Lecture 3 - Mood Disorders

Question 1

major depressive disorder (MDD):

symptoms must last more than _____ ____ that cannot be due to ____, medical condition, or ____

Answer 1

2 weeks;

drugs, bereavement

Question 2

biogenic amine hypothesis in MDD:

_____ Causes depression by depleting NE and 5HT from vesicles;

Answer 2

reserpine

agents that increase 5HT and NE are effective in treating depression

Question 3

Neuroendocrine hypothesis in MDD:

overactivity of the _____ axis and elevated ___ are seen in almost all depressed patients.

Answer 3

hypothalamic-pituitary-adrenal (HPA), CRF

stress/cortisol = increased CRF

Question 4

neurotrophic hypothesis in MDD:
based off of what molecule/factor?
it is associated with increased ____ in neurons;
depressed patients have ____ levels

Answer 4

BDNF (brain derived neurotrophic factor);
branching/sprouting;
decreased

Question 5

integrated hypothesis in MDD:
hippocampal glucocorticoid receptors are ____ by cortisol during stress, _____ BDNF levels.

chronic activation of monoamine receptors ____ BDNF levels and leads to a _____ of the HPA axis

Answer 5

activated, decreasing;

increase, downregulation

Question 6

do antidepressants have an immediate or delayed therapeutic response?

Answer 6

delayed

for reasons unknown

Question 7

MOAa breaks down what molecules?

what about MOAb?

Answer 7

MOAa = Dopa, NE, 5HT;
MOAb = just dopamine

Question 8

name 3 non selective MOA inhibitors (MOAIs)

Answer 8

tranylcypromine, phenelezine, isocarboxazid

Question 9

____ is a MOA-B selective inhibitor. ____ is a MOA-A selective inhibitor

Answer 9

selegiline;

moclobemide

Question 10

MOAI side effects:
CNS \_\_\_\_\_. 
sexual dysfunction or no?
\_\_\_\_ syndrome
hypertensive crisis with ingestion of \_\_\_\_, which is found in what foods?

Answer 10

stimulation;
serotonin syndrome
yes;
tyramine–>aged cheese, wine (plus others)

Question 11

HTN crisis:
what herbal remedy has some MOAI activity?
tyramine does what that causes this?
treat with _____

Answer 11

St. John’s Wort;
displaces other NTs into synaptic cleft–>sympathetic stimulation;
phentolamine

Question 12

selegiline can be used to treat what?

Answer 12

Parkinson disease

Question 13

imipramine, amitriptyline, trimipramine, clomipramine, and doxepin belong to what drug class?

they are ____ amines

Answer 13

TCA’s;

tertiary

Question 14

name 2 secondary amines (TCA’s)

Answer 14

desipramine, nortriptyline

also protiptyline

Question 15

TCA mechanism of action

Answer 15

inhibit NE and 5HT reuptake

ie inhibit NET, SERT

Question 16

TCA’s:
which is used for OCD?
what about migraine prophylaxis?
____ can be used for nocturnal enuresis.

Answer 16

clomipramine;
amitriptyline;
imipramine

Question 17

TCA side effects:
inhibit what other 3 receptors besides their mechanism of action?
which subclass of TCAs has worse side effects?

Answer 17

Alpha1 (orthostatic hypotension);
Ach (atropine effects ie urinary retention)
H1 (CNS sedation);

tertiary amines (ie amitriptyline)

Question 18

TCA side effects:

three C’s =

Answer 18

convulsions, coma, cardiotoxicity

Question 19

TCA’s:
cardiotoxic due to _____ channel ____ = arrythmia
convulsions due to blocking of ____

Answer 19

Na channel inhibition;

GABAa

Question 20

TCA’s:
weight ____;
use ______ to treat cardiotoxicity in overdose;
side effects are worse in ______

Answer 20

gain;
NaHCO3;
elderly patients

Question 21

TCA’s:

____ is a specific NET inhibitor = _____ side effects

Answer 21

maprotiline; less

Question 22

is this an SSRI or an SNRI?
venlafaxine = 
fluoxetine = 
duloxetine = 
sertaline =

Answer 22

SNRI;
SSRI;
SNRI;
SSRI

Question 23

SSRI or SNRI?
escitalopram, citalopram = 
levomilnaciprain = 
paroxetine = 
fluvoxamine =

Answer 23

SSRI;
SNRI;
SSRI;
SNRI

Question 24

SSRIs:
used in what eating disorder?
what sexual disorder can they be used in?

Answer 24

bulimia;
premature ejaculation

plus the usual MDD, anxiety, PTSD obvs

Question 25

Serotonin syndrome: characterized by the 3 A's = treat with ____ which does what?

Answer 25

neuromuscular hyperActivity; Autonomic stimulation Agitation; cyproheptadine = 5HT2 receptor antagonist

Question 26

``` SSRI side effects: sexual dysfunction or no? _____ (an endocrine thing); weight ____; discontinuation syndrome = ____ symptoms ```

Answer 26

yep; SIADH; gain; flu-like (ie sweating, nausea, vertigo)

Question 27

Vilazadone = injhibits ____, ____ receptor partial agonist. have reduced ____ effects compared to SSRIs

Answer 27

SERT (5HT reuptake); 5HT1a; sexual side

Question 28

Vortioxetine: inhibits ____, ____ receptor agonist and ____ receptor antagonist

Answer 28

5HT reuptake; 5HT1a; 5HT3

Question 29

amoxapine is a _____ inhibitor and a ____ antagonist

Answer 29

NET; | D2

Question 30

mirtazapine = a presynaptic _____ antagonist and a potent ____ and _____ antagonist; also ____ antagonist which causes sedation

Answer 30

alpha 2; 5HT2, 5HT3; H1

Question 31

buproprion = inhibits ___ and ____; used for ____ in addition to MDD

Answer 31

NET, DAT (and SERT according to notes); | smoking cessation

Question 32

``` trazodone: primarily blocks ____; also weakly inhibits ___; used for ____; fun side effect it has? ```

Answer 32

5HT2; SERT; insomnia; priapism (erection lasting longer than 4 hours)

Question 33

SNRI's: _____ is used for GAD and peripheral neuropathy; ___ is indicated for GAD, panic disorder, PTSD and diabetic neuropathy milnaciprain is used for _____

Answer 33

duloxetine; venlafaxine; fibromyalgia

Question 34

_____ is a selective NET inhibitor and is used for ____

Answer 34

atomexitine; | ADHD