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32 Cards in this Set
- Front
- Back
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T/F Depression is the most common mental abnormality
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True
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Reactive depression
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- 60%
- Normal response to problems such as death - Decreases over time |
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Endogenous depression
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- No clear correlation w/ life events
- 25% unipolar - 15% bipolar |
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Symptoms of depression
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Decreased mood, dec in interests, sleep disturbances, appetite changes, loss of energy, feelings of worthlessness, denial of past accomplishments, guilt, intense psychological pain
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Biochemical basis for depression
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Depletion of neurotransmitters in the CNS (amine hypothesis) like NE and 5HT
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Depression can be treated with __ therapy or __ therapy
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Electroconvulsive; pharmacologic
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ECT depression therapy
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Benzodiazepine given first. Shock is equivalent to a gran mal seizure.
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Clinical uses of antidepressants (5)
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1- Depression
2- Bulimia 3- OCD 4- Panic attacks 5- ADD |
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General mechanism of action- antidepressants
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Increase neurotransmitter in the CNS
- Trancyclics, SSRIs, SNRIs => inhibit neurotransmitter reuptake - MAO => inhibit neurotransmitter breakdown |
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Tricyclic Antidepressants (2)
(1st generation) |
Imipramine, amitriptyline
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The first generation of antidepressants inhibit __ uptake
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NE
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Selective serotonin reuptake inhibitors (7) (2nd generation)
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1- Fluoxetine
2- Sertraline 3- Paroxetine 4- Fluvoxamine 5- Citalopram 6- Escitalopram 7- Vilazodone |
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SNRIs (4) (3rd generation)
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Inhibit NE and 5HT reuptake
1- Venlafaxine 2- Duloxetine 3- Milnacipram 4- Desvenlafaxine |
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Newer antidepressants w/ unknown mechanism (3)
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1- Buproprion
2- Nefazodone 3- Mirtazapine |
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S.E. of 1st generation antidepressants (TI 5-6)
(3 SE and 2 characteristics) |
- Low T.I.
- Sedation - Anticholinergic effects (antimuscarinic effects) - Cardiovascular effects (alpha 1 blockade=> dec BP, arrhythmias, OH) - Act on Ach, alpha 1, and histamine receptors |
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S.E. of 2nd generation antidepressants (TI 25-30)
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GI upset, insomnia, dec libido
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S.E. of 3rd generation antidepressants (TI 30+)
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GI upset, insomnia, dec libido, inc cardiovascular effects (arrhythmias)
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Toxic effects of antidepressants (3)
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Seizures, arrhythmias, kidney failure. Leading cause of suicidal drug overdose!
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Pharmacokinetics/dynamics of antidepressants
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- Effects may take weeks
- High volume of distribution; stored in fat cells - Long T1/2; stored in fat cells - Not to be mixed with EtOH |
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Mechanism of action of MAO inhibitors
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- Inhibit breakdown of catecholamines
- Normal patient taking these become hyperexcitable |
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The MAO inhibitors (3)
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1- Tranylcypromine
2- Phenelzine 3- Isocarboxazid |
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Toxicity of MAO inhibitors causes what? (5)
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Insomnia, agitation, hallucinations, seizures, liver toxicity
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T/F There is an increase risk for suicide in children and teens who take antidepressants
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True
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Drug interactions of antidepressants
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- When used w/ indirect acting amines (drugs that cause release of NE and 5HT- i.e. tyramine), a hypertensive crisis results
- Tyramine containing foods: aged cheese, wine, smoked foods |
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Tx for manic depression
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ECT and antipsychotic drugs
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Lithium
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- DOC for manic depression
- Has no effect on a regular person |
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Lithium mechanism of action
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Not clear but may stabilize the glutamate set point or blocks IP pathways.
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Pharmacokinetics of Li+
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- Low T.I. (1-2)
- Given orally - Takes about a week to start working |
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Short term side effects of Li+
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- Tremors
- Inc thirst and urination=> dec response to ADH - Weight gain and edema |
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Long term side effects of Li+ (2)
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Kidney damage and hypothyroidism
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At toxic levels Li+ can cause __ and __.
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Delirium; coma
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Diuretics __ Li+ uptake
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Increase
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