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29 Cards in this Set
- Front
- Back
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How long is an acute trial of treatment?
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4-6 weeks
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What timescale is considered maintenance treatment?
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6 months or longer
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What is the difference between relapse and recurrence?
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Timescale - relapse occurs before recurrence and occurs before recovery (1 year). Recurrences occur after recovery, during the maintenance phase.
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What treatments are considered primary antidepressants?
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SSRIs
Mixed monoamine reputake inhibitors Monoamine receptor antagonists Tricyclics (TCAs), heterocyclics MAOIs NMDA antagonists |
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what is the mechanism of action of SSRIs?
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Inhibit 5-HT reuptake transporter on the presynaptic cleft
Downregulate presynaptic 5-HT1A autoreceptors Increase 5-HT release Increase 5-HT in synaptic cleft, causing an increase in the stimulation of postsynaptic 5-HTRs |
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Name some SSRIs
*multiple examples will be given |
*Fluoxetine (Prozac)*
Sertraline (Zoloft) Paroxetine (Paxil) Fluvoxamine (Luvox) Citalopram (Celexa) Escitalopram (Lexapro) |
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Name some side effects of SSRIs
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Nausea, headaches
Orgasmic dysfunction, decreased libido Interact with tryptophan, MAOIs, fenfluramine Withdrawal Weight gain |
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What are the benefits of SSRIs?
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Effective in 60-70% patients
Broad comorbidity coverage (eg. anxiety disorders) Safer in overdose and less side effects than TCAs |
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What is the mechanism of action of mixed monoamine reuptake inhibitors?
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Inhibit reuptake of monoamines by presynaptic cleft
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What monoamines does Bupropion inhibit and what conditions does it treat?
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NE and DA
Smoking (Zyban) and Depression (Wellbutrin) |
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What is the mechanism of action for monoamine receptor antagonists?
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Block receptors binding monoamines, preventing stimulation of post-synaptic neuron
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Which antidepressant class of drugs is considered to be the "legacy antidepressants?"
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Tricyclics (TCAs), heterocyclics, secondary amines, and tetracyclics
First antidepressants to be used (1950s) Aren't used much anymore |
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Mechanism of TCAs
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Block NE and 5-HT reuptake transporters
Therefore, increase the amount and duration of neurotransmitter in the synaptic cleft |
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Why aren't TCAs used much anymore?
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Serious Side Effects = Lethal in overdose
Also, cardiac conduction effects, withdrawal |
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What is the mechanism of MAOIs?
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Block MAO, decreasing the degradation of monoamine neurotransmitters
Therefore, increases the availability of neurotransmitter |
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Why aren't older MAOIs used anymore?
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Have potentially lethal drug interactions with opiates, SSRIs, sympathomimetics, and food compounds (tyramine)
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Recall: what are the different classes of primary antidepressants?
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SSRIs
Mixed Monoamine Reuptake Inhibitors Monoamine receptor antagonists MAO Inhibitors Tricyclics and heterocyclics NMDA antagonists |
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Aside from antidepressants, what other types of antidepressant treatments exist?
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Mood Stabilizers (Thymoleptics)
Stimulants Electroconvulsive Therapy (ECT) Surgery Combination Biomedical Approaches Psychosocial |
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What novel approaches to depression are being taken?
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Continuation ECT
Repetitive transcranial magnetic stimulation (rTMS) Magnetic seizure therapy (MST) Vagus Nerve Stimulation (VNS) Deep brain stimulation (DBS) Somatic treatments |
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How does ECT treat depression?
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Induces seizure
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Side effects of ECT
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headaches, cognitive, stigma, anesthesia risk
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What subtypes exist within the class of Mood Stabilizers?
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Lithium
Anticonvulsants Atypical neuroleptics |
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What classes of treatments are available for someone with bipolar disorder?
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Antimanics
Antidepressants Thymoleptics |
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Name two widely used antimanic medications
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Lithium
Divalproex (Valproate) |
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What is the mechanism of Lithium?
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Increases 5-HT and Ach fxn
Decreases DA fxn Decreases phosphatidylinositide turnover Decreases adenylate cyclase activity Regulates G protein and PKC activity |
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Mechanism of Divalproex (Valproate)?
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*Antimanic med
Increases GABA synthesis & release Decreases GABA catabolism Increases GABA effects at receptor Regulates PKC activity |
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Name some atypical neuroleptics
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*Clozapine (Clozaril)*
*Olanzapine (Zyprexa)* Risperidone (Risperdal) |
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What is important to know about the side effects of atypical neuroleptics?
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They are often delayed in manifestation
*important to counsel pts on this* |
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Lamotrigine belongs to what class of drugs and treats what disorder?
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NMDA antagonist
Antidepressant & treats Epilepsy Efficacious in preventing bipolar depression relapse |
