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63 Cards in this Set

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what & of ppl who have major depression will have a recurrent episode?
60%
MDD is subclassified into what two categories?
Melancholic and Psychotic
What is an identifying characteristic of melancholic depression?
Dysthymia. Depression that waxes and wanes during a period greater than 2 years.
What is an identifying characteristic of psychotic depression?
Psychosis. Delusions and hallucinations.
What is the diff b/w delusions and hallucinations?
Delusions=false beliefs
Hallucinations=internal stimuli that pt. thinks is from the outside
what is the meaning of double depression?
dysthymic d/o with an adverse event that plunges the pt. into a major depression.
a normal funtioning pt. presents with depression that she says seemed to be triggered by stressors like moving to a new state and ending a long term relationship. Dx?
adjustment d/o with depressed mood
it is impt to rule out organic causes of depression before treating depression. what are examples of dzes that can manifest as depression?
brain tumors
hypothyroidism
thyroid dz
cancer
exogenous drugs: amphetamines, cocaine, reserpine
what are the cardinal sxs of MDD?
anxiety, agitation, somatization, melancholy, insomnia, early morning waking, fatigue, anorexia, poor concentration
According to the AMJ what is the #1 disabling d/o in the US?
depression!
What was the effect seen in post MI patients given Zoloft (sertraline?)
lower morbidity and lower mortality compared to controls
what is the pharm theory of depresssion? what observations in drug users support this theory?
Depletion of NE and Epi in the brain causes depressive sxs.

Ppl who take amphetamines (NE) never show depressive sxs during their high...while people on reserpine (NE depleting Rx) showed significant sxs of depression
What are some non drug txes of depression?
ECT, Transcranial magnetic stimulation, vagal nerve stimulation, light therapy
Describe the two types of Bipolar D/O?
Type I=depression and MANIA
Type II= depression and HYPOMANIA
What is the prevalance of BP and is it seen more in men or women?
1% prevalance
seen more in women (3:2 ratio)
Why is BP harder to treat than some other psych disorders?
The mania component of BP gives pts a high that they enjoy--also, this mania can prevent a person from understanding that something is wrong with them
what is the pharm theory of BP?
too much NE stimulation
Drug tx for BP is Lithium and what other two drug classes?
Anti-convulsants and neuroleptics
why is it IMPERATIVE to give a mood stabilizer with an anti-depressant to a BP pt?
anti-depressants can stimulate NE activity which can bring a depressed patient into a manic state
Lithium has potential toxicity in what two organs? What blood protein must be monitored in pts taking Lithium?
Lithium has potential renal and thyroid toxicity. Must monitor T3 and T4 levels.
Neuroleptics are easier to use than Lithium because they have less toxic SE. What ARE their SE?
weight induction and hyperglycemia. Watch closely in a diabetic pt!
Name some neuroleptics?
Zyprexa, Risperdal, Seroquel, Abilify, Geodon
Lamictal is an anti-convulsant that is used in BP to prevent which phase?
the depressive phase
What are the medical implications of depression?
Pts over 55 with MDD die 4X more often than general population. Pts with MDD have poorer health status.
What are some neuroendocrine abnormalities seen with depression?
Increased blood cort
Blunted Growth Hormone response to insulin challenge
Blunted TSH response to TRH
What are essential features of mania?
distinct periods of abnl elevated/irritable mood, grandiosity/inflated self esteem, fast talking, flight of ideas, distractibility, great motivation and drive, and decreased need for sleep.
What are the essential features of Dysthymic Disorder?
chronically depressed mood for most of the day, on most days, for over 2 years. Difficulty making decisions, low energy, low self-esteem, poor concentration, loss of interest in pleaure, irritability, sx-free period lasts no longer than 2 months.
How are the dysthymia features different than the depressive features?
In MDD, the pt has more obsessive rumination, somatic complaints, delusions, hallucinations, excessive tearfulness. They have more overall acute dysfunction (life disruption) than a pt with dysthymia.
How does long term treatment with agonists or antagonists alter the post-synaptic site?
It alters the density and/or sensitivity of the Rs at the post synaptic cleft.
What is the amine hypothesis of depression?
The amine hypothesis states that depression is a deficit in amine function. It was shown that reserpine caused amine depletion and subsequent depression...
What happens to NT R sensitivity when the amount of NT R goes up?
The sensitivity of the R goes down
What is Reserpine used to treat? How does it cause depression?
Reserpine is used to treat HTN and schizophrenia. It causes depression by depleting amine NTs (serotonin and NE) from vesicle in the pre-syn. cleft
How do MAO inhibitors increase levels of amine in the syn. cleft?
MAOIs inhibit the degradation of NT by blocking the action of the enzyme MAO (which is responsible for the breakdown of serotonin and NE)
How to TCAs increase levels of amine in the syn. cleft?
TCAs block the Monamine reuptake pump from pumping NT out of the synapse.
MAOs increase levels of monoamines everywhere in the body and therfore see limited use because of low efficacy and toxicity. When are MAOs used?
In atypical depression
What chemical contained in foods has an interaction with MAOIs? What kinds of foods is Tyramine found?
Tyramine. It is found in aged foods: cheese, beer, wine, and chicken liver.
How do MAOIs and Tyramine cause HTNsive crises?
Tyramine is usually inactivated by MAO in the gut. When MAOIs are present, Tryamine goes up in high amounts --> release of large amounts of catecholamines from nerve terminals. Catecholamines cause dangerous elevations in BP.
Which other drugs have negative interactions with MAOIs?
1) L-DOPA, sympathomimetic tryclics --> HTNsive crisis
2) opioids, TCA's --> fever, delirium
3) oral hypoglycemics --> low blood glucose
MAOIs usage require that the pt be intelligent and compliant with recognizing sxs of BP increase. The pt must understand the importance of strict adherence to diet restrictions.
Just impt to note!
Future MAOIs will likely be reversible and selective. What will the two types be and what will they inhibit?
MAO-A will inhibit NE, Serotonin, and Tyramine.

MAO-B will inhibit Dopamine
Imipramine is a TCA with sedative properties. Why is it useful in treating depression?
It blocks the reupatke pump of amnines in the pre-syn cleft --> NT stays in the syn. cleft
What is the potential disadvantage of increasing the amount of NT in the syn cleft?
There is eventual downregulation of the NT R in the post syn. cleft.
Besides blocking the reuptake pump, what other Rs do TCAs block?
Alpha-adrenergic Rs
Muscarinic Rs
Histamine Rs
How fast are TCA's metabolized?
They have signficant first pass metablism; they are incompletely absorbed.
Is the lipid solubility of TCA's high or low? How does this affect protein binding?
The lipid solubility of TCA's is high, therefore their protein binding in the blood is also high.
What is the SE of TCAs on blockade of H1 Rs?
weight gain and drowsiness
What is the SE of TCAs on blockade of muscarinic Rs?
can't see, can't spit, can't pee, can't shit
What is the SE of TCAs on blockade of a adrenergic Rs?
dizziness and hypotension
What is the most difficult to manage SE of TCAs? How are they handled?
Cardiac toxicity: conduction defects and arrhythmias. Use antiarrhythmics with the least depressant effects on cardiac conduction.
Prozac (fluoxetine) is an SSRI that inhibits what liver E? What is the consequence of this?
CYP 450 --> causes multiple drug interactions
Trazadone is also an SSRI that causes what major SE?
sedation
What R do SSRIs act on?
5 HT Rs (serotonin Rs)
Wellbutrin (bupropion) is an antidepressant that is also used to treat?
smoking cessation
Venlafaxine has dual effects on what two NT?
It blocks reuptake of both NE and Epi
Hypericum is aka?
St. John's wort
What are the actions of Hypericum?
it's a natural MAOI and Serotonin Re-uptake I
What phase does Lithium tx in BP?
Lithium txs the manic phase. It prevents relapse in BP.
What kind of depression is Lithium used to tx?
Resistant depression
Lithium can upset a pts electrolyte balance. What is its therapeutic index?
Low therapeutic index: therapeutic dose=900mg
toxic dose=1800 mg
SEs of TCAs?
can't see, spit, pee, shit, mania, hypotension, arrhythmias
SSRI SEs?
nausea, vomiting, dry mouth, agitation
MAOI SEs?
same SEs as TCAs plus interaction with Tyramine
Anti-psychotics are very effective in treating schizophrenia but do they alter the course of the dz?
No