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ANTIDEPRESSANTS & MOOD STABILISERS
MEDICATION EXAM 2025| 67 QS & AS|A+ VERIFIED
What is depression? Anedhonia, low mood and low energy What is neuronal plasticity? The process that underlies learning and memory The nervous system modifies itself functionally and structurally in response to an injury or an event How does stress affect neuronal plasticity? Stress causes synaptic loss in cortex and limbic areas What is the role of the hippocampus? learning and memory What is the role of the nucleus accumbens?
part of dopamine reward system What are the five neurotransmitters and their functions? -Dopaminergic system- coordination of movements and motivation -Noradrenaline- influences attention and wakefulness -Serotonin- mood regulator, decreases negative feelings -Histamine- mediator of allergic reactions and mediates wakefulness -Adrenaline- function not clear What are the different classes of antidepressants? SSRIs, NRIs, SNRIs, MAOIs, TCAs and atypical antidepressants How many serotonin receptors are there altogether? 14 Why do anti-depressants have many drug-drug interactions? p450 inhibitors
How are SSRI absorbed and transported? Absorbed in the GI tract → bind to proteins in the blood and crosses the brain-blood barrier What length of time are there peak plasma levels of SSRI? 1-8 hours Where are SSRI metabolised? Liver What is the half life of SSRI? 1 day Which SSRI do not inhibit P450 enzymes?
citalopram and escitalopram --> which is why they are more likley to be used in elderly patients with polypharmacy What are the indications for SSRI? -first line antidepressants for anxiety, panic disorder, OCD, PTSD Which two CYP enzymes effect SSRI efficacy and safety? CYP 26 CYP 2C What are the side effects of SSRI? -QT prolongation -GI sx -Dizziness -Sexual dysfunction -Drowsiness -Insomnia
What symptoms may patients experience in discontinuation syndrome? Dysphoria Dizziness GI distress Fatigue/ Myalgia Can SSRIs be used in pregnancy? Yes if benefit outweighs risk Which SSRI is used in pregnancy? Fluoxetine Which SSRI causes QTc prolongation citalopram
Name an example of NRI Reboxetine What is the main use of Reboxetine? major depressive disorder How do NRIs work? Inhibit noradrenaline reuptake receptors → this allows more noradrenaline to remain in the synapse → increased noradrenaline stimulation What are the side effects of NRI? Excess noradrenaline → stimulates the sympathetic nervous system (fight or flight symptoms) What are SNRIs and how do they work? serotonin and norepinephrine reuptake inhibitors
What CYP inhibitor is duloxetine? Moderate CYP 2D6 inhibitor Side effects of SNRI? Hypertension (venlafaxine only) Hepatic failure Loss of appetite +SSRI side effects What is the mechanism of action of Monoamine oxidase inhibitors (MAOI)? MAO enzymes normally breakdown serotonin (5-HT), norepinephrine, and dopamine MAO stop this they are IRREVERSIBLE INHIBITORS What are the potentially lethal adverse reactions of MAOI? hypertensive crises
What lifestyle change must you make when on MAOI? very strict dietary restrictions Give an example of MAOI? selegilline Side effects of MAOI -GI upset -Headache -Dry mouth -Hypotension -myoclonic jerks What should MAOI never be prescribed with? Should NEVER be co-prescribed with SSRI or SNRI → risk of serotonin syndrome
Name 2 examples of Tricyclic antidepressants (TCA) and their metabolites? -Amitryptylline - nortryptylline -Imiprimaine- desprpramine, clomipramine Mechanisms of action of TCA -Inhibit serotonin reuptake -Inhibit norepinephrine reuptake -Histamine receptor antagonist -Muscarinic and alpha adrenergic receptor antagonist -Block Na+ and Ca+ channels What conditions can TCA be given for? Depression Anxiety Bulimia nervosa Neuropathic pain Smoking cessation
What is the half life of TCA? 1 day Which is TCA has superior pharmacological properties to other TCA? nortryptylline Which TCA is often used in refractory depression? nortryptylline Why is nortryptylline usedful in refractory depression? safe to be used with MAOI or selected SSRIs (sertraline) can use combinations of meds minimal drug interactions What are the side effects of TCA? -Antihistaminic- sedation, weight gain and confusion
Examples of atypical antidepressants Bupropion Mirtazapine Vortioxotine Buproprtion mechanism of action dopamine and norepinephrine reuptake inhibitor inhibits P Mirtazipine mechanism of action presynaptic alpha 2 adrenergic and post synaptic serotonin blockade Which antidepressant can be used for chronic pain? SNRI When do you review response to SSRI?
within 1 week due to side effects for desired effect/response- check after 4 weeks
