Antidepressants

Question 1

What is the common mechanism of how all antidepressants work?

Answer 1

Increase the amount of neurotransmitter in the synaptic cleft and approximately 2 weeks later there is a down-regulation of post-synaptic receptors.

Question 2

Why have SSRIs replaced tricyclic antidepressants recently?

Answer 2

SSRIs have the same effectiveness with more desirable side effects.

Question 3

What are common side effects of SSRIs?

Answer 3

Nausea, Insomnia, nervousness, and sexual dysfunction

Question 4

What is “serotonin reaction”?

Answer 4

When SSRI and MAO inhibitors are together can cause hyperthermia, muscle rigidity, and cardiovascular collapse.

Question 5

What can happen if you suddenly discontinue taking SSRIs?

Answer 5

You would go into SSRI withdrawal causing dizziness, shock-like sensations, visual disturbances, anxiety, headache, etc.

Question 6

How can you prevent SSRI withdrawal and which drugs cause more withdrawal?

Answer 6

Short acting SSRIs - Sertraline cause more withdraw due to shorter half-life, compared to Fluoxetine.
You can prevent by tapering the dose when the patient is discontinuing the drug. Fluoxetine has a long half-life and typically does not elicit withdrawal symptoms.

Question 7

What are the differences between Mesolimbic tract and Mesocortical tract?

Answer 7

Mesolimbic tract - arousal, memory, stimulus processing, motivation. Too much dopamine = Positive Symptoms
Mesocortical tract - cognition, communication, and social activity. Diminished dopamine = negative symptoms

Question 8

How do SSRIs work in the synaptic cleft?

Answer 8

They block SERT preventing the reuptake of serotonin.

Question 9

What is another approved use of SSRIs other than depression and anxiety?

Answer 9

Fibromyalgia and chronic pain.

Question 10

How do Tricyclic Antidepressants work, compared to SSRI drugs?

Answer 10

Tricyclic drugs block NE reuptake

SSRI drugs block Serotonin reuptake

Question 11

What drug blocks with serotonin and norepinephine reuptake?

Answer 11

Duloxetine

Side effects - more similar to SSRI

Question 12

How does the overdose risk of SSRIs compare with MAOIs and Tricyclic drugs?

Answer 12

Acute toxicity with SSRIs are significantly less than that of MAOI and Tricyclic.

Question 13

What is a unique side effect of SSRIs when they are being taken by a teenager?

Answer 13

Can increase risk of suicidal in children and teenagers.

Question 14

What is a short-half life SSRI and what is it used for?

Answer 14

Sertraline.

Used for OCD, PTSD, and Panic

Question 15

What is a long-half life SSRI that does not usually cause withdrawal?

Answer 15

Fluoxetine

Question 16

What atypical antidepressant is used for nicotine withdrawal?

Answer 16

Bupropion

Question 17

How does Bupropion work and what are the benefits?

Answer 17

Blocks the reuptake of NE and Dopamine.

There is no weight gain or sexual dysfunction.

Question 18

What drug blocks the Alpha2 receptors from negative feedback?

Answer 18

Mirtazapine.

Question 19

Where are the highest amounts of Tricyclic antidepressants found in the body?

Answer 19

Brain and Heart. Thus reasoning for contraindication in individuals with recent MIs.

Question 20

What Tricyclic antidepressant has a very long plasma half life and is a prodrug?

Answer 20

Amitriptyline

Question 21

What is are notable side effects of Amitriptyline?

Answer 21

Decreases REM sleep, Anticholinergic effects, Sedation, Cardiac abnormalities, and can cause acute overdose more easily. Drug interactions with adrenergic HTN drugs.

Question 22

What tricyclic drug is used for obsessive complusive disorder?

Answer 22

Clomipramine. Block Serotonin more than NE.

Question 23

What tricyclic drug is used primarily for treating chronic pain?

Answer 23

Amitriptyline

Question 24

How do MAO inhibitors work and common side effects?

Answer 24

Blocks the breakdown of NE, Dopamine, and Serotonin.
Patient must restrict food intake - Tyramine (not broken down) can cause hypertensive crisis.
Acute Toxicity is possible.

Question 25

What is the most commonly used MOA inhibitor?

Answer 25

Phenelzine, treats depression and narcolepsy.