Pharmacology for mood disorders Flashcards by Hugh Janus

What are indications for antidepressants

depressive illness (moderate-severe or chronic mild) 
anxiety disorders
neirpathic pain 
insomnia 
bulemia 
migraines 
IBS
narcolepsy 
ME
impulsivity

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what is the neurropharmacology of antidepressants

generally increase the neurotransmission of seratonin or noradrenaline

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how long do antidepressants take to work

1-6 weeks

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examples of SSRIs

sertraline
fluoxetine
citalopram
paroxetine
escitalopram

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what are the best tolerated antidepressants

SSRIs

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common SSRI side effects

nausea

anxiety exacerbation

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SSRI side effects

insomnia
apathy/fatigue
diarrhoea 
dizziness
restlessness
sexual dysfunction

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which antidepressant is associated with teratogenicity and what does it do

paroxetine - cardiac dysfunction in the 1st trimester

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what are the second most prescribed antidepressants

SNRIs

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examples of SNRIs

venlafaxine

duloxetine

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side effects of SNRIs

similar to SSRis

may be more sedative and has greater discontinuation symptoms

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What are some bad parts about TCAs

tolerated poorly
Toxic in overdose

teratogenic

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examples of TCAs

amitryptaline 
clomipramine
lofepramine
imipramine
dosulepin

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what are side effects of TCAs

mainly antimuscarinic side effects: 
sedation 
hypotension 
dizziness
weight gain
Delerium 
constipation 
urinary retention 
dry mouth

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How do MAOIs work

prevent metabolism of neurotransmitters

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when are MAOIs typically used

usually only in atypical/treatment resistant depression

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what food interactions do MAOIs have

Foods high in tyramine:
aged wines
aged cheeses
cured/processed meats
beer
sourdough
liver
sauerkraut
soy products 
yeast extract

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examples of MAOIs

phenelzine
tranylcypromine
isocarboxazid
moclobemide (reversible)

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apart from food interactions - what side effects do MAOIs have

dry mouth
nausea
change in bowel habt
sleep disturbance 
postural hypotension

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what are examples noradrenergic/specific seratoninergic antidepressants

mirtazapine

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what are some side effects to noradrenergic/specific seratoninergic antidepressants

significant sedation 
weight gain 
appetite
drowsiness
dizziness
headache

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how do noradrenergic/specific seratoninergic antidepressants compare to SSRIs

effective anti anxiety medication, and potentially superior to SSRIs in the treatment of depression

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how long is required to wait until a treatment can be decided to be effective or not when medicating for depression

3-4 weeks (up to 12 in elderly)

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what % of people respond to the first medication in mood disorders

70%

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what do you do if there is a partial response in the 1st 4 weeks when using antidepressants

keep going for 2-4 more weeks

how long do you treat for depression

6 months following resolution of symptoms

what are typical withdrawal symptoms for SSRIs

``` dizziness N+V numbness tingling headache anxiety sweating sleep disturbance strange dreams shaking electric shock-like symptoms ```

what helps reduce withdrawal symptoms for SSRIs

tapering dose over 4 weeks (minimum) can help reduce symptoms

what are indications for mood stabilisers

bipolar prophylaxis acute mania/hypomania bipolar depression treatment-resistant depression with antidepressants

how does the use of lithium affect suicide attempts

decreased by 80%

what are the risks of lithium use

narrow therapeutic range - must be titrated and monitored closely

common side effects of lithium

``` tremor polyuria GI issues weight gain odema polydipsia (thirst) ```

what are the common causes of lithium toxicity

decreased sodium diet dehydration drug interaction (NSAIDS, ACE-i, Thiazide + loop diuretics) illness

What plasma concentration is a toxic dose for lithium

>1.5mmol/L

symptoms of lithium toxicity

``` Diarrhoea coarse tremor ataxia dysarthria (unclear articulation) nystagmus confusion convulsions ```

what plasma concentration of lithium is an indication for urgent haemodialysis

>2.5mmol/L

what is the monitoring program for lithium toxicity

lithium levels 1 every 3 months and after every dose change (1 week after, 12 hours after taking the dose) U+E 1 every 6 months TFT 1 every 6 months

what teratogenicity does lithium cause

Ebstein's anomaly - tricuspid is ineffective, and lower down into the right ventricle + an ASD (400x) 5x increased chance of overall cardiac defects

how does sodium valproate work

Inhibits GABA breakdown, alters synaptic plasticity, promotes BDNF expression and Protein Kinase C levels

what teratogenicity does Valproate exhibit

autism neural tube defects low verbal IQ Congenital Malformation

what are indications for lamotrigine

bipolar depression bipolar prophylaxis augmentation of antidepressants in depression

indications for valproate

bipolar prophylaxis acute mania augmentation of antidepressants in depression

why does valproate need to be titrated up

it causes steven-johnson syndrome (flu symptoms + rash)

is lamotrigine teratogenic

yes but its the least teratogenic - it causes cleft lip palate in 1st trimester

what are the indications for carbamazepine

bipolar depression bipolar prophylaxis acute mania/hypomania

what's the difference between lamotrigine and valoproate in the types of bipolar disorder they treat

lamotrigine - much better for bipolar depression valproate - better at treating mania

What are the indications for ECT

treatment-resistant depression life-threatening severe depression catatonia treatment-resistant mania

how long is ECT

course is 2x a week for 4-12 sessions

what are the proposed mechanisms for ECT

Neurotransmitter modulation changes in blood distribution in brain modulation of neuronal connectivity alteration of neuronal structures (hippocampal neurogenesis)

contraindications for ECT

``` cochlear implant raised ICP intracranial aneurysm cerebral hemorrhage DVT recent MI decompensated congestive heart failure acute resp infection ```

side effects for ECT

``` anesthetic associated complications headache confusion impaired cognition temporary retro/anterograde amnesia long term - autobiographical memory impairment ```

how severe are ECT side effects

usually mild and stop on completion of course

how effective is ECT

very - 50-80% overall effectiveness, may even be up to 90% for treatment resistant depression

how are the electrodes administered in ECT

bilateral - more effective, more side effects unilateral - less effective, less side effects

how does ECT work

seizure threshold is established using dose titration

what is the risk of combining an SSRI with an NSAID, and what do you do to alleviate the risk

GI bleeding, PPI should be prescribed alongside

what electrolyte disturbance are SSRIs associated with

hyponatremia

what damage is associated with SSRI use in the 3rd trimester

persistent pulmonary hypertension

what SSRI is preferred after an MI

Sertraline

what regime should be used for tapering one SSRI into another one

reduce the dose of the original SSRI over 2 weeks, have a washout period of 4-7 days with no medication, then start the new one at the starting dose

Pharmacology for mood disorders Flashcards

(60 cards)