Antidepressants

Front 1

The most prevalent form of mental illness in the U.S.
_______% of adults suffer from it.

Back 1

Depression (Unipolar)

17%

Front 2

A group of mental illnesses that include depresson and manic-depression (bipolar disorder)

Back 2

Affective disorders

Front 3

Characterized by swinging between being happy and depressed

Back 3

Bipolar Disorder (aka manic-depression)

Front 4

TRUE OR FALSE

Tradegy or trauma can precipitate depression

Back 4

TRUE

Front 5

Clinical depression is characterized by:

Back 5

Intense feelings of sadness, hoplessness, despair and the inability to find pleasure in usual activities

Front 6

The diagnosis of clinical depression indicates that feelings associated with the illness are ________in both intensity and _________ to the extent that they begin to be incapacitating

Back 6

increased

duration

Front 7

What is the definition of Mania?

Back 7

opposite of depression=enthusiasm, rapid thought and speech patterns, extreme self-confidence/impaired judgement

Front 8

What are secondary symptoms of depression?

Back 8

anorexia, sleep disorders, fatigue, lack of self esteem, somatic complaints, irrational guilt, recurrent througths of death and suicide

Front 9

Symptoms of depression that are used for diagnosis:

Back 9

1. general dysphoric mood (sadness, irritability, "down in the dumps" attitude)

2. general lack of interest in previously pleasurable activity

Front 10

What are these?

1. recent stressful incident or misfortune
2.Genetic factors
3. Neurochemical imbalance

Back 10

Causes of depression

Front 11

What are the drug categories for Antidepressant Drugs?

Back 11

1. Tricyclic antidepressants
2. Selective serotonin reuptake inhibitors (SSRI) *NEWER GENERATION
3. Monoamine oxidase(MAO)inhibitors

Front 12

Which MAO treats what illness?

MAO A treats__________
MAO B treats__________

Back 12

MAO A =for depression

MAO B =for Parkinson's

Front 13

Desipramine is the prototype for what group of Antidepressants?

Back 13

Tricyclic

Front 14

Tricyclics share a common_____ -______ chemical structure.

Back 14

three-ring

Front 15

What is the mechanism of action for Desipramine (the Tricyclic prototype)?

Back 15

1. Acts by blocking reuptake of norepinephrine (and some dopamine) AND serotonin uptake into nerve terminals

2. Can also block receptors for serotonin, histamine, muscarinic and ? adrenoceptors

Front 16

TRUE OR FALSE:

Psychological dependence and addiction are the same

Back 16

FALSE

Addiction is a craving, which is different from your body having a physiological need.

Front 17

Biggest issue = feel like you're in a fog

Antimuscarinic
-dry mouth, blurred vision, constipation,urinary retention

CVS
-cardiac arrhythmias, orthostatic hypotension, reflex tachycardia

CNS
-sedation and headache
*HIGH POTENTIAL FOR FATAL OVERDOSE and/or SUICIDE RISK =why its use has declined

Back 17

Tricyclic Antidepressant Side Effects

Front 18

1. Severe major depression
2. Imipramine has been used to control bed-wetting in children

Back 18

Therapeutic uses of Tricyclic Antidepressants

Front 19

Tricyclic Pharmacokinetics:

1. administration
2.onset of action

Back 19

1. Active orally (widely distributed in body fluids *including the brain)

2. about 2-4 weeks before seeing a response

Front 20

Tricyclic Pharmacological Actions:

Back 20

1. Elevates mood, improves mental alertness and increases physical activity

2. Can also reduce morbid preoccupation in 50-70% of patients

3. Physical and psychological dependence has been reported with this drug's use

Front 21

Tricyclic mech. of action (cont.):

Acts by allowing neurotransmitters to ________ at the synapse leading to prolonged stimulation of receptors and a ________ in its sensitivity.

*change in receptor sensitivity may account for the antidepresseant effects

Back 21

accumulate

decrease

Front 22

What are the OT Implications (3 parts)?

Back 22

Antimuscarinic effects:
Dry mouth=need water, blurred vision=color code,constipation=increase fiber intake, urinary retention

CVS:
cardiac arrhythmias=monitor BP, orthostatic hypotension=avoid sudden mvmt, reflex tachycardia=decrease exercise stress

CNS:
sedation and headache=time tx for time pt has decreased effects

Front 23

Selective Serotonin Reuptake Inhibitors (SSRIs) are the ___ choice of antidepressant drugs

Back 23

#1 choice

Front 24

Fluoxetine is the prototype for what group of Antidepressants?

Back 24

Selective Serotonin Reuptake Inhibitors (SSRIs)

Front 25

Selective Serotonin Reuptake Inhibitors (SSRIs)

Mechanism of Action:

Back 25

Acts specifically to inhibit reuptake of serotonin at nerve terminals

Front 26

In terms of pharmacological actions, SSRIs are as _________ as tricyclics

Back 26

potent

Front 27

sexual dysfunction (loss of libido, delayed ejaculation), insomnia, anxiety, anorexia, tremors, nausea and flatulence

Back 27

SSRI side effects

Front 28

_________ are used for treating depression and obsessive compulsive disorder

Back 28

SSRIs

Front 29

OT Implications for SSRIs

Back 29

Biggest problem related to side effects:

Some people stops taking this medication because of its effect on sexual functioning

Front 30

Monoamine Oxidase Inhibitors are the _____ ______ for treating depression

Back 30

last resort

Front 31

Monoamine Oxidase Inhibitors are often given in combination with other antidepressant meds. However, combining meds __________ side effects

Back 31

increases

Front 32

Phenelzine is the prototype for which antidepressant drug group?

Back 32

Monoamine Oxidase(MAO)Inhibitors

Front 33

1. inhibits MAO, an enzyme that breaks down norepinephrine, dopamine and serotonin.
->allowing these neurotransmitters to accumulate at the synapse=leading to increased activation of postsynaptic receptors

2. Inhibit oxidases responsible for metabolism of compounds such as tyramine (i.e. found in aged cheese)

Back 33

Monoamine Oxidase(MAO)Inhibitors

Mechanism of Action

Front 34

Monoamine Oxidase(MAO)Inhibitors allow __________ availability of __________ to be released.

Back 34

increased

serotonin

Front 35

Monoamine Oxidase(MAO)Inhibitors:

Administration?

Onset of action?

Contraindications?

Back 35

1. Active orally

2. Slow onset...minimum of 2 weeks

3. Pts should avoid high tyramine foods(i.e. cheese, salami, chocolate, wine, beer, chicken liver, yogurt, etc) because of risk of hypertensive crisis

Front 36

Monoamine Oxidase(MAO)Inhibitors

NOTE:

Back 36

Inhibition of neurotransmitter uptake in peripheral sympathetic system may increase cardiovascular side effects

Front 37

Monoamine Oxidase(MAO)Inhibitors

Side effects?

Back 37

Orthostatic hypotension, headache, sexual disturbances, weight gain, anticholinergic effects and seizures

Front 38

Monoamine Oxidase(MAO)Inhibitors are used for...

Back 38

Pts with depression who are unresponsive or allergic to tricyclics

Front 39

What is used for treatment of Mania?

Back 39

Lithium Salts

Front 40

Lithium salts (Lithobid, Lithonate)

Mechanism of action?
Helps with...
Administration?
Side Effects?

Back 40

1. EXACT Mech of Action is UNKNOWN
2.relief from signs and symptoms of Mania *stabilizes mood
3. Active orally
4. Ataxia, tremors, confusion and convulsions

***HAS A NARROW THERAPEUTIC INDEX

Front 41

Lithium salts work well but take time to kick in so be sure to ______ pt. closely

Back 41

watch

Front 42

For all antidepressants, it is important for OTs to watch for...

Back 42

increased depression in pts while waiting for drug to kick in.