Antidepressants and Mood Stabilizers

Question 1

Describe two policies that have reduced suicide by limiting means.

Answer 1

• In England, the most common method of suicide until the 1970s was using the oven. After the country switched to clean gas that cannot be used as a lethal tool, suicide rates dropped by 30%
• In Israel, there had been a high suicide rate among those in the military. Most suicides were on the weekend, so the military prohibited taking guns home over the weekend; this lowered the suicide rate.

Question 2

The time course of ________________ corresponds to response to treatment.

Answer 2

brain-derived neurotrophic factor (BDNF)

Question 3

Placebo studies have shown what effect in the use of SSRIs?

Answer 3

That placebos have a similar response immediately, but that relapse rates are higher in groups on placebos

Question 4

The STAR-D (sp?) study demonstrated what?

Answer 4

That people need to be on antidepressants for 8 - 14 weeks to evaluate efficacy

Question 5

Bupropion is contraindicated in what patients?

Answer 5

Those with bulimia; it can induce seizures in anyone, but it is especially so in those with bulimia.

Question 6

All antidepressants have shown ______________, but ________________.

Answer 6

efficacy in treating depressing; there are no trials comparing efficacy between newer drugs

Question 7

What are the pros and cons of tricyclic antidepressants?

Answer 7

Pros:

• time-tested efficacy
• more effective in severe depression
• blood levels can be monitored

Cons:

• alpha blocking leads to orthostatic hypotension
• antimuscarinic effects
• sexual side effects
• dangerous

Question 8

What drug combination led to Libby Zion’s death?

Answer 8

MAO inhibitor and demerol (a pyridine that requires MAO to be metabolized)

Question 9

What are the side effects of SNRIs?

Answer 9

Diastolic hypertension
Withdrawal leads to flu-like symptoms and “electric shock” symptoms in the back of the head
Sweating
Sexual dysfunction

Question 10

What are the three approved treatments for bipolar depression?

Answer 10

Quetiapine
Olanzapine + fluoxetine
Lurasidone

There are zero “large” trials showing positive results in treating bipolar depression.

Question 11

True or false: valproic acid is used as a maintenance treatment.

Answer 11

False. It is only used as an acute treatment for mania.

Question 12

It’s thought that SSRIs may promote the expression of _______________, leading to increased neuronal growth (specifically in the hippocampus).

Answer 12

BDNF

Question 13

True or false: more than 50% of people treated with SSRIs will achieve complete remission.

Answer 13

False. Only about 1/3 will.

Question 14

What is the mechanism of mirtazapine?

Answer 14

It blocks 5HT2A, 5HT2C, 5HT3, and alpha-2.

Question 15

Mirtazapine is also helpful in treating _____________.

Answer 15

insomnia

Question 16

What is the best assessment of current research on ketamine treatment for depression?

Answer 16

There is some research, but trials are small and of short duration.