Flashcards in Depression Deck (61):
What are the three severities of depression?
Depression is more common when in the presence of what other things?
Excessive and chronic alcohol misuse
Lack of social support
Name the three main types of antidepressant.
Selective serotonin reuptake inhibitors
Monoamine oxidase inhibitors
What are the characteristic features of depression?
Early morning wakening
Feelings of guilt
How long do features of depression need to have been persisting for it to be classed as depression?
What is the most effective treatment for depression?
Combination of cognitive behavioural therapy and an antidepressant
What things can determine the choice of antidepressant prescribed?
Side effects (either positive or negative for patient)
How do SSRIs work?
Inhibit reuptake of serotonin within synapse, therefore prolonging its effects
Name the SSRIs.
What are the common side effects of SSRIs?
Loss of libido
Why are SSRIs preferred over TCAs? (in terms of side effects)
SSRIs have no anti-cholingeric side effects
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
What is serotonin syndrome?
A toxic hyperserotonergic state
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
What are some symptoms of serotonin syndrome?
How can you reduce the effect of insomnia caused by SSRIs?
Advise to take in morning
What are some adverse effects of SSRIs?
Why are patients gradually reduced off SSRIs instead of just being stopped?
Sudden stopping can lead to withdrawal syndrome
Why should care be taken when giving SSRIs to epileptics?
SSRIS lower the seizure threshold
What are the characteristics of withdrawal syndrome
Name some tricyclic antidepressants.
How do TCAs work?
Potentiate actions of monoamines (serotonin and noradrenaline) by inhibiting reuptake into nerve terminals
What are the oldest antidepressants and therefore have the most evidence for them?
What are the antimuscarinic effects of TCAs?
What cardiovascular side effects can TCAs cause?
Why is it not wise to prescribe TCAs to patients with suicidal thoughts?
TCAs are toxic in overdose
What are some side effects of TCAs?
Why do TCAs have cardiovascular side effects?
Block the alpha1-adrenoreceptor
What are the contraindications of prescribing TCAs?
Narrow angle glaucoma
In which patients should you be cautious to prescribe TCAs?
Ischaemic heart disease
What kind of drugs can TCAs interact with?
Those with sedative effect, e.g.
Those that prolong QT interval, eg.
Catecholamines, eg adrenaline
How does venlafaxine work?
Potent blocker of serotonin reuptake, with some action on noradrenaline reuptake
In which individuals should venlafaxine not be prescribed?
Those with uncontrolled hypertension
Those prone to cardiac arrhythmias
How do MAOIs work?
Irreversibly inhibit intracellular enzymes monoamine oxidase A and B, leading to increase of noradrenaline, dopamine and serotonin in the brain
What should be avoided when taking MAOIs?
Foods rich in tyramine, e.g. mature cheese, pickled herring, yeast extracts
In someone diagnosed with depression what should they be advised to stop doing?
Taking depressive drugs, e.g. steroids
What are examples of MAOIs?
What does monoamine oxidase A have a preference to?
What does monoamine oxidase B have a preference to?
What are some adverse effects of MAOIs?
CNS stimulation (insomnia, restlessness, hallucinations)
How long can MAOIs stay in the body after they are stopped?
Up to 3 weeks
What type of drug can MAOIs interact with?
Ephedrine-containing drugs, e.g. OTC cough and cold medications, other antidepressants
How does mirtazapine act?
Antagonises presynaptic alpha2-adrenoreceptors, enhancing release of serotonin and noradrenaline
Also blocks H1-receptors
What kind of drug is trazodone?
A tetracyclic antidepressant
How does trazodone work?
Blocks 5-HT(2a) and 5-HT(2c) receptors, blocking serotonin reuptake
What are the side effects of mirtazapine and trazodone?
Risk of increased appetite (therefore weight gain)
Why are mirtazapine and trazodone less dangerous in overdose than TCAs?
Fewer autonomic side effects, so are less cardiotoxic
How does duloxetine work?
Inhibits both noradrenaline and serotonin reuptake
When is venlafaxine used?
In severe cases of depression
When is duloxetine used?
Major depressive disorder
Can be used to treat urinary incontinence and diabetic neuropathy
What is the first line treatment for depression in someone post-MI?
Which TCA has the least anticholinergic activity?
What are the two subtypes of benzodiazepines?
What are hypnotic BZDs used to treat?
Name some hypnotic BZDs.
What are anxiolytic BZDs used to treat?
Name some anxiolytic BZDs.
How do BZDs work?
Agonists that bind to site on GABAa receptor, enhancing inhibitory effect of GABA by opening chloride channels
Why should BZDs not be taken with alcohol?
Danger of overdosing, due to both affecting same receptor (BZDs indirectly, alcohol directly)
What are some adverse effects of BZDs?
Impairment judgement and dexterity