Depression

Question 1

What are SSRIs?

Answer 1

Selective Serotonin Reuptake Inhibitors

Question 2

What are the clinically common SSRIs?

Answer 2

Citalopram
Fluoxetine
Paroxetine
Sertraline

Question 3

How do SSRIs work?

Answer 3

Selectively inhibit neuronal reuptake of 5-HT

Enhance synaptic concentrations and downregulate presynaptic receptors

Question 4

When are SSRIs used?

Answer 4

1st line in depression

anxiety disorders, panic disorders, OCD

Question 5

What are TCAs?

Answer 5

Tricyclic Antidepressants

Question 6

What are the clinically common TCAs?

Answer 6

Amitryptyline
Dothiepin
Lofepramine
Nortriptyline

Question 7

How do TCAs work?

Answer 7

Inhibit neuronal uptake of NA/5-HT
Enhance synaptic concentrations
Downregulation of presynaptic a2/5-HT receptors and postsynaptic beta adrenoceptors

Question 8

Why do TCAs have a wide range of side effects?

Answer 8

Bind at a range of receptors

• Muscarinic
• Histamine
• a1-adrenoceptors
• 5-HT receptors

Question 9

What are the main side effects of TCAs?

Answer 9

Sedating & dangerous in overdose
Antimuscarinic
-dry mouth
-blurred vision
-constipation
-urinary retention

Question 10

In what patients are TCAs not suitable?

Answer 10

IHD sufferers
>70 years
Suicide risk

Question 11

What cardiac effects do TCAs have?

Answer 11

QT interval prolongation
Heart block
Arrhythmias

Question 12

What, apart from depression, is Amitryptyline used to treat?

Answer 12

Sleep impairment
Neuropathic pain
Migraine prophylaxis
IBS

Question 13

What are NARIs?

Answer 13

Noradrenaline Reuptake Inhibitors

REBOXETINE

Question 14

How do NARIs work?

Answer 14

Selectively inhibit NA reuptake

Question 15

In what patients are NARIs used?

Answer 15

Patients who cannot take TCAs but are resistant to SSRIs

Question 16

What are SNRIs?

Answer 16

Serotonin-Noradrenaline Reuptake Inhibitors

VENLAFAXINE

Question 17

How do SNRIs work?

Answer 17

Inhibit 5-HT & Na reuptake

Question 18

What are the benefits of SNRIs?

Answer 18

Don’t bind to additional receptors (ie. TCAs)

Question 19

What are the side effects of SNRIs?

Answer 19

GI side effects

Hypertension

Question 20

What are NaSSAs?

Answer 20

Noardrenergic and Specific Serotonergic Antidepressants

MIRTAZAPINE

Question 21

How do NaSSAs work?

Answer 21

a2-adrenoceptor antagonists - inhibit neg feedback by presynaptic receptors
Increase Na/5-Ht transmission

Question 22

What are the benefits of NaSSAs?

Answer 22

Limited antimuscarinic side effects

Sedation in early treatment

Question 23

What are SRMs?

Answer 23

Serotonin Receptor Modulators

NEFAZODONE/TRAZODONE

Question 24

How do SRMs work?

Answer 24

Inhibit 5-HT reuptake

Selectively inhibit postsynaptic serotonin receptors

Question 25

What are MAOIs?

Answer 25

Mono-amine Oxidase Inhibitors

Question 26

Give examples of MAOIs

Answer 26

``` Rarely used clinically Isocarboxazid Moclobemide Phenelzine Tranylcypromine ```

Question 27

How do MAOIs work?

Answer 27

Inhibit MAO irreversibly - increases concentration of neurotransmitters Prevent breakdown of Tyramine

Question 28

What is the effect of elevated Tyramine?

Answer 28

Release of catecholamines - Hypertension

Question 29

For how long after cessation of MAOIs do the effects persist?

Answer 29

2-3 weeks

Question 30

What is the recommended treatment for mild depression?

Answer 30

``` Watchful waiting and reassessment after 2 weeks If drugs advised -1st line SSRIs -2nd line TCAs Psychological treatment ```

Question 31

How long does it take for an effect to occur when treated with antidepressants?

Answer 31

2 weeks

Question 32

What should be done if initial treatment fails?

Answer 32

Switch to another SSRI/class

Question 33

How long should treatment be continued for?

Answer 33

6/12 after remission | 2 years if 2 recent depressed episodes

Question 34

How should antidepressants be removed?

Answer 34

Reduced doses over >4 weeks (esp. Paroxetine)

Question 35

What is St. John's Wort?

Answer 35

Herbal medicine w/ similar MoA to SSRIs

Question 36

Why should St. John's Wort be avoided?

Answer 36

Toxicity w/ SSRIs | Enzyme inducer

Question 37

What is Bipolar Affective Disorder?

Answer 37

A mental health condition causing severe mood swings

Question 38

How should Bipolar Affective Disorder be treated?

Answer 38

1st line - Lithium | 2nd Line - Anticonvulsants/Antipsychotics

Question 39

How does Lithium work?

Answer 39

MoA unknown

Question 40

When should Lithium be avoided?

Answer 40

Renal impairment

Question 41

How are Anticonvulsants used to treat Bipolar Affective Disorder?

Answer 41

2nd line as prophylactic mood stabilisers - CARBAMAZEPINE/VALPROATE

Question 42

What Anticonvulsants are used unlicensed when other treatments have failed?

Answer 42

LAMOTRIGINE | GABAPENTIN

Question 43

How are Antipsychotics (neuroleptics) used to treat Bipolar Affective Disorder?

Answer 43

Control psychotic symptoms | HALOPERIDOL/CHLORPROMAZINE

Question 44

What drugs are used to treat Anxiety?

Answer 44

Antidepressants to improve long-term outcome | Benzodiazepines/Beta-blockers

Question 45

How are Beta-blockers used to treat Anxiety?

Answer 45

``` Treat physical symptoms -sweating -palpitations -tremor -tachycardia PROPRANOLOL ```

Question 46

How are Benzodiazepines used to treat Anxiety?

Answer 46

Reduce anxiety/aggression, induce sleep | Increase GABA activity

Question 47

What is the main difficulty in treating Anxiety with Benzodiazepines?

Answer 47

Tolerance and dependence | Treatment limited 2-4 weeks

Question 48

What is Buspirone?

Answer 48

5-HT/dopamine receptor agonist | Used to treat anxiety

Question 49

What are the side-effects of Buspirone?

Answer 49

Dizzines Nausea Headache