T3 L6 Affective disorders

Question 1

What was the first MAOi?

Answer 1

Iproniazid

Question 2

What was the first tricyclic?

Answer 2

Imipramine

Question 3

What studies show a decrease in serotonin concentrations?

Answer 3

Acute tryptophan depletion studies

Question 4

What study showed a reduction in serotonin transporter?

Answer 4

Post mortem suicide studies

Question 5

Where are serotonin cell bodies located?

Answer 5

In raphe nuclei

Question 6

Where are NA cells located?

Answer 6

In locus coerulus

Question 7

What does the monoamine theory of depression suggest?

Answer 7

Relative deficiency in synaptic levels of serotonin & noradrenaline in key CNS pathways underlies depressive illness

Question 8

What is the prefrontal cortex involved in?

Answer 8

Executive functions

Question 9

What is the limbic system involved in?

Answer 9

Behaviour
Motivation
Emotion

Question 10

What structures are included in the limbic system?

Answer 10

Hippocampus
Anterior cingulate cortex
Hypothalamus
Amygdala

Question 11

What types of drugs are primary generation antidepressants?

Answer 11

Monoamine oxidase inhibitors

Tricyclic antidepressants

Question 12

Give some examples of MAOi drugs

Answer 12

Phenelzine

Tranylcypromine

Question 13

How do MAOis work?

Answer 13

Non-selectively inhibit enzymes involved in the breakdown of monoamines including serotonin, dopamine and noradrenaline

Question 14

What are the side effects of MAOi?

Answer 14

Dry mouth
GI side effects
Headache
Drowsiness
Insomnia
Dizziness
Food interactions

Question 15

Give some examples of tricyclic antidepressants

Answer 15

Amitriptyline

Clomipramine

Question 16

How do tricyclic antidepressants work?

Answer 16

Non-selectively inhibit reuptake of monoamines including serotonin, dopamine and noradrenaline

Question 17

What are the side effects of tricyclic antidepressants?

Answer 17

Constipation
Orthostatic hypotension
Dry mouth
Drowsiness
Cardiac toxicity in overdose

Question 18

What types of drugs are secondary generation antidepressants?

Answer 18

SSRI
SNRI
Alpha & 5-HT2c antagonist
Dopamine-noradrenaline reuptake inhibitor (not approved as antidepressant in UK)

Question 19

Give some examples of SSRIs

Answer 19

Sertraline
Citalopram
Escitalopram
Fluoxetine

Question 20

What can SSRIs be used for?

Answer 20

OCD
PTSD
Panic
GAD
social anxiety

Question 21

What are the side effects of SSRIs?

Answer 21

GI symptoms - nausea, diarrhoea
Headache
Irritability
Anxiety
Reduction in libido & sexual dysfunction
Worse in first few weeks

Question 22

What SSRIs produce the worst withdrawal symptoms?

Answer 22

Venlafaxine
Paroxetine
Due to their short half life

Question 23

Give examples of SNRI drugs

Answer 23

Venlafaxine

Duloxetine

Question 24

What are some side effects of venlafaxine?

Answer 24

Nausea
Vertigo
Headache
Insomnia

Question 25

What do alpha & 5-HT2c antagonists do?

Answer 25

Modulate serotonin and noradrenaline release | Example is mirtazapine

Question 26

What are the side effects of mirtazapine?

Answer 26

``` Drowsiness Sedation Hypotension Increase appetite Weight gain ```

Question 27

Describe the link between inflammation and depression

Answer 27

Raised plasma cytokine levels (IL-6, TNF-alpha) and inflammatory markers High comorbidity between chronic inflammation and depression Administration of cytokines provokes depression

Question 28

What are the medical prefrontal and anterior cingulate cortical regions involved in?

Answer 28

Processing emotion and automatic or implicit regulation of emotion

Question 29

What are lateral prefrontal cortical systems involved in?

Answer 29

Cognitive control and voluntary or effortful regulation of emotion

Question 30

What structures are in the medial prefrontal-limbic network?

Answer 30

Amygdala Anterior cingulate cortex Medial prefrontal cortex

Question 31

Give an example of a 1st generation D2/D3 antagonist antipsychotic drug?

Answer 31

Haloperidol

Question 32

Give examples of 2nd generation D2/D3 antagonist antipsychotic drugs?

Answer 32

``` Olanzapine Risperidone Quetiapine Lurasidone Asenapine Amisulpride Clozapine ```

Question 33

What long term effects do antipsychotics have?

Answer 33

Weight gain Glucose regulation Lipids Except for aripiprazole, amisulpride and lurasidone

Question 34

What are the mechanisms of action of lithium?

Answer 34

Multiple neurotransmitters including dopamine Cellular signalling Neurotrophic factors

Question 35

Give examples of anticonvulsants

Answer 35

Valproate Lamotrigine Carbamazepine

Question 36

Describe valproate mechanism

Answer 36

Actions via GABA, intracellular signalling, sodium channel blockage, epigenetic modulation

Question 37

What can valproate be used for?

Answer 37

Anti-manic and prevention of mania

Question 38

What is the concern with valproate?

Answer 38

Risk of foetal teratogenesis and impaired intellectual development

Question 39

What is the mechanism of Lamotrigine?

Answer 39

Action via GABA, glutamate and sodium channel blackage

Question 40

What is Lamotrigine useful in?

Answer 40

Preventing depressive relapses

Question 41

What is Lamotrigine not useful in?

Answer 41

Anti-manic agents

Question 42

Describe Carbamazepine use

Answer 42

Less effect in maintenance treatment than lithium but may be used as mono therapy if lithium is ineffective Especially in patients who don't show classical pattern of episodic euphoric mania Almost exclusively effective against manic relapse

Question 43

What is the treatment for depressive episodes?

Answer 43

Antipsychotics - quetiapine, lurasidone Fluoxetine / olanzapine combinations Antidepressants co-prescribed with anti-manic drug Condiser lamotrigine with anti-manic drug

Question 44

What is the treatment for acute manic episodes?

Answer 44

Dopamine antagonists - haloperidol, olanzapine, risperidone, quetiapine Valproate Discontinue any antidepressant treatment

Question 45

What alternatives can be used to prevent new episodes if lithium is ineffective?

Answer 45

Valproate Dopamine antagonists / partial agonists Carbamazepine

Question 46

What are the side effects of long term treatment?

Answer 46

Weight gain - most medications, especially olanzapine & quetiapine Metabolic syndrome - olanzapine, queitapine, risperidone Hyperlactinemia - dopamine antagonists Tardive dyskinesia - much lower risk with newer agents Liver damage - valproate Kidney & thyroid dysfunction - poorly regulated lithium