Depression

Question 1

What are the 2 patterns of depressive states?

Answer 1

Unipolar - low level of mood affecting QoL. Dysthymia = low level, chronic, MDD - clinical depression
Treated with CBT and antidepressants

Bipolar - recurrent episodes of mania and depression. Bipolar disorder, cyclothymia, low level
Treated with antipsychotics

Question 2

Name 2 key symptoms of depression

Answer 2

Persistent sadness or low mood and/or

Marked loss of interests or pleasure

Question 3

What other symptoms should be looked out for if 2 key symptoms are present?

Answer 3

Disturbed sleep (more/less)

Decreased/increased appetite

Fatigue or loss of energy

Agitation/slowing of movements

Poor concentration or indecisiveness

Feeling worthless, excess inappropriate guilt

Suicidal thoughts or acts

Question 4

What are the 3 grades of major depressive disorder?

Answer 4

Mild depression - few symptoms that result in only minor functional impairment

Moderate depression - symptoms or functional impairment are between ‘mild’ and ‘severe’

Severe depression - most symptoms that markedly interfere with functioning +/- psychosis

Question 5

Which 2 areas of the brain are increased in depression?

Answer 5

Amygdala

Hypothalamus

Question 6

Which 2 areas of the brain are decreased in depression?

Answer 6

Prefrontal cortex

Hippocampus

Question 7

What are the 4 main theories for depression?

Answer 7

Neurotransmitter

• 5HT
• NA

Neurohormonal

• Steroids
• HPA axis (stress, anxiety)

Immune (?auto)

Circadian

Question 8

What are the 4 main theories for depression?

Answer 8

Neurotransmitter

• 5HT
• NA

Neurohormonal

• Steroids
• HPA axis (stress, anxiety)

Immune (?auto)

Circadian

Question 9

Where is the main site of 5HT production?

Answer 9

Raphe Nuclei

brainstem

Question 10

Where is the main sites of NA production?

Answer 10

Locus Coeruleus - projects the cortex and thalamus

Lateral tegmental area - projects to cerebellum + spinal cord

Question 11

Where is the main sites of NA production?

Answer 11

Locus Coeruleus

Lateral tegmental area

Question 12

Describe the reactions between 5HT and NA

Answer 12

Interactions in the brainstem speed activity (cell body end)

Interactions in the cortex slow activity (dendrite end)

Question 13

Describe the reactions between 5HT and NA

Answer 13

Interactions in the brainstem speed activity

Interactions in the cortex slow activity

Question 14

What are the 5 main treatments for depression?

Answer 14

CBT

Pharmacological

Transcranial magnetic stimulation (TMS)

Transcranial direct current stimulation (tDCS)

Electroconvulsive therapy (ECT)

Question 15

What are the 4 main families of drugs to treat depression?

Answer 15

Selective Serotonin Reuptake Inhibitors (SSRIs)

Tricyclic Antidepressants (TCAs)

Monoamine Oxidase Inhibitors (MAOI-A)

Atypical Antidepressants

Question 16

What are 2 major side effects of ECT?

Answer 16

Memory loss

Short term muscle aches

Question 17

What are the first line SSRIs?

Answer 17

Sertraline

Citalopram

Question 18

What is the MoA of SSRIs?

Answer 18

Answer

Question 19

Inflammatory mediators in the CNS lead to (3):

Answer 19

Microglia activation (act as RBCs)

Cell dysfunction

Cell death

Question 20

Describe the role of neurogenesis in depression

Answer 20

Depression is associated with decreased dendritic branching and decreased number of synapses

Also overproduction of receptors.

This results in a less profound transmission to the post-synaptic cell

Deficit can be reversed by neuronal growth factors and antidepressants.

Question 21

Describe transcranial magnetic stimulation (TMS)

Answer 21

Magnetic pulses targeted at prefrontal cortex and limbic system

Good for severe unresponsive depression

Fewer side effects than drug therapy

Less stigma than ECT

Question 22

Describe ECT

Answer 22

Gold standard for severe depression

50% show improvement

Side effects

• memory loss
• short term muscle aches
• stigma

Question 23

What are the main classes of antidepressants?

Answer 23

SSRIs

Atypical antidepressants
-NRI
-SNRI
5HT partial agonists

Tricyclic antidepressants

Monoamine oxidase inhibitors (MAOI-A)

a-adrenoreceptors

Question 24

Describe the mechanism of action of SSRIs

Answer 24

Inhibits serotonin reuptake pump

Question 25

What are the 2 main SSRIs?

Answer 25

Sertraline Citalopram

Question 26

Describe the mechanism of action of atypical antidepressants

Answer 26

Noradrenaline reuptake inhibitor (same principle as SSRIs) - Reboxetine SNRI - 5HT and NA reuptake inhibitor - Venlafaxine 5HT partial agonist - reduce activity of 5HT to increase transmitter levels (more condensed) - Buspirone

Question 27

What class of drugs is reboxetine?

Answer 27

NRIs | NA reuptake inhibitors

Question 28

What class of drugs in Venlafaxine?

Answer 28

SNRI | combined NA 5HT reuptake inhibitor

Question 29

What class of drugs is Buspirone?

Answer 29

5HT partial agonist

Question 30

Describe the MoA of agomelatine

Answer 30

Melatonin agonist Increases slow wave sleep

Question 31

What is agomelatine?

Answer 31

Melatonin agonist

Question 32

What are the 5 main actions of tricyclic antidepressants (TCAs)?

Answer 32

5HT reuptake inhibitor NA reuptake inhibitor a1 adrenoreceptor antagonist H1 receptor antagonist M1 receptor antagonist

Question 33

Give 2 examples of TCAs

Answer 33

Amitriptyline Nortriptyline

Question 34

Give the side effects of TCAs with link to the receptors they work on

Answer 34

a1 adrenoreceptor antagonist - postural hypotension (usually constrict smooth muscle in blood vessels) H1 receptor antagonist - antihistamine action, cause sedation M1 receptor antagonist - cardiac arrhythmias (cardiac smooth muscle)

Question 35

What are some common side effects of TCAs?

Answer 35

Sedation Postural hypotension Confusion Visual problems Cardiac dysrhythmia Mania Drug interactions (aspirin, alcohol)

Question 36

What is the mechanism of action of monoamine oxidase inhibitors?

Answer 36

Increases 5HT/NA levels by reversibly inhibiting the action of the enzyme monoamine oxidase A

Question 37

What is the main MAOI-A?

Answer 37

Moclobemide

Question 38

What class of drugs is moclobemide?

Answer 38

MAOI-A

Question 39

What are some common side effects of MAOIs?

Answer 39

Postural hypotension Restlessness Convulsions Sleep disorders Cross drug reactions - not to be px with SSRIs/ TCAs Cheese reaction - tyramine, enhances action of drug

Question 40

Outline how a-1 and a-2 receptors work under normal conditions

Answer 40

α-1 receptors increase transmitter release α-2 receptors slow transmitter release So α-1 agonists and α-2 antagonists increase transmission

Question 41

What is mirtazapine?

Answer 41

a-2 antagonist | increases activity of NA and 5HT in synapse

Question 42

What are the 4 aims of CBT?

Answer 42

Identify thinking that causes problematic feelings and behaviour Question the individual’s negative thinking/feeling in order to enable positive change in thought processes Identify unwanted behaviour patterns Plan goals to achieve the change sought, and the step by step process for the achievement of the goals

Question 43

Name 3 drawbacks to CBT

Answer 43

May not be suitable for those with learning difficulties or complex health needs Confrontation of emotions - can be difficult in early stages, patients need to be ready Only focuses on individuals capacity for change, not wider family or systems problems

Question 44

What is the ABCD approach of rational emotive behaviour therapy (REBT)?

Answer 44

A = activating event B = belief about the event C = consequences of the event D = disputing the belief/anticipated consequences of the event