Depression, Bipolar

Question 1

What are the three types of depression?

Answer 1

Reactive
Unipolar (major)
Bipolar

Question 2

Unipolar depression types

Answer 2

Typical
Atypical
Other

Question 3

Typical depression

Answer 3

insomnia, weight loss, decreased appetite, social disinterest

Question 4

Atypical

Answer 4

Hypersomnia, increased appetite, weight gain, sensitivity

Question 5

Which theory of depression is the most likely?

Answer 5

Neurotransmitter theory

Question 6

What is the belief of the NT theory of depression?

Answer 6

Upregulation of auto-receptors is the main reason why a person experiences depression due to a lack of NT, once the NT levels are re-established the body must down regulate the receptors (latency period)

Question 7

Strategies to treat depression

Answer 7

Block NT reuptake
Block NT degradation
Increase NT release

Question 8

Selective Serotonin Reuptake Inhibitors

Answer 8

Fluoxetime

Question 9

MOA of Fluoxetime (SSRI)

Answer 9

Selective inhibition of 5HT reuptake

SERT 300x&raquo_space;> NET

Question 10

Use of Fluoxetime

Answer 10

Major depression

Question 11

When will a patient begin to experience effects of Fluoxetime?

Answer 11

3-8 weeks

Question 12

When does tolerance begin to develop in Fluoxetime?

Answer 12

3-8 weeks

Question 13

When does the effect start to wear off in SSRIs?

Answer 13

> 18 months

Question 14

What are the main side effects of SSRIs?

Answer 14

5HT1A and 5HT2A: Serotonin Syndrome
5HT2: sexual dysfunction
5HT3: GI distress

Question 15

What are the contraindications of SSRIs / Fluoxetime?

Answer 15

MAOIs

Question 16

What is an Serotonin Norepinephrine Reuptake Inhibitor?

Answer 16

Duloxetine

Question 17

MOA of Duloxetine

Answer 17

Inhibition of SERT and NET equally

No action at A-1, H1 or M3

Question 18

TCAs

Answer 18

Amitriptylline

Question 19

MOA of Amitryptilline

Answer 19

NON-selective (block NE, 5HT, H1, A-1, M3) everything

Inhibit NET > SERT

Question 20

What are the most common associated symptoms with amitryptilline?

Answer 20

Anticholinergic
H1: Drowsy/sedation
A-1: Vasodilation, postural hypotension
5HT2: Sexual dysfunction
Overdose toxicity

Question 21

What is the concern with overdose toxicity in amitryptilline?

Answer 21

Neurological and cardio, severe tachycardia, hypotension and arrhythmia (inhibiting Na+ channels)

Question 22

What are two atypical anti-depressants?

Answer 22

Bupropion

Mirtazepine

Question 23

What is the likely mechanism of Bupropion

Answer 23

1) Block reuptake of NE and DA at NET and DAT

2) Increase release of NE and DA

Question 24

What is a benefit of using Atypical anti-depressants

Answer 24

Not associated with sexual dysfunction

Question 25

Which atypical is used for smoking cessation?

Answer 25

Bupropion (Zyban)

Question 26

What is the black box warning for Bupropion?

Answer 26

Smoking cessation - neuropsychiatric effects (using antidepressant for patient that does not have depression)

Question 27

What is the contraindication of Bupropion?

Answer 27

Epilepsy (lowers seizure threshold)

Question 28

What is the MOA of Mirtazepine

Answer 28

A-2 autoreceptor antagonist - increase release of 5HT and NE

Question 29

What is the benefit for using Mirtazepine

Answer 29

Good for patients that have insomnia and weight loss and want to gain weight

Question 30

What are the MAOIs?

Answer 30

Phenelzine | Selegiline

Question 31

What is the MOA of Phenelzine?

Answer 31

Non-selective irreversible inhibitor of MAO-A and MAO-B | MAO-A is the main target

Question 32

When are MAOIs used to treat depression?

Answer 32

Treatment resistant depression | Atypical depression

Question 33

What is the most concerning side effect of Phenelzine?

Answer 33

HTN crisis (wine and cheese effect)

Question 34

What is the MOA of Selegiline (unique property)?

Answer 34

Low dose: selective for MAO-B (Parkinson tx) | High dose: non-selective, MAO-A selective (depression tx)

Question 35

What is the high dose tx w/ Selegiline?

Answer 35

Depression

Question 36

What is the way that Selegiline is administered in treating depression?

Answer 36

Transdermal patch

Question 37

What is the benefit of using a transdermal patch?

Answer 37

``` Less toxicity Bypass GI (no wine and cheese HTN crisis) ```

Question 38

What drug is used to treat bipolar disorder?

Answer 38

Lithium

Question 39

What is Lithium

Answer 39

Monovalent Cation

Question 40

What is the most concerning side effect of lithium use?

Answer 40

Arrythmias (cation similar to Na+)

Question 41

What are other side effects of Lithium use?

Answer 41

Tremor, polyuria, polydipsia, diabetes insipidus, thyorid dysfunciton

Question 42

What is the range of Lithium

Answer 42

Very narrow range (0.8-1.2 mEq/L)

Question 43

Which drug is associated with diabetes like side effects?

Answer 43

Lithium