Antidepressants: MAOIs, TCAs, and SSRIs

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Questions and Answers

Why does the consumption of tyramine-rich foods pose a risk for individuals taking MAOIs?

  • MAOIs inhibit the breakdown of tyramine, potentially leading to a buildup of tyramine and a hypertensive crisis. (correct)
  • MAOIs directly convert tyramine into norepinephrine, leading to a hypertensive crisis.
  • Tyramine blocks the effects of MAOIs, rendering them ineffective and causing a drop in blood pressure.
  • Tyramine competes with MAOIs for enzyme binding, causing unpredictable fluctuations in mood.

A patient taking Isocarboxazid, Phenelzine, or Selegiline should be especially cautious about consuming which of the following?

  • Foods high in glutamate.
  • Foods high in tryptophan.
  • Foods high in tyramine. (correct)
  • Foods high in phenylalanine.

A psychiatrist is considering prescribing a TCA for a patient. Which of the following factors would most strongly favor choosing clomipramine over amitriptyline?

  • The patient has previously responded well to SSRIs.
  • The patient has co-morbid obsessive-compulsive disorder (OCD). (correct)
  • The patient has a history of chronic pain.
  • The patient has significant sleep disturbances.

How do SSRIs achieve their therapeutic effect in treating depression?

<p>By blocking the reuptake of serotonin, thus increasing its availability in the synaptic cleft. (D)</p> Signup and view all the answers

A patient with depression who also has low serotonin levels would likely benefit from which class of medication?

<p>SSRIs (C)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of Escitalopram, Fluoxetine, Paroxetine and Sertraline?

<p>Selective inhibition of serotonin reuptake transporters in the central nervous system. (C)</p> Signup and view all the answers

Why might a doctor prefer prescribing an SSRI over an MAOI as a first-line treatment for depression?

<p>SSRIs typically have fewer dietary restrictions and a lower risk of serious side effects compared to MAOIs. (B)</p> Signup and view all the answers

A patient is prescribed Amitriptyline. Knowing its mechanism of action, for which other condition might this medication provide a therapeutic benefit?

<p>Chronic Pain (D)</p> Signup and view all the answers

What is the primary mechanism by which clomipramine exerts its therapeutic effect in treating obsessive-compulsive disorder (OCD)?

<p>Blocking the reuptake of serotonin, thereby increasing its concentration and prolonging its action in the synapse. (B)</p> Signup and view all the answers

If a patient with depression has a deficiency in serotonin, which medication would directly address this issue by inhibiting its reuptake?

<p>Fluoxetine (C)</p> Signup and view all the answers

Which mechanism distinguishes SNRIs from SSRIs in the treatment of depression?

<p>Blocking the reuptake of both serotonin and norepinephrine. (C)</p> Signup and view all the answers

A patient with treatment-resistant depression is being considered for rapid-acting antidepressant therapy. Which of the following options is most appropriate?

<p>Ketamine or Esketamine. (B)</p> Signup and view all the answers

A patient is prescribed an SNRI. Which of the following medications aligns with this classification?

<p>Atomoxetine. (B)</p> Signup and view all the answers

What primary characteristic defines the mechanism of action of SSRIs?

<p>They block the serotonin transporter (SERT). (A)</p> Signup and view all the answers

Which of the following drug classifications includes Venlafaxine and Duloxetine?

<p>Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). (A)</p> Signup and view all the answers

In the context of mental health treatment, which medication class is typically used in the management of mania?

<p>Mood stabilizers such as Carbamazepine, Valproic Acid, and Lithium. (A)</p> Signup and view all the answers

Which medication is uniquely indicated for rapid antidepressant response?

<p>Ketamine/Esketamine. (D)</p> Signup and view all the answers

What is the crucial mechanism of action by which SSRIs like Fluoxetine, Fluvoxamine and Paroxetine exert their therapeutic effects on the brain?

<p>Selectively preventing the reuptake of serotonin in the synaptic cleft. (C)</p> Signup and view all the answers

Besides depression, which of the following conditions may be treated with Clomipramine, Fluoxetine, Fluvoxamine, or Paroxetine?

<p>Obsessive-compulsive disorder (OCD). (B)</p> Signup and view all the answers

Which pharmacological intervention is specifically approved for treatment-resistant depression?

<p>Esketamine. (C)</p> Signup and view all the answers

A patient with GAD is prescribed Buspirone. What receptor activity underlies its therapeutic effect?

<p>Selective 5-HT1A serotonin agonism (D)</p> Signup and view all the answers

For a patient experiencing severe anxiety with the need for immediate relief due to job demands, what is a key consideration when prescribing benzodiazepines?

<p>Potential for dependence and tolerance (C)</p> Signup and view all the answers

A student experiencing situational anxiety before an exam is prescribed a beta-blocker. What is the primary target of beta-blockers in this scenario?

<p>Blocking autonomic manifestations of anxiety-induced SANS activation (C)</p> Signup and view all the answers

Which of the following best describes how tricyclic antidepressants (TCAs) affect neurotransmitter function to achieve their therapeutic effect?

<p>Inhibiting the reuptake of serotonin and norepinephrine (D)</p> Signup and view all the answers

A researcher is investigating the mechanism of action of MAO inhibitors. What is the direct enzymatic target of these drugs?

<p>Monoamine oxidase (D)</p> Signup and view all the answers

A psychiatrist is determining which TCA to prescribe. Considering the differences in target affinities, which statement accurately describes the distinct mechanism of action among imipramine, desipramine, and clomipramine?

<p>Imipramine equally targets SERT and NET, desipramine preferentially targets NET, and clomipramine preferentially targets SERT. (D)</p> Signup and view all the answers

A patient is prescribed Buspirone for GAD but is not experiencing immediate relief. How does Buspirone's mechanism of action explain this?

<p>As a selective 5-HT1A serotonin agonist, it modulates serotonin activity gradually, leading to a delayed therapeutic effect. (D)</p> Signup and view all the answers

Why are beta-blockers particularly useful for addressing the somatic symptoms of anxiety, such as palpitations and sweating, but less effective for the cognitive aspects of anxiety, such as worry and rumination?

<p>Beta-blockers selectively block peripheral adrenergic receptors, mitigating physical symptoms without directly impacting cognitive processes. (D)</p> Signup and view all the answers

Given that TCAs like imipramine, desipramine, and clomipramine inhibit both serotonin and norepinephrine reuptake, what potential risk should be carefully monitored when prescribing these medications?

<p>Potential for hypertensive crisis, especially when combined with certain foods or medications (B)</p> Signup and view all the answers

How is it that MAO inhibitors can interact dangerously with a wide variety of foods and medications, leading to potentially severe side effects like hypertensive crisis?

<p>By directly inhibiting the metabolism of tyramine and other monoamines in the digestive system and liver (D)</p> Signup and view all the answers

Flashcards

Why are MAOIs not used frequently?

MAOIs activate amines such as norepinephrine, and serotonin. Tyramine build-up can lead to a hypertensive crisis.

Modern examples of MAOIs

Isocarboxazid, Phenelzine, Selegiline.

Clomipramine

A tricyclic antidepressant (TCA) used for OCD; targets the serotonin transporter.

Amitriptyline

A tricyclic antidepressant (TCA) used for depression and pain management.

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Commonly used SSRIs

Escitalopram, Fluoxetine, Paroxetine, and Sertraline

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MOA for SSRIs

SSRIs block the serotonin transporter, increasing serotonin availability in the synaptic cleft. Effective for depression, especially when low serotonin levels are present.

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Atomoxetine

SNRI used for ADHD treatment.

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Rapid Antidepressant Drugs

Ketamine and Esketamine are used to achieve a fast antidepressant effect, especially in treatment-resistant depression.

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Treatment for Mania

Carbamazepine, Valproic Acid, and Lithium.

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T or F: SSRIs are SERT blockers

SSRIs block the serotonin transporter (SERT).

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Clorimipramine, Fluoxetine, Fluvoxamine, Paroxetine

These SSRIs can be used to treat OCD.

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Buspirone

A selective 5-HT1A serotonin agonist used to treat Generalized Anxiety Disorder (GAD).

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Benzodiazepines for Anxiety

Benzodiazepines like alprazolam and clonazepam are rapid-acting anxiolytics, but carry a risk of dependence/tolerance.

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Beta-Blockers for situational anxiety

Beta-blockers block the autonomic manifestations of anxiety (fight or flight), such as feeling like you are going to vomit before an exam.

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Tricyclic Antidepressants (TCAs) MOA

TCAs inhibit serotonin and norepinephrine reuptake by blocking SERT and NET, increasing neurotransmitter availability in the synaptic cleft..

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MAO Inhibitors MOA

MAO inhibitors prevent the breakdown of dopamine, norepinephrine, and serotonin by inhibiting monoamine oxidase, increasing neurotransmitter levels in the neuron.

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Imipramine, Desipramine, Clomipramine

Imipramine equally targets SERT and NET. Desipramine preferentially targets NET. Clomipramine preferentially targets SERT.

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Study Notes

  • Buspirone is a selective 5-HT1A serotonin agonist used for Generalized Anxiety Disorder (GAD).
  • Benzodiazepines like alprazolam and clonazepam are rapid-acting anxiolytics but have a high dependence/tolerance risk.
  • Beta-blockers can be used for situational anxiety to block autonomic manifestations of anxiety-induced sympathetic activation (fight or flight response), such as the feeling of vomiting before an exam.
  • Tricyclic antidepressants (TCAs) inhibit serotonin and norepinephrine reuptake by blocking SERT (serotonin transporter) and NET (norepinephrine transporter), allowing these neurotransmitters to stay in the synaptic cleft longer.
  • Monoamine oxidase inhibitors (MAOIs) inhibit monoamine oxidase, the enzyme that breaks down dopamine, norepinephrine, and serotonin. This leads to increased levels of these neurotransmitters in the neuron and more release at the synapse.
  • Imipramine equally targets SERT and NET, increasing serotonin and norepinephrine in the synaptic cleft.
  • Desipramine preferentially targets NET, increasing norepinephrine.
  • Clomipramine preferentially targets SERT, increasing serotonin.
  • Monoamine Oxidase Inhibitors (MAOIs) are not used as frequently because they indirectly activate amines, including norepinephrine, serotonin, dopamine, and dietary tyramine.
  • A buildup of tyramine can lead to excessively high levels of norepinephrine, potentially causing a hypertensive crisis.
  • Modern examples of MAOIs include:
    • Isocarboxazid
    • Phenelzine
    • Selegiline
  • Clomipramine is a tricyclic antidepressant (TCA) used for obsessive-compulsive disorder (OCD).
    • It targets the serotonin transporter.
  • Amitriptyline is a TCA used for depression and pain management.
  • Commonly used Selective Serotonin Reuptake Inhibitors (SSRIs) include:
    • Escitalopram
    • Fluoxetine
    • Paroxetine
    • Sertraline

MOA for SSRIs

  • SSRIs block the serotonin transporter.
  • This inhibits the reuptake of serotonin into the neuron, allowing it to stay longer in the synaptic cleft.
  • This potentiates serotonin's effect on the brain/body.
  • SSRIs are effective for depression, as patients with depression usually have low levels of serotonin.

MOA for SNRIs

  • SNRIs block the serotonin AND norepinephrine transporter.
  • This inhibits their reuptake into the neuron.
  • Allows serotonin and norepinephrine to stay in the synaptic cleft longer.
  • Potentiates serotonin's effect on the brain/body.

Commonly used SNRIs

  • Venlafaxine
  • Duloxetine

Atomoxetine

  • SNRI used for ADHD

Drugs used for rapid antidepressant response

  • Ketamine
  • Esketamine (approved for treatment-resistant depression)

Treatment for Mania

  • Carbamazepine
  • Valproic Acid
  • Lithium

SSRIs and SERT Blockers

  • TRUE - SSRIs block the serotonin transporter (SERT)

SSRIs That Can be Used to Treat OCD

  • Clorimipramine
  • Fluoxetine
  • Fluvoxamine
  • Paroxetine

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