(Exam 3) Antidepressants

Question 1

purpose of ADs?

Answer 1

alleviate distress of clinical depression, relieve anxiety; improve quality of life; repair neuronal damage

Question 2

adverse side effects of ADs

Answer 2

sexual dysfunction, weight gain, cog effects, suicidal ideation

Question 3

what type(s) of depression do ADs work best for?

Answer 3

moderate-severe

Question 4

symptoms of MDD

Answer 4

affective disorder with alteration of emotion/mood, anhedonia, insomnia, fatigue, no energy, feelings of worthlessness, excessive guilt, thoughts of death or suicide

Question 5

severe depression symptoms

Answer 5

psychosis, loss of touch with reality

Question 6

what is dysthymia

Answer 6

relatively mild but persistent symptoms

Question 7

what is the classic theory of MDD?

Answer 7

deficiency in 5-HT, NE, and DA; restoration to normal mood state involved increasing NT activity (2 weeks longer for effect); delay in clinical effect due to changes in Rs

Question 8

neurogenic theory?

Answer 8

neurons are able to repair or remodel themselves; brain is capable of neurogenesis

Question 9

what does MDD do to neurons?

Answer 9

MDD damages neurons + decreases neurogenesis

Question 10

what does BDNF stand for

Answer 10

brain derived neurotrophic factor

Question 11

pathophysiology of MDD

Answer 11

depression is consequence of environmental + cellular stress

Question 12

what does stress do to the brain?

Answer 12

stress damages the brain and weakens its ability to recover

Question 13

what do ADs do to neurons?

Answer 13

AD drugs may repair neurons + increase neurogenesis; promote neuronal survival

Question 14

what is the immediate effect of ADs?

Answer 14

modulate synaptic levels

Question 15

what is the ultimate target for ADs?

Answer 15

intracellular molecules for maintenance of neuronal health and plasticity

Question 16

short term MOA of ADs

Answer 16

increase 5-HT and NE

Question 17

long term MOA of ADs

Answer 17

decrease in R function but increase in BDNF

Question 18

what does an increase in BDNF cause?

Answer 18

increase in neuro- and synaptic protection/function

Question 19

MDD effects on hippocampus

Answer 19

chronic stress=decreased BDNF (causes atrophy/death of neurons)

Question 20

what does TCA stand for

Answer 20

tricyclic antidepressant

Question 21

what does MAOI stand for

Answer 21

monoamine oxidase inhibitor

Question 22

what does SSRI stand for

Answer 22

selective serotonin reuptake inhibitor

Question 23

what does SNRI stand for

Answer 23

selective norepinephrine reuptake inhibitor

Question 24

what is the monoamine hypothesis of mania and depression?

Answer 24

depression is a deficiency of DA, NE, and 5-HT; mania is excess

Question 25

which ADs are classified as first-gen?

Answer 25

TCAs, MAOIs

Question 26

why are TCAs called tricyclic?

Answer 26

they have a 3 ring molecular core

Question 27

MOA of TCAs

Answer 27

block presynaptic NE and 5-HT reuptake; block H and Ach Rs

Question 28

TCAs account for what 2 pharmacological actions?

Answer 28

therapeutic and side effects

Question 29

what are the 3 clinical limitations to TCAs?

Answer 29

slow onset, significant side effects, and overdose = cardiotoxic and potentially fatal

Question 30

what are efficacy problems with MAOIs?

Answer 30

use limited by interactions

Question 31

what kinds of interactions occur with MAOIs?

Answer 31

adrenaline-like drugs (nasal sprays, asthma, cold meds); foods with tyramine (high-protein foods: cheeses, pickled + fermented liquids, foods, sauces)

Question 32

are MAOIs as safe as SSRIs?

Answer 32

yes

Question 33

MAOIs may work in pts who respond poorly to what?

Answer 33

TCAs and/or SSRIs

Question 34

MAOIs are tx for what disorders?

Answer 34

MDD, BPD, dysthymia, panic, and phobia

Question 35

what do SSRIs do?

Answer 35

block presynaptic transporter for 5-HT reuptake

Question 36

what are concerns with SSRI therapy?

Answer 36

Tx-resistant patient and serotonin syndrome

Question 37

when does serotonin syndrome occur?

Answer 37

after high doses or polypharmacy

Question 38

what are symptoms of serotonin syndrome?

Answer 38

altered cognition, behavioral alterations, autonomic, neuromuscular impairment

Question 39

when does serotonin syndrome resolve?

Answer 39

within 24-48 hours

Question 40

what happens if you increase activity at 5-HT1?

Answer 40

antidepressant + anxiolytic effects

Question 41

what happens if you increase activity at 5-HT2?

Answer 41

insomnia, anxiety, agitation, sexual dysfunction

Question 42

what happens if you increase activity at 5-HT3?

Answer 42

nausea

Question 43

what happens if you increase activity at 5-HT2 and 5-HT3?

Answer 43

adverse effects

Question 44

if you take an SSRI, what happens at 5-HT Rs? Which ones?

Answer 44

increased activity at all R types

Question 45

what are the side effects of SSRIs?

Answer 45

sedation, cog impairment, weight gain, sexual dysfunction, sleep disturbance, suicidal ideation in children + adolescents

Question 46

what do dual-action ADs do?

Answer 46

inhibit presynaptic reuptake of 5-HT and NE

Question 47

what did the STAR D study test?

Answer 47

the effectiveness of AD tx for MDD

Question 48

what did the STAR D study find?

Answer 48

no AD superior to others

Question 49

what were the specific results of STAR D?

Answer 49

2/3 of pts were able to achieve remission if they didn't withdraw