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Flashcards in Depression Deck (61):
1

What are the three severities of depression?

Mild
Moderate
Severe

2

Depression is more common when in the presence of what other things?

Physical disease
Excessive and chronic alcohol misuse
Social stresses
Interpersonal difficulties
Lack of social support

3

Name the three main types of antidepressant.

Tricyclic antidepressants
Selective serotonin reuptake inhibitors
Monoamine oxidase inhibitors

4

What are the characteristic features of depression?

Low mood
Early morning wakening
Lethargic
Anhedonia
Feelings of guilt

5

How long do features of depression need to have been persisting for it to be classed as depression?

2 weeks

6

What is the most effective treatment for depression?

Combination of cognitive behavioural therapy and an antidepressant

7

What things can determine the choice of antidepressant prescribed?

Side effects (either positive or negative for patient)
Co-morbid illness
Interactions

8

How do SSRIs work?

Inhibit reuptake of serotonin within synapse, therefore prolonging its effects

9

Name the SSRIs.

Citalopram
Escitalopram
Fluvoxamine
Fluoxetine
Sertraline
Paroxetine

10

What are the common side effects of SSRIs?

Nausea
GI disturbances
Dry mouth
Insomnia
Loss of libido

11

Why are SSRIs preferred over TCAs? (in terms of side effects)

SSRIs have no anti-cholingeric side effects

12

Why are SSRIs not prescribed to under 18s?

Studies have shown there to be a higher risk factor for the development of suicidal/self harm ideation in under 18s taking SSRIs

13

What is serotonin syndrome?

A toxic hyperserotonergic state

14

What is serotonin syndrome caused by?

Ingestion of two or more drugs that increase serotonin levels, e.g. SSRIs combined with MAOIs, dopaminergic drugs or TCAs

15

What are some symptoms of serotonin syndrome?

Agitation
Confusion
Tremor
Diarrhoea
Tachycardia
Hypertension
Hyperthermia

16

How can you reduce the effect of insomnia caused by SSRIs?

Advise to take in morning

17

What are some adverse effects of SSRIs?

Hyponatraemia
GI bleeding
Serotonin syndrome
QT prolongation

18

Why are patients gradually reduced off SSRIs instead of just being stopped?

Sudden stopping can lead to withdrawal syndrome

19

Why should care be taken when giving SSRIs to epileptics?

SSRIS lower the seizure threshold

20

What are the characteristics of withdrawal syndrome

Shivering
Dizziness
Anxiety
Headache
Nausea
'Electric shocks'

21

Name some tricyclic antidepressants.

Imipramine
Amitriptyline
Lofepramine
Nortriptyline
Clomipramine

22

How do TCAs work?

Potentiate actions of monoamines (serotonin and noradrenaline) by inhibiting reuptake into nerve terminals

23

What are the oldest antidepressants and therefore have the most evidence for them?

MAOIs

24

What are the antimuscarinic effects of TCAs?

Dry mouth
Constipation
Tremor
Blurred vision
Urinary retention

25

What cardiovascular side effects can TCAs cause?

QT prolongation
Arrhythmias
Postural hypotension

26

Why is it not wise to prescribe TCAs to patients with suicidal thoughts?

TCAs are toxic in overdose

27

What are some side effects of TCAs?

Weight gain
Sedation
Confusion
Motor incoordination

28

Why do TCAs have cardiovascular side effects?

Block the alpha1-adrenoreceptor

29

What are the contraindications of prescribing TCAs?

Prostatism
Narrow angle glaucoma
Recent MI
Heart block

30

In which patients should you be cautious to prescribe TCAs?

Those with:
Ischaemic heart disease
Epilepsy

31

What kind of drugs can TCAs interact with?

Those with sedative effect, e.g.
Alcohol
Opioids
Sedative anti-histamines
Anxiolytics
Those that prolong QT interval, eg.
Amiodarone
Catecholamines, eg adrenaline

32

How does venlafaxine work?

Potent blocker of serotonin reuptake, with some action on noradrenaline reuptake

33

In which individuals should venlafaxine not be prescribed?

Those with uncontrolled hypertension
Those prone to cardiac arrhythmias

34

How do MAOIs work?

Irreversibly inhibit intracellular enzymes monoamine oxidase A and B, leading to increase of noradrenaline, dopamine and serotonin in the brain

35

What should be avoided when taking MAOIs?

Foods rich in tyramine, e.g. mature cheese, pickled herring, yeast extracts

36

In someone diagnosed with depression what should they be advised to stop doing?

Drinking alcohol
Taking depressive drugs, e.g. steroids

37

What are examples of MAOIs?

Phenelzine
Isocarboxazid
Isoniazid
Tranylcypromine
Moclobemide

38

What does monoamine oxidase A have a preference to?

Serotonin

39

What does monoamine oxidase B have a preference to?

Phenylethylamine
Dopamine

40

What are some adverse effects of MAOIs?

Postural hypotension
Atropine-like effects
Weight gain
CNS stimulation (insomnia, restlessness, hallucinations)

41

How long can MAOIs stay in the body after they are stopped?

Up to 3 weeks

42

What type of drug can MAOIs interact with?

Ephedrine-containing drugs, e.g. OTC cough and cold medications, other antidepressants

43

How does mirtazapine act?

Antagonises presynaptic alpha2-adrenoreceptors, enhancing release of serotonin and noradrenaline
Also blocks H1-receptors

44

What kind of drug is trazodone?

A tetracyclic antidepressant

45

How does trazodone work?

Blocks 5-HT(2a) and 5-HT(2c) receptors, blocking serotonin reuptake

46

What are the side effects of mirtazapine and trazodone?

Sedative effect
Risk of increased appetite (therefore weight gain)

47

Why are mirtazapine and trazodone less dangerous in overdose than TCAs?

Fewer autonomic side effects, so are less cardiotoxic

48

How does duloxetine work?

Inhibits both noradrenaline and serotonin reuptake

49

When is venlafaxine used?

In severe cases of depression

50

When is duloxetine used?

Major depressive disorder
Can be used to treat urinary incontinence and diabetic neuropathy

51

What is the first line treatment for depression in someone post-MI?

Sertraline

52

Which TCA has the least anticholinergic activity?

Lofepramine

53

What are the two subtypes of benzodiazepines?

Hypnotics
Anxiolytics

54

What are hypnotic BZDs used to treat?

Insomnia

55

Name some hypnotic BZDs.

Temazepam
Nitrazepam
Zopiclone
Zopidem
Zaleplon

56

What are anxiolytic BZDs used to treat?

Anxiety

57

Name some anxiolytic BZDs.

Diazepam
Chlordiazepoxide
Lorazepam
Oxazepam

58

How do BZDs work?

Agonists that bind to site on GABAa receptor, enhancing inhibitory effect of GABA by opening chloride channels

59

Why should BZDs not be taken with alcohol?

Danger of overdosing, due to both affecting same receptor (BZDs indirectly, alcohol directly)

60

What are some adverse effects of BZDs?

Drowsiness
Falls
Impairment judgement and dexterity
Forgetfulness
Confusion
Irritability
Aggression

61

What are BZDs usually indicated for?

Short-term relief of severe, disabling anxiety or insomnia