Term
| Depression: 5 types of disturbances: |
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Definition
1. Mood disturbance
2. Cognitive disturbance
3. Psychological disturbance
4. Somatic disturbance
5. Vegetative disturbance (ANS disturbance) |
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Term
| Depression Lifetime prevalence ~ ___% |
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Definition
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Term
| Depression: Females with a ______ incidence than males |
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Definition
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Term
Depression: Genetic Loading
Various studies estimate ____-____X more likely if a first-degree relative is depressed |
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Definition
1.5-3
"It is a multi-gene trait. Genetic Loading -> this info came from twin studies ex. Netherlands & Denmark -> revealed about 50% genetic" |
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Term
DEPRESSION: DIAGNOSTIC CRITERIA (DSM IV)
(1) ______ mood
(2) Diminished _____
(3) Significant ______ loss
Or _____ but usually loss
(4) _____/______
(5) Psychomotor ______/______
(6) ______/_______
(7) ______/_______
(8) decreased ability to _____
(9) ______ ideation |
|
Definition
(1) Depressed mood
(2) Diminished interest
(3) Significant weight loss
Or gain but usually loss
(4) Insomnia/hypersomnia
(5) Psychomotor agitation/retardation
(6) Fatigue/loss of energy
(7) Worthlessness/guilt
(8) decreased ability to think
(9) Suicidal ideation |
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Term
Biological Basis of Depression "Amine Hypothesis"
Depression is caused by a decrease in biogenic amines(primarily _____ & ____). Depletion of biogenic amines with _______ can induce depression in normal individuals. Drugs with antidepressant properties increase levels of biogenic amines (typically by _____ ______) |
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Definition
NE & 5-HT
reserpine -> "antipsychotic and antihypertensive drug that depletes monoamine neurotransmitters in the synapses & causes subsequent depression"
blocking re-uptake |
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|
Term
Dopamine affects (4)
NE affects (2)
Seretonin affects (2)
All three effect (1)
NE & Seretonin affect (1) |
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Definition
[image]
We can influence mood by any of these 3 b/c they overlap for mood |
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Term
| Drugs for Attention Deficit Hyperactive Disorder (3) |
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Definition
Methylphenidate (Ritalin)
Amphetamine (Vyvanse; Adderall)
Atomoxetine (strattera) |
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Term
| Which ADHD drugs are CNS stimulants? -> in normal people will keep you awake all night |
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Definition
Methylphenidate (Ritalin)
Amphetamine (Vyvanse; Adderall |
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Term
| Amphetamine (Vyvanse; Adderall) acts on neurotransmitter ________ more than the others. |
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Definition
|
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Term
| which ADHD drug has high abuse potential so is contraindicated in adults? |
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Definition
| Amphetamine (Vyvanse; Adderall) |
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Term
| which ADHD drug so is ideal for adults? |
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Definition
|
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Term
| Atomoxetine (strattera) acts on _____ neurotransmitter |
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Definition
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Term
Biological Basis of Depression "Receptor Hypothesis"
Antidepressants must be taken ___-___ week before clinical effect is seen and even longer (3-6 weeks) for maximum effect. Implies that...........
Some antidepressants decrease ___ and/or ____ receptors or decrease the _____ of these receptors. |
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Definition
1-3
....something downstream of receptor (transporter) blockade is esponsible for clinical efficacy
NE
5-HT
sensitivity |
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Term
| Antidepressant Drug Classes (4) |
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Definition
Tricyclic Antidepressants (TCAs)
Heterocyclics (Atypical) Antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs) Note: First-Choice Agents***
Monoamine Oxidase Inhibitors (MAOIs) |
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Term
| What is the first choice antidepressant drug class? |
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Definition
|
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Term
| no single TCA is more effective than the parent TCA _____ |
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Definition
|
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Term
| no other class of antidepressants is more effective at treating depression than the ____. However they are used less frequently because of lethal potential in _____. |
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Definition
TCAs
overdose -> can be used for suicide |
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Term
| ANTIDEPRESSANT DRUGS ARE ROUGHLY EQUIVALENT IN TERMS OF ____ |
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Definition
EFFICACY
Even though they are all comparably effective, sometimes you will have to hunt for a drug that is most effective in your patient by trying different classes of drugs. |
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Term
| ____ and ____ are usually primary considerations in deciding which drug will be tried first in a depressed patient (usually a ____) |
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Definition
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Term
FYI
Although antidepressant drugs are roughly equivalent drugs for groups of patients, individual patients may fare better on one drug than on another for unknown reasons
OFTEN FINDING THE RIGHT DRUG FOR THE RIGHT PATIENT MUST BE DONE EMPIRICALLY |
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Definition
|
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Term
|
Definition
Fluoxetine (Prozac®, generic)
Sertraline (Zoloft®)
Paroxetine (Paxil®)
Citalopram (Celexa®)
Escitalopram (Lexapro®)
Fluvoxamine* (Luvox®) |
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Term
| Fluoxetine is what type of drug? |
|
Definition
|
|
Term
| Sertraline is what type of drug? |
|
Definition
|
|
Term
| Paroxetine is what type of drug? |
|
Definition
|
|
Term
| Citalopram is what type of drug? |
|
Definition
|
|
Term
| Escitalopram is what type of drug? |
|
Definition
|
|
Term
| Fluvoxamine is what type of drug? |
|
Definition
|
|
Term
| Methylphenidate is what type of drug? |
|
Definition
|
|
Term
| Amphetamine is what type of drug? |
|
Definition
|
|
Term
| Atomoxetine is what type of drug? |
|
Definition
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Term
| _______ was the first SSRI -> of all the agents, this one has a little higher propensity for _____ |
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Definition
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Term
| ______ (SSRI)-> may have some hypersomnia -> side effects will diminish with repeated use |
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Definition
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Term
| Will likely prescribe SSRIs for _____-_____. If have another episode, will then be on it for another _____ |
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Definition
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Term
| ______ -> SSRI specifically approved for OCD |
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Definition
|
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Term
| newest generation of antidepressants are ____ |
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Definition
|
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Term
| Mechanism of action of SSRIs? |
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Definition
selectively block serotonin reuptake
5-HT increased in synapse
Receptors for 5-HT (14 subtypes) are presumably modified (down regulated) |
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Term
| SSRIs have ____ side effects than older agents and are much safer in _____ |
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Definition
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Term
| SSRIs: Other Clinical Uses (4) |
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Definition
1. ANXIETY
-> Obsessive compulsive disorder (fluvoxamine)
-> Panic disorder
-> Premenstrual dysphoric disorder
2. Social phobia
3. Premature ejaculation
4. Chronic pain (not as often as TCAs) |
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Term
| _____ agents like _____ are better for chronic pain. |
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Definition
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Term
| SSRIs: Common Side Effects (5) |
|
Definition
1. sexual dysfunction (~30-40%)
-> Men difficulty ejaculating
-> Women difficultly orgasm
-> It is often the partner who is affected by the
sexual dysfunction
2. GI disturbances
-> Some drugs the appetite will go up
3. initial agitation
4. initial insomnia
-> Particularly w/ fluoxetine
5. Sedation
-> Particularly w/ Sertraline |
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Term
| SSRIs: Somewhat Less Common Side Effects FYI: |
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Definition
anxiety
nervousness
headache
tremor
asthenia
lightheadedness
dizziness
rashes
pruritis
tremor
sweating
dry mouth |
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Term
| Why don't prescribe SSRIs to teens? |
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Definition
| Evidence for increased suicidal thought and behavior; however, no increase in completed suicides in any of the FDA cited studies |
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Term
| SSRIs cause ________. So get _____ w/ discontinuation. If stop suddenly, get _________. |
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Definition
physical dependence
withdrawal
discontinuation syndrome |
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|
Term
____________: Occurs with abrupt discontinuation of SSRIs after chronic treatment
Flu-like syndrome (20% of pts). Usually mild
Achy, don’t feel very good
How to avoid this? |
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Definition
discontinuation syndrome
taper off the dose slowly |
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Term
| Discontinuation syndrome is Less pronounced with _______ due to longer half-life than many of the other SSRIs. It is Most pronounced with ______. |
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Definition
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Term
SSRIs inhibit various drug metabolizing enzymes - leads to potential interactions with a variety of other drugs
Watch out for _______ |
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Definition
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Term
| The combination of an SSRI with an _____can be lethal! ->(SEROTONIN SYNDROME) |
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Definition
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Term
| Serotonin Syndrome: Symptoms FYI |
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Definition
altered mental status
fever
agitation
tremor
myoclonus
hypereflexia
ataxia
incoordination
diaphoresis; shivering
GI symptoms |
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Term
| What is the symptom of serotonin syndrome that is lethal? |
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Definition
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Term
| Amitriptyline is what type of drug? |
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Definition
TCA
I only included this one one slides b/c he said in class that it is the only one of the TCAs that we neeeded to know |
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Term
| what is the baseline drug for chronic pain b/c has better efficacy? |
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Definition
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Term
| Mechanism of action of TCAs? |
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Definition
| Block the reuptake of monoamine neurotransmitters (primarily NE and 5-HT, but also DA to a lesser extent) |
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Term
|
Definition
Antimuscarinic
§blurred vision
§dry mouth
§constipation
§urinary hesitancy
§confusion
Metabolic/Endocrine
§weight gain
§sexual disturbances
Sympathomimetic
§tremor
§insomnia
Cardiovascular
§orthostatic hypotension
§conduction alterations
§arrhythmias
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Term
A patient may overdose on as little as a ___ day supply of TCAs (depressed patients are at increased risk for suicide)
The pharmacokinetics of many TCAs hinder treatment of overdose -> why? |
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Definition
4
(large volume of distribution and high plasma protein binding make dialysis ineffective in removing ingested drug) Once amitriptaline has been absorbed, there is not much you can do and it iteracts w/ heart rhythms |
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Term
| How does amitriptyline work for chronic pain? |
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Definition
| Decreases the emotionally debilitating effects of pain |
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Term
| Other than chronic pain, what else can TCAs be used for? (3) |
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Definition
1. Enuresis -> Nocturnal bed wetting
So given to kids in a flavored syrup
2. panic disorder
3. attention deficit hyperkinetic disorder |
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Term
| Amitriptyline has the most ____ and strongest _____ side effects of all the TCAs (useful in ____) |
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Definition
sedative
antimuscarinic
enuresis |
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Term
| Amitriptyline Blocks ____ and_____ reuptake. |
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Definition
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Term
| Amitriptyline is Lethal in overdose through a quinidine-like effect on the heart. How is the heart affected? |
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Definition
| Slows conduction and sets up re-entrant arrhythmias |
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Term
| Venlafaxine is what type of drug? |
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Definition
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Term
| Bupropion is what type of drug? |
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Definition
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Term
| Trazodone is what type of drug? |
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Definition
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Term
| Duloxetine is what type of drug? |
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Definition
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Term
| Mirtazapine is what type of drug? |
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Definition
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Term
| Maprotiline is what type of drug? |
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Definition
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Term
| Nefazodone is what type of drug? |
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Definition
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Term
| Amoxapine is what type of drug? |
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Definition
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Term
| Bupropion interacts with the uptake site in _____ reuptake -> same mechanism as ______ -> Indicates an abuse potential, but bupropion is such a weak interaction that the abuse potential is very low -> it also has no ____ side effects. |
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Definition
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Term
what antidepressant can be prescribed for smoking cessation b/c it decreases smoking desire?
How does it decrease smoking desire? |
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Definition
Bupropion
Inhibitor of neuronal nicotinic receptors |
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Term
| What is the SSNRI that Lilly is marketing as being particularly useful in the treatment of painful physical symptoms of depression that has received FDA approval for treating diabetic neuropathic pain? |
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Definition
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Term
| What antidepressant has the Potential for seizures at high doses and is contraindicated in those with a seizure disorder? |
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Definition
Bupropion
"Typically don’t see this in SSRIs" |
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Term
| Venlafaxine Inhibits ____ and ___ reuptake |
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Definition
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Term
| Venlafaxine is a Low ___ and has _____ effects |
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Definition
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Term
| Venlafaxine has a Dose-related effect of sustained increase in _____. Particularly problematic in ____. |
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Definition
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Term
| if SSRIs don't work, what is the next line of treatment? |
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Definition
|
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Term
| Mechanism of action of MAOIs? |
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Definition
inhibit MAO, which metabolizes monoamines
Increased NE, 5-HT and DA in synapse with receptor down-regulation |
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Term
| MAOIs have adverse interactions with ____ in food |
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Definition
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Term
| MAOIs have high toxicity in ____ |
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Definition
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Term
| Phenelzine is what type of drug? |
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Definition
|
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Term
| Phenelzine - _______ inhibitor of MAO |
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Definition
|
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Term
| Tranylcypromine - ______ inhibitor of MAO |
|
Definition
reversible
"but very long acting" |
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Term
| Have to give pt. a week or two to get MAOIs out of their system before you switch them to an SSRI -> otherwise could get _____ |
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Definition
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Term
| MAOIs are rarely used because of the risk of interactions with many foods (those high in ____) and drugs (____ agents) |
|
Definition
tyramine
sympathomimetic (substances that mimic the effects of the sympathetic nervous system) |
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Term
| MAOIs block ______ of dietary tyramine. At noradrenergic nerve terminals tyramine produces the release of ___ which in turn results in a potentially fatal increase in ____ |
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Definition
deamination
NE
blood pressure |
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Term
| Foods to Avoid with MAOIs FYI: |
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Definition
aged cheeses
pickled herring
beers and wine
liver
yeast extract
dry sausages
fava beans |
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Term
| Serotonin Syndrome Symptoms FYI: |
|
Definition
hyperthermia
muscle rigidity
rapid changes in mental status and vital signs
myoclonus |
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|
Term
Manic Episode Criteria:
Elevated, expansive, or irritable mood for ___ week
__or more of the following, __ if irritable mood: (DTRHIGH)
D
T
R
H
I
G
H |
|
Definition
1+
3
4
Distractible
Talkative or pressured speech
Racing thoughts or flight of ideas
Hyper-alert = decreased need for sleep
Increased activity or psychomotor agitation
Grandiose
Hypersexual = risky acts |
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Term
Bipolar Disorder
Lifetime prevalence rate is ____-____%
First degree relatives ___X more likely to develop bipolar disorder
Concordance rate 79% in MZ twins and 19% in DZ twins
Average onset age ___ |
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Definition
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Term
|
Definition
|
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Term
| Mania never occurs without at some point a subsequent ____; often, the disorder starts with a ____ episode and have more of them than mania. |
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Definition
|
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Term
| baseline treatment for people w/ bipolar disorder? |
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Definition
|
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Term
| When lithium was Tested on psychiatric patients – in the midst of a full blown mania, lithium didn’t work, nor did it work in full blown depression, But if they are on a steady dose, then it reduced mania & depression |
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Definition
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Term
Lithium:
effects on electrolytes (substitutes for ____)
effects on neurotransmitter systems (___,____,___)
many of these effects are seen acutely, yet lithium must be taken for 2-3 weeks before clinical effects are seen. |
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Definition
|
|
Term
lithium has a very ____ therapeutic index
acute ~ 1.0-1.5 meq/L
maintenance ~0.5 - 1.2 meq/L
toxic levels ~ 2.0 meq/L
NOTE: ___-___% of bipolar patients do not respond to lithium. |
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Definition
|
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Term
| Lithium: Adverse Effects FYI: |
|
Definition
tremor
renal dysfunction (polydipsia & polyuria)
edema
weight gain
cardiac conduction problems
gastric distress
mild cognitive impairment
hypothyroidism |
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Term
| Valproic Acid + Sodium Valproate = Divalproex Sodium is what type of drug? |
|
Definition
Anticonvulsant Drug used to treat bipolar
Effective as lithium but hard on the stomach |
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Term
| Carbamazepine is what type of drug? |
|
Definition
Anticonvulsant drug used to treat bipolar
Easier in terms of side effects |
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|
Term
| Lamotrigene is what type of drug? |
|
Definition
Anticonvulsant drug used to treat bipolar
Used less |
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Term
| _______ or _______ are antipsychotic drugs Primarily used for controlling acute mania. |
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Definition
| Olanzepine or Haloperidol |
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Term
| Sedative drugs such as _____ may be given to sedate a manic individual w/ the permission of a police officer. |
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Definition
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Term
| In people w/ bipolar, they also have depression superimposed. They are probably stable on lithium but still falling into depression, but need to have mood stabilizer in place ____ getting on antidepressants because of the Danger of activation of mania if antidepressant is started too soon (ex. ______) |
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Definition
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Term
| _____ & _____ are antidepressants that are most likely to cause switch to mania (ex. Extreme euphoria), but SSRIs can certainly cause this as well |
|
Definition
|
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Term
| _______ is an antidepressant that has a low probability of a switch to mania (ex. Extreme euphoria) |
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Definition
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