59 Questions
Which drugs are used to treat psychoses including schizophrenia and dementias?
Antipsychotics
What is the common public perception related to depression, as mentioned in the text?
The patient is to blame
According to the text, how are neuropsychiatric disorders viewed in comparison to other medical disorders?
They are no different
What is the approximate lifetime incidence of depressive disorders?
10-20%
Which neurotransmitters are implicated in the underlying pathology of depression?
Norepinephrine, dopamine, serotonin
What is the lifetime risk of Major Depressive Disorder (MDD) in the population?
10-20%
Which medical conditions are associated with aggression/behavioral issues for which antidepressants are prescribed?
Alzheimer's, Parkinson's, brain injury
What are the symptoms of hypomania?
Highly elevated mood or energy, increased talkativeness
What distinguishes 'primary' depression from 'secondary' depression?
Primary depression occurs independently of any other medical diagnosis, while secondary depression occurs in the context of another medical diagnosis
Which receptors does mirtazapine antagonize?
5-HT2A, 5-HT2C, 5-HT3
What is the unique mechanism of action of gepirone as an antidepressant?
Selective partial agonist for the serotonin 5HT1A receptor and a2-adrenergic receptor antagonist
What are the serious concerns associated with gepirone?
Efficacy in the treatment of MDD, QT prolongation, and high incidence of adverse effects
What is the role of the gepirone metabolite, 1-PP?
a2-AR receptor antagonist
What is the mechanism of action of mirtazapine as an antidepressant?
a2-adrenergic receptor antagonist, 5-HT2A, 5-HT2C, 5-HT3 receptor antagonist
Which antidepressant produces its actions through inhibition of the dopamine and norepinephrine transporters?
Bupropion (Wellbutrin)
Which antidepressant is a weak 5-HT reuptake inhibitor and 5-HT2A receptor antagonist?
Vilazodone (Viibryd)
Which antidepressant has an increased risk of seizures, especially at higher doses?
Bupropion (Wellbutrin)
Which antidepressant is uniquely different because its antidepressant activity is generated through blockade of a2-adrenergic receptors?
Mirtazapine (Remeron)
Which class of antidepressants produces their actions through inhibition of SERT and NET, similar to the TCAs, but with fewer adverse effects related to blocking other receptors?
SNRIs
Which type of antidepressant is known to have interactions with various neurotransmitter receptors such as alpha-1, histamine, muscarinic, serotonin, and K+ channels?
Tricyclic Antidepressants (TCAs)
Which type of antidepressant came into prominence in the 1960s and is chemically related to phenothiazine antipsychotics?
Tricyclic Antidepressants (TCAs)
Which class of antidepressants is known for having irreversible and nonselective first-generation agents, while second-generation agents are more selective?
Monoamine Oxidase Inhibitors (MAOIs)
Which substance depletes monoamines and causes depression?
Reserpine
Which antidepressant blocks dopamine reuptake and enhances mood?
Cocaine
Which drug was the first selective serotonin reuptake inhibitor (SSRI) approved by the FDA for Major Depressive Disorder (MDD)?
Fluoxetine (Prozac®)
Which drug is known to produce m-CPP, an active metabolite and serotonergic agonist?
Trazodone (Desyrel®)
Which class of antidepressants inhibits both the serotonin transporter (SERT) and norepinephrine transporter (NET)?
Tricyclic Antidepressants (TCAs)
Which drug is chemically and pharmacologically related to Nefazodone (Serzone®)?
Sertraline
Which symptom is associated with Serotonin Syndrome induced by drugs increasing serotonin?
Cognitive, autonomic, and somatic effects
What is the approximate lifetime incidence of bipolar disorders?
1%
What is the approximate lifetime incidence of depressive disorders?
15-20%
Which neurotransmitters are implicated in the underlying pathology of depression?
Serotonin and norepinephrine
Which drug is chemically and pharmacologically related to Nefazodone (Serzone®)?
Trazodone
Which medical conditions are associated with aggression/behavioral issues for which antidepressants are prescribed?
Neuropsychiatric disorders
Which neurotransmitter is implicated in the underlying pathology of depression?
Serotonin (5HT)
What is the lifetime risk of suicide for individuals with Major Depressive Disorder (MDD)?
3%
Which medical condition is NOT associated with aggression/behavioral issues for which antidepressants are prescribed?
Hypertension
What is the approximate lifetime risk of Major Depressive Disorder (MDD) in the population?
10-20%
What is the primary mechanism of action of most presently available drugs for the treatment of depression?
Facilitating monoamine neurotransmission
Which of the following antidepressants has minimal adverse effects on sexual function due to lack of 5-HT2A activation?
Mirtazapine
Which antidepressant is known to have an increased risk of seizures, especially at higher doses?
Bupropion
Which neurotransmitter receptors does vilazodone primarily inhibit to produce its antidepressant actions?
SERT and NET
Which antidepressant has its unique intrinsic activity to activate 5-HT1A receptors, distinguishing it from SSRIs?
Vortioxetine
Which antidepressant is a weak 5-HT reuptake inhibitor and 5-HT2A receptor antagonist?
Trazodone
Which neurotransmitter receptor does mirtazapine primarily antagonize to produce its antidepressant effects?
5-HT1A
Which neurotransmitter receptor does gepirone act as a partial agonist for?
Serotonin 5-HT1A receptor
What is the unique mechanism of action of Gepirone as an antidepressant?
Selective partial agonism of 5-HT1A receptors
Which neurotransmitter receptor does Ketamine primarily antagonize to produce its antidepressant effects?
NMDA
Which neurotransmitter receptor does Brexanolone primarily modulate to produce its antidepressant effects?
GABAA
Which neurotransmitters are implicated in the underlying pathology of depression?
Serotonin, norepinephrine, and dopamine
Which class of antidepressants came into prominence in the 1960s and is chemically related to phenothiazine antipsychotics?
Tricyclic Antidepressants (TCAs)
Which drug depletes monoamines and causes depression?
Reserpine
Which type of antidepressant is known for having irreversible and nonselective first-generation agents, while second-generation agents are more selective?
Monoamine Oxidase Inhibitors (MAOIs)
Which class of antidepressants inhibits both the serotonin transporter (SERT) and norepinephrine transporter (NET)?
Tricyclic Antidepressants (TCAs)
Which of the following drugs is known to produce m-CPP, an active metabolite and serotonergic agonist?
Trazodone (Desyrel®)
Which class of antidepressants is associated with irreversible and nonselective first-generation agents, while second-generation agents are more selective?
Tricyclic Antidepressants (TCAs)
Which drug has extensive off-label use as a sedative among the '2nd generation antidepressants'?
Trazodone (Desyrel®)
Which drug was the first selective serotonin reuptake inhibitor (SSRI) approved for Major Depressive Disorder (MDD)?
Fluoxetine (Prozac®)
Which adverse effect is associated with Tricyclic Antidepressants (TCAs) but not with Selective Serotonin Reuptake Inhibitors (SSRIs)?
Cardiac arrhythmias
Study Notes
Antidepressants: A Comprehensive Overview
- Tricyclic Antidepressants (TCAs) such as imipramine and amitriptyline inhibit SERT and NET, with nine available in the U.S.
- TCAs have adverse side effects including cardiac arrhythmias, hypotension, anti-cholinergic effects, and sedation.
- Fluoxetine (Prozac®), the first selective serotonin reuptake inhibitor (SSRI), was FDA approved for MDD in 1987 and achieved significant commercial success.
- Fluoxetine has been approved for various conditions including OCD, bulimia nervosa, panic disorder, and premenstrual dysphoric disorder.
- Success of fluoxetine led to the development of other SSRIs such as sertraline, paroxetine, and citalopram.
- Side effects of fluoxetine and SSRIs in general include nausea, vomiting, insomnia, sexual dysfunction, anxiety, appetite suppression, and increased risk of suicide (Black Box Warning).
- The FDA's Black Box Warning on antidepressant use in adolescents has led to decreased diagnosis and treatment of childhood depression, decreased use of antidepressants in all age groups, and a decrease in MDD diagnoses.
- Serotonin Syndrome can be induced by drugs increasing serotonin (e.g., SSRIs) and has symptoms such as cognitive, autonomic, and somatic effects, and can be life-threatening.
- Treatment for Serotonin Syndrome is mostly supportive and involves discontinuation of implicated drugs, use of the antagonist cyproheptadine, and dantrolene to control rigidity and fever.
- Trazodone (Desyrel®) was the first of the "2nd generation antidepressants" and has extensive off-label use as a sedative, while Nefazodone (Serzone®) is chemically and pharmacologically related.
- Both Trazodone and Nefazodone produce m-CPP, an active metabolite and serotonergic agonist.
- Other drugs that can induce Serotonin Syndrome include monoamine oxidase inhibitors, sibutramine, tramadol, meperidine, dextromethorphan, amphetamines, and ecstasy.
Antidepressants: A Comprehensive Overview
- Tricyclic Antidepressants (TCAs) such as imipramine and amitriptyline inhibit SERT and NET, with nine available in the U.S.
- TCAs have adverse side effects including cardiac arrhythmias, hypotension, anti-cholinergic effects, and sedation.
- Fluoxetine (Prozac®), the first selective serotonin reuptake inhibitor (SSRI), was FDA approved for MDD in 1987 and achieved significant commercial success.
- Fluoxetine has been approved for various conditions including OCD, bulimia nervosa, panic disorder, and premenstrual dysphoric disorder.
- Success of fluoxetine led to the development of other SSRIs such as sertraline, paroxetine, and citalopram.
- Side effects of fluoxetine and SSRIs in general include nausea, vomiting, insomnia, sexual dysfunction, anxiety, appetite suppression, and increased risk of suicide (Black Box Warning).
- The FDA's Black Box Warning on antidepressant use in adolescents has led to decreased diagnosis and treatment of childhood depression, decreased use of antidepressants in all age groups, and a decrease in MDD diagnoses.
- Serotonin Syndrome can be induced by drugs increasing serotonin (e.g., SSRIs) and has symptoms such as cognitive, autonomic, and somatic effects, and can be life-threatening.
- Treatment for Serotonin Syndrome is mostly supportive and involves discontinuation of implicated drugs, use of the antagonist cyproheptadine, and dantrolene to control rigidity and fever.
- Trazodone (Desyrel®) was the first of the "2nd generation antidepressants" and has extensive off-label use as a sedative, while Nefazodone (Serzone®) is chemically and pharmacologically related.
- Both Trazodone and Nefazodone produce m-CPP, an active metabolite and serotonergic agonist.
- Other drugs that can induce Serotonin Syndrome include monoamine oxidase inhibitors, sibutramine, tramadol, meperidine, dextromethorphan, amphetamines, and ecstasy.
Test your knowledge of antidepressants with this comprehensive overview quiz. Explore the mechanisms, side effects, and uses of tricyclic antidepressants, selective serotonin reuptake inhibitors, and other related medications. Gain insight into the FDA's Black Box Warning, serotonin syndrome, and treatment options.
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