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18 Cards in this Set
- Front
- Back
Major Depression Epidemiology
-Lifetime Risks -Duration of untreated episodes -Risk of recurrence and hypothesized biological correlate |
-10% LTR for men
-20% LTR for women -Average untreated episode: 9-12 months -2/3 of all cases are recurrent. 50% after 1 episode, 80% after 2, 90% after 3. -R.o.R. may reflect kindling effect in limbic system |
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Etiology of Major Depression
-Stress-diathesis model -Final common biological pathway -Response to failure -Response to success |
-interplay between biological vulnerability and environmental stressors
-Dysregulation of limbic system/monoamine pathways. (5HT, NE, and DA) -Personal, permanent and pervasive -Impersonal, transient, and specific |
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Diagnostic criteria for MDD
-4 domains of symptoms -X of these 2 -X of 9 others -Symptom duration -Symptom consequences -Exclusion criteria |
-Departure from normal mood, psychomotor activity, cognitive functioning, and vegetative features.
-Depressed Mood and/or Loss of interest or pleasure -change in appetite, weight or sleep; fatigue; poor concentration; psychomotor agitation or retardation; worthlessness or guilt; suicidal thoughts; etc -Must last >2 weeks -Must cause marked distress or functional impairment -Cannot be caused by substance or general medical condition. Doesn't meet criteria for mixed episode (mania copresent). |
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SSRI
-Example -Proposed mechanism -Common Side Effects -Dangerous rare side effects |
Ex: Fluoxetine
-??Downregulation of 5-HT1A?? -??Increased BDNF?? Common side effects *Sexual dysfunction (5-HT2) *Nausea, diarrhea, other GI (5-HT3) -appetite changes -headaches -insomnia -initial anxiety, but subsides Dangerous Side Effects -Serotonin syndrome: agitated and confused, autonomic hyperactivity, and motor tremors. |
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SNRI
-Two drugs -Differences in dosage effects and one special usage -4 major side effects |
Venlafaxine: first SSRI, then NRI as dose increases; slight DRI at high dose.
Duloxetine: Both SSRI and NRI at low doses. Used for neuropathic pain. -HTN, insomnia, constipation, and sweating |
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NDRI
-Major benefits/uses -Major side effects |
Buproprion
Major benefits/uses - less weight gain, smoking cessation, possibly improve SSRI sexual dysfunction Major side effects -seizure risk in bulemics, insomnia, tremor, dry mouth, odd tastes. |
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SA(S)RI
-Key difference from SSRI side effects -1 drug no longer used: Mechanism and side effect -1 drug still used: Mechanism and side effect |
Both are more sedating and have less sexual dysfunction because of 5-HT2C block.
Nefazodone: SSRI, 5-HT2C antagonist, and alpha-1 antagonist. However, liver toxicity. Trazodone: SSRI, 5-HT2C antagonist, H1 antagonist, and alpha-1/2 antagonist. Used for its sedative properties. Rare Priapism! |
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NASSA/NSA
-Action -Receptors affected and their effects |
Mirtazapine: Noradrenergic serotinergic antagonist
Antagonist for the following receptors: -5-HT2a: antidepressant effects -5-HT2c: anxiolytic, sedative, reduced sexual dysfunction -5-HT3: less nausea -Alpha-2: increased NE and 5-HT output -H1: sedation and weight gain |
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MAOI
-Reversible? -Which enzymes? -Diet -Side effects -Severe side effects |
-Irresversible inhibitors
-MAO-A--> NE metabolism -MAO-B--> DA metabolism -Tyramine in diet can lead to HTN -Side effects: hypotension/orthostasis, antocholinergic (constipation, dry mouth, urinary retention), CNS (headaches, weakness, tremor), weight gain, impotence -Severe: coma, seizure, death from OD |
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TCA
-Two groups -Secondary biochemical effects -Common Side effects -Metabolism |
-NRI and SNRI
-H1 antagonist -alpha-1 antagonist -M1 antagonist -ion channel blocking. -Anticholinergic side effects -cardiovascular -CNS: sedation, confusion, tremor, seizures -Other: weight gain, impotence, mania in BP patients -P450 metabolism -1 week overdose can be lethal -Very cheap drugs |
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Major Depression: Remission
-Remitters -Responders |
-Remission: patient no longer meets criter for MDD, is asymptomatic/minimally symptomatic and has functional improvement
-Responders have symptomatic improvement, but remain majorly functionally impaired -3X risk of relapse |
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Duration of antidepressant therapy
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- First MDE: 12 months
- >or=2 MDE: maintenance treatment - >3 MDE: lifelong |
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Maintenance Therapy
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-Prevent recurrence
-Continue >or= 4 months -Same dose/drug as acute therapy -Duration, 2 episode cycles -Slowly taper over 3-6 months |
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Neurotransmitter: 5-HT
-Origin -Excess receptor stimulation side effects for 5HT-2 and 5HT-3 |
-Originates in Raphe Nucleus
Excess 5-HT2: sexual dysfunction and insomnia Excess 5-HT3 (?4?): Nausea, diarrhea, appetite |
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Neurotransmitter: DA
-Origin -Excess D2 Blockade side effects |
-Substantia Nigra
-Excess D2 Blockade: EPS, flattened affect, slowed cognition, increased prolactin |
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Neurotransmitter: NE
-Origin -Excess Alpha-1 Blockade side effects |
-Locus Ceruleus
-Alpha-1 Blockade: dizziness, hypotension, drowsiness, sexual dysfunction |
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Neurotransmitter: ACh
-Origin -Excess receptor inhibition side effects |
-??
-Anticholinergic (antimuscarinergic??) : blurred vision, dry mouth, constipation, difficulty urinating, confusion/delirium |
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Neurotransmitter: Histamine
-Origin -Excess H1 Blockade side effects |
-Hypothalamus
-H1 Blockade: sedation, weight gain, hypotension |