DBB - Exam 1 - Antidepressants

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DBB - Exam 1 - Antidepressants
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2012-09-20 12:58:01
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  1. 5 types of antidepressant groups
    • Tricyclic antidepressants
    • Monoamine oxidase inhibitors
    • SSRIs
    • Serotonin-Norepinephrine Reuptake Inhibitors
    • Bupropion
  2. DSM Symptoms of Depression
    • 5 or more of the following for several weeks:
    • Depressed mood most of the day, every day
    • Diminished interest/pleasure in most activities most of the day, every day
    • Changes in body weight/appetite
    • Insomnia or hypersomnia
    • Psychomotor agitation or retardation
    • Fatigue/loss of energy
    • Feelings of worthlessness or excessive guilt
    • Diminished ability to think/concentrate; indecisiveness
    • Recurrent thoughts of death/suicide with or without a specific plan
  3. 6 Different Types of Depression
    • Major, non-psychotic depression
    • Dysthymia
    • Minor depression
    • Bipolar depression
    • Psychotic depression
    • Secondary depressions
  4. Dysthymia
    Less severe but more chronic and longer lasting than major, non-psychotic depression 
  5. 3 key regions in emotional processing in brain:
    • Medial PFC
    • Subgenual ACC
    • Amygdala
  6. 3 key regions in motivational processing in brain:
    • Ventral tegmental area (VTA)
    • Nucleus accumbens
    • PFC
  7. 3 key regions in higher cognitive processing in brain:
    • dlPFC
    • Parietal cortex
    • medial PFC
  8. Hypothalamic-pituitary axis:
    • Negative feedback loop involved in stress response
    • Hypothalamus releases corticotropin releasing factor (CRF), causing the pituitary to release adrenocorticotropic hormone (ACTH), causing the adrenal gland to release glucocorticoids, which negative feedbacks the hypothalamus
    • Stress increases glucocorticoid levels
  9. Three Treatment Approaches to Depression:
    • Somatic: physical (medication, ECT, TMS, etc...)
    • Psychotherapeutic: evidence-based therapies (e.g. CBT)
    • Therapeutic lifestyle changes: e.g. exercise, nutrition, etc...
  10. Pharmacotherapeutic approach to non-psychotic unipolar depression
    Antidepressant
  11. Pharmacotherapeutic approach to psychotic unipolar depression
    Antidepressant and antipsychotic
  12. Pharmacotherapeutic approach to bipolar depression
    Mood stabilizer and possibly antidepressant
  13. Pharmacotherapeutic approach to depression linked to substance abuse
    Detoxification as a first step
  14. Locus coeruleus releases which neurotransmitter?
    Norepinephrine
  15. Norepinephrine is relesed by what brain region?
    Locus coeruleus in the pons
  16. The Raphae nuclei release which neurotransmitter?
    Serotonin
  17. Serotonin is released by which brain region?
    Raphae nuclei in the pons
  18. Short term and long term influences of antidepressants:
    • Short term: some block reuptake of NE and/or 5-HT
    • Long term: influence long term changes enhancing cellular protection
  19. Why do antidepressants take so long to work?
    • NOT due to pharmacokinetics (half-life ~1 day)
    • Due to the long term changes in enhancing cellular protection
    • Typically take 4-6 weeks to act
  20. Specifically, describe the long-term effects of antidepressants.
    • By blocking reuptake, there is more NE and/or 5-HT in synapse
    • This leads to having weeks of increased second messenger systems
    • Leads to more transcription of proteins that allow for growth of synapses and healthier neuronal cells
  21. Relation between stress and BDNF
    More stress --> more glucocorticoids --> less BDNF --> cell atrophy and decreased survival
  22. Relation between antidepressants and BDNF
    Antidepressants --> more NE and/or 5-HT --> more BDNF --> increased cell growth and survival
  23. Two tertiary amine TCAs:
    • Amitriptyline
    • Imipramine
  24. Two secondary amine TCAs:
    • Nortriptyline
    • Desipramine
  25. Amitriptyline (secondary or teritary amine?)
    Tertiary
  26. Imipramine (secondary or tertiary amine?)
    Tertiary
  27. Nortriptyline (secondary or tertiary amine?)
    Secondary
  28. Desipramine (secondary or tertiary amine?)
    Secondary
  29. Binding of tricyclic antidepressants to these 3 receptor types contributes to side effects:
    • mAChR
    • Histamine receptors (H1 and H2)
    • alpha-adrenergic receptors
  30. What do tricyclic antidepressants do that contribute to their antidepressant effects?
    Block NE and 5-HT reuptake
  31. Antimuscarinic (anticholinergic) side effects of TCAs:
    • blurred vision
    • glaucoma
    • dry mouth
    • constipation
    • urinary retention
    • memory dysfunction
    • speech blockage
    • decreased sweating
  32. Antihistamine (H1) side effects of TCAs:
    sedation, drowsiness
  33. Antihistamine (H2) side effects of TCAs:
    mental confusion (?)
  34. Anti-alpha-adrenergic side effects of TCAs:
    • orthostatic hypotension
    • tachycardia
    • arrythmias
    • dizziness
  35. Sudden drop in blood pressure and resulting light-headed feeling when you stand up
    Orthostatic hypotension
  36. VOD of TCAs is large or small?
    Large
  37. Half-life of TCAs
    18-25 hrs
  38. Which TCA is converted into an active metabolite (another TCA), and what is the name of the active metabolite?
    Amitriptyline ----> Nortriptyline
  39. What does "PRN" mean?
    Medication taken as needed
  40. 3 examples of SSRIs:
    • Fluoxetine (Prozac)
    • Sertraline (Zoloft)
    • Citalopram (Celexa)
  41. Half-life of fluoxetine
    87 hours
  42. Half-life of sertraline
    26 hours
  43. Typical side effects of SSRIs:
    • Sexual dysfunction
    • Nausea
    • Vomiting
    • Diarrhea
    • Anorexia
    • Anxiety
    • Asthenia (tiredness)
    • Insomnia
  44. 2 examples of SNRIs:
    • Venlafaxine (Effexor)
    • Duloxetine (Cymbalta)
  45. These drugs are similar to TCAs, but are better in that they don't have as many side effects
    SNRIs
  46. 3 examples of MAO-Is:
    • Phenelzine (Nardil)
    • Cypromine (Parnate)
    • Isocarboxazid (Marplan)
  47. Effects associated with an overdose of SSRIs or with drug interactions of MAO-Is
    Serotonin syndrome
  48. Symptoms of serotonin syndrome:
    • Severe agitation
    • Disorientation and confusion
    • Ataxia
    • Muscle spasms
    • Fever, shivering, chills
    • Diarrhea
    • Elevated blood pressure
    • Increased heart rate
  49. An enzyme that breaks down dopamine, norepinephrine, and serotonin
    Monoamine oxidases
  50. What substance typically broken down by MAO A in the gut cannot be eaten when on MAOIs?
    Tyramine
  51. Drug interactions of MAO-Is can lead to these two severe side effects:
    • Hypertensive crisis
    • Serotonin syndrome
  52. Interactions of MAO-Is with what drugs can lead to hypertensive crisis?
    • Sympathomimetics
    • L-DOPA
    • TCAs
    • Venlaxafine
  53. Interactions of MAO-Is with what drugs can lead to serotonin syndrome?
    • SSRIs
    • Clomipramine
  54. Bupropion affects which neurotransmitter?
    Dopamine
  55. What's important about the antidepressant effects of ketamine?
    • Low doses given IV can have a rapid antidepressant effect that lasts for days
    • However, has many behavioral side effects (similar to those of PCP), but these are minor at low doses
  56. Ketamine blocks which receptor?
    NMDA

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