxiety agitation and suicidal ideation during the first few weeks

Question 45

What is the clinical significance of escitalopram?

Answer 45

S-enantiomer of citalopram with improved efficacy and fewer side effects

Question 46

Describe the cytokine hypothesis of depression.

Answer 46

Proposes that increased levels of pro-inflammatory cytokines contribute to depressive symptoms

Question 47

How do SNRIs differ from SSRIs in terms of neurotransmitter targets?

Answer 47

SNRIs inhibit the reuptake of both serotonin and norepinephrine while SSRIs are selective for serotonin

Question 48

What is the role of electroconvulsive therapy (ECT) in depression?

Answer 48

Used for severe depression especially when rapid treatment response is needed or other treatments have failed

Question 49

What are the most common side effects of tricyclic antidepressants?

Answer 49

Sedation anticholinergic effects orthostatic hypotension and cardiotoxicity

Question 50

What is the role of St. John’s wort in treating depression?

Answer 50

Herbal antidepressant that may interact with various drugs and has a risk of inducing serotonin syndrome

Question 51

How is bipolar disorder treated with anticonvulsants?

Answer 51

Anticonvulsants like valproate and lamotrigine are used for mood stabilization and to prevent manic episodes

Question 52

What are the potential interactions between SSRIs and NSAIDs?

Answer 52

Increased risk of gastrointestinal bleeding

Question 53

How does serotonin receptor antagonism contribute to antidepressant effects?

Answer 53

Blocking certain serotonin receptors can help alleviate depressive symptoms and improve mood

Question 54

What is the role of atypical antipsychotics in treating bipolar disorder?

Answer 54

Used for mood stabilization and treatment of acute manic episodes

Question 55

What are the implications of CYP450 polymorphism in antidepressant therapy?

Answer 55

Genetic variations can lead to differences in drug metabolism and response among individuals

Question 56

How does ketamine work as a rapid-acting antidepressant?

Answer 56

Acts on the glutamate system particularly NMDA receptors to produce quick antidepressant effects

Question 57

What is the clinical use of tricyclic antidepressants in neuropathic pain?

Answer 57

TCAs are effective in treating chronic neuropathic pain due to their analgesic properties

Question 58

What is the significance of serotonin-norepinephrine reuptake inhibition?

Answer 58

Provides a dual mechanism of action enhancing both serotonin and norepinephrine neurotransmission for improved efficacy in depression

Question 59

How does the inhibition of MAO contribute to the antidepressant effect?

Answer 59

Prevents the breakdown of monoamine neurotransmitters increasing their availability in the brain

Question 60

What are the therapeutic effects of bupropion?

Answer 60

Antidepressant and smoking cessation aid with a favorable side effect profile including minimal sexual dysfunction