Antidepressants

What is the Amine Hypothesis?

The following is the definition of what?

Abnormally low levels of norepinephrine and/or serotonin underlie depression

What evidence is there of the Amine Hypothesis?

What are the following evidence of?
 Reserpine, an (old) antihypertensive drug depletes pre-synaptic stores of
norepinephrine (NE) and is associated with depressive symptoms,
 Autopsy studies of the brains of depressed suicide victims indicate a low
level of NE and/or serotonin (5-HT) metabolism in most brain regions,
 Drugs found to be beneficial act to enhance NE or 5-HT levels.

What is the major weakness of the Amine Hypothesis?

What is the Neuroendocrine Hypothesis?

Which drugs are Serotonin Selective Reuptake Inhibitors (SSRIs)?

What are the antidepressant drug classes?

What is the antidepressant drug class of the following?

Amitriptyline

What is the antidepressant drug class of the following?

Clomipramine

What is the antidepressant drug class of the following?

Imipramine

What is the antidepressant drug class of the following?

Phenylzine

What is the antidepressant drug class of the following?

Tranylcypromine

What is the antidepressant drug class of the following?

Selegiline

What is the antidepressant drug class of the following?

Fluoxetine

What is the antidepressant drug class of the following?

Paroxetine

What is the antidepressant drug class of the following?

Sertraline

What is the antidepressant drug class of the following?

Citalopram

What is the antidepressant drug class of the following?

Escitalopram

What is the antidepressant drug class of the following?

Venlafaxine

What is the antidepressant drug class of the following?

Duloxetine

What is the antidepressant drug class of the following?

Trazodone

What is the antidepressant drug class of the following?

Mirtazapine

What is the antidepressant drug class of the following?

Bupropion

What is the antidepressant drug class of the following?

Desvenlafaxine

What is the Neurotrophin Hypothesis?

What is described below?

 Laboratory research indicates that antidepressants increase BDNF production in hippocampus
- This requires long term (weeks) not short term (days) treatment
 BDNF increases neurogenesis and synaptic connectivity
 Stress, pain and depression can reduce BDNF
 Imaging studies indicate reduced hippocampal volume (size) in depression

Why do none of the depression hypotheses provide the full answer?

Inhibition of serotonin transporter (SERT) is the mechanism of action for which
antidepressant drug class?

What is the mechanism of action of Serotonin Selective Reuptake Inhibitors (SSRIs)?

Which antidepressant drug class is first line in treating depression?

Which SSRI(s) is approved for children?

Which SSRI(s) is approved in adolescents?

Which antidepressant drug class (and which drugs) are used for the following?

Depression, GAD, PTSD, OCD, panic disorder, PMDD,
bulimia

What are the SSRIs used for?

Which SSRIs are potent inhibitors of CYP 2D6?

- Interactions with tamoxifen and other CYP 2D6 substrates

Which SSRI does the following apply to?

Long half life of active metabolite; risk
of serotonin syndrome if switching to MAOI

Which antidepressant drug class has high selectivity for SERT (serotonin transporter)?

Which antidepressant drug class has a high therapeutic index?

What are the adverse effects of SSRIs?

Which SSRI is Category D?

Risk of heart defects with first trimester exposure

True or False

Discontinuation syndrome is an adverse effect of SSRIs and SNRIs

True or False

Significant weight loss is an adverse effect of SSRIs.

Which drugs are Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?

Which antidepressant drug class have high selectivity for SERT and NET (norepinephrine transporter)?

Which antidepressant drug class (and drugs) are used for depression, neuropathic pain, GAD, stress urinary
incontinence, and vasomotor symptoms of menopause?

Venlafaxine is metabolized to what by CYP 2D6?

What are the uses of SNRIs?

What are the adverse effects of Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)?

Discontinuation syndrome is an adverse effect of which antidepressants?

The adverse effects of SNRIs are similar to SSRIs but also include what?

Which drugs are Tricyclic antidepressants (TCAs)?

The following applies to which antidepressant drug class?

Dominant class of antidepressants until ~ 1990s when SSRIs took over

What is used in depression that is unresponsive to SSRIs and SNRIs?

What are Tricyclic antidepressants (TCAs) used for?

As a class, Tricyclic antidepressants (TCAs), inhibit what?

The following applies to which antidepressant drug class?

Narrow therapeutic index and bothersome side effects explain reduced use

When are Tricyclic antidepressants (TCAs)
taken?

The following applies to which antidepressant drug class?

Metabolized by CYP 2D6, serum levels are affected by inhibitors (e.g. fluoxetine)

The following applies to which antidepressant drug class?

Potentially lethal in overdose

What are the adverse effects of tricyclic antidepressants (TCAs)?

What are the drug interactions of TCAs?

The following are drug interactions for which antidepressant drug class?

CNS depressants, e.g. antihistamines, alcohol, benzodiazepines

The following applies to which antidepressant?

Antagonist for 5-HT2A receptor

The following applies to what antidepressant?

Used for depression and anxiety
 Seldom used as monotherapy
 Adjunct with SSRI for patients with insomnia

What is Trazodone used for?

The following applies to which antidepressant?

Used as a hypnotic – highly sedating and not associated with tolerance or dependence

If Trazodone is used as a hypnotic, how many times a day should it be taken?

The following applies to which antidepressant?

Rapid metabolism requires multiple doses per day

What are the adverse effects of Trazodone?

The following are the adverse effects of which antidepressant?

Sedation
GI
α1-antagonism: orthostatic hypotension
Has been associated with priapism

The following applies to which antidepressant?

Has CNS stimulating effects, inhibits NE and dopamine transporters;
increases presynaptic release of NE and dopamine

What is the mechanism of action of Bupropion?

What is the mechanism of action of Trazodone?

The following applies to what antidepressant?

 Not used for anxiety
 Not sedating
 Not associated with sexual side effects, bleeding or weight gain

The following are the adverse effects of what antidepressant?

 Agitation, anxiety, headache, insomnia, nausea, anorexia
 Lowers seizure threshold, problem in epilepsy, alcoholism, eating disorders

What is the pharmacology of Mirtazapine?

The following applies to what antidepressant?

Complex pharmacology; antagonist at adrenergic α2 and 5-HT2 receptor;
also H1 antagonist (sedative effects, weight gain)

The following applies to which antidepressant?

 Not associated with sexual side effects
 Sedating – useful for depression with insomnias
 Appetite stimulating – may be useful in depression plus anorexia

True or False

Mirtazapine is useful for depression with insomnias.

True or False

Mirtazapine may be useful for depression plus anorexia.

Mirtazapine is sedating and appetite stimulating. This could be useful in treating people who have depression and what other two conditions?

The following are the adverse effects of what antidepressant?

 Weight gain, dry mouth, constipation

What are the adverse effects of Mirtazapine?

What are the drug-drug interactions of Mirtazapine?

The following are the drug-drug interactions of what antidepressant?

Drug interactions with alcohol, benzodiazepines (increased sedative effects)

What drugs are Monoamine oxidase inhibitors (MAOI)?

What class of antidepressant drugs are described below?
 Irreversible inhibition of MAO-A and MAO-B; long duration of effect
 MAO-A: metabolizes NE, 5-HT and dopamine
 MAO-B: metabolizes dopamine

True or False

Monoamine oxidase inhibitors (MAOI) lead to irreversible inhibition of MAO-A and MAO-B

True or False

 MAO-A: metabolizes dopamine
 MAO-B: metabolizes NE, 5-HT and dopamine

What class of antidepressant drugs are used in treatment resistant depression?

What are Monoamine oxidase inhibitors (MAOI) used for?

The following are the adverse effects of what class of antidepressant drugs?

 Potentially lethal in overdose (autonomic, cardiac, seizures)
 Orthostatic hypotension, weight gain
 Insomnia, restlessness
 Discontinuation syndrome

What are the adverse effects of Monoamine oxidase inhibitors (MAOI)?

What food interactions are possible with Monoamine oxidase inhibitors (MAOI)?

What foods should be avoided with Monoamine oxidase inhibitors?

What classes of antidepressants are approved for PTSD, OCD, social anxiety,
GAD and panic disorder?

Therapeutic use of antidepressants requires how many months for benefit?

How long is the trial period for the therapeutic use of antidepressants? What should be done if there is inadequate response?

What are the therapeutic uses of antidepressants for pain?

Which antidepressants are approved therapies for Premenstrual Dysphoric Disorder?

Which antidepressant is as effective as nicotine patches for Smoking Cessation?

True or False

Antidepressants have more success helping anorexia than bulimia.

Most antidepressants have
sexual side effects. Which do not?

Which class of antidepressant can help with premature ejaculation?

Which class of antidepressant can help with “hot flashes”?

What is Serotonin Syndrome?

St. John’s wart can cause serotonin syndrome in the presence of what?

How do you choose an antidepressant?

True or False

At the population level, efficacy is similar for all antidepressant drugs.

Another treatment is augmentation of SSRI by adding another drug. What drugs could be added?