Podcast
Questions and Answers
Which of the following is a symptom of Major Depressive Disorder (MDD)?
Which of the following is a symptom of Major Depressive Disorder (MDD)?
High levels of cortisol have positive effects on brain cells.
High levels of cortisol have positive effects on brain cells.
False
What is the goal of Electroconvulsive Therapy (ECT)?
What is the goal of Electroconvulsive Therapy (ECT)?
To induce seizures via application of electricity to the brain.
The neurogenic hypothesis of depression suggests that decreased dendritic branching and decreased cell birth leads to decreased _____ and decreased ability to regulate HPA.
The neurogenic hypothesis of depression suggests that decreased dendritic branching and decreased cell birth leads to decreased _____ and decreased ability to regulate HPA.
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Match the following antidepressant types with their characteristics:
Match the following antidepressant types with their characteristics:
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What is a negative side effect of Tricyclic antidepressants?
What is a negative side effect of Tricyclic antidepressants?
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Brain derived neurotrophic factor (BDNF) levels are typically high in individuals with depression.
Brain derived neurotrophic factor (BDNF) levels are typically high in individuals with depression.
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Which of the following is NOT a known side effect of Selective Serotonin Reuptake Inhibitors (SSRIs)?
Which of the following is NOT a known side effect of Selective Serotonin Reuptake Inhibitors (SSRIs)?
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Dual-Action Antidepressants primarily target serotonin reuptake without affecting norepinephrine.
Dual-Action Antidepressants primarily target serotonin reuptake without affecting norepinephrine.
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What role does the amygdala play in the stress response?
What role does the amygdala play in the stress response?
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What is the primary therapeutic action of Duloxetine (Cymbalta)?
What is the primary therapeutic action of Duloxetine (Cymbalta)?
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The ___________ hypothesis suggests that increasing brain-derived neurotrophic factor (BDNF) leads to increased dendritic branching.
The ___________ hypothesis suggests that increasing brain-derived neurotrophic factor (BDNF) leads to increased dendritic branching.
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Match the antidepressants with their corresponding characteristics:
Match the antidepressants with their corresponding characteristics:
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What is a potential advantage of NMDA receptor antagonists in antidepressant treatment?
What is a potential advantage of NMDA receptor antagonists in antidepressant treatment?
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Name a critical limitation of older antidepressants compared to newer options.
Name a critical limitation of older antidepressants compared to newer options.
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What is the role of serotonin in the pain pathways?
What is the role of serotonin in the pain pathways?
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Which of the following best describes the term 'opiate'?
Which of the following best describes the term 'opiate'?
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Which of the following substances primarily functions as a pure agonist at mu receptors?
Which of the following substances primarily functions as a pure agonist at mu receptors?
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Which compound is synthesized from proenkephalin?
Which compound is synthesized from proenkephalin?
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What is the expected effect of opioids on emotional processing?
What is the expected effect of opioids on emotional processing?
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Which medication is primarily used to reverse opioid overdose?
Which medication is primarily used to reverse opioid overdose?
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What is the action of buprenorphine in relation to respiratory depression?
What is the action of buprenorphine in relation to respiratory depression?
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Which of the following combinations describes Suboxone?
Which of the following combinations describes Suboxone?
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What limits the clinical use of Pentazocine?
What limits the clinical use of Pentazocine?
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Which characteristic is true about Tramadol?
Which characteristic is true about Tramadol?
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Study Notes
Major Depressive Disorder (MDD) Treatment
- Symptoms: Sadness, helplessness, worthlessness, impaired sleep, concentration, anhedonia, physical pain; symptoms consistently interfere with daily life.
- Stress Response (HPA Axis): The amygdala detects stress, alerting the hypothalamus. The hypothalamus triggers the pituitary gland to release ACTH, signaling the adrenal glands to release cortisol and adrenaline for "fight or flight." This is part of the sympathetic nervous system.
Depressed Brain: Issues
- Chemical Imbalances: High cortisol levels negatively affect brain cells, impacting plasticity. A dexamethasone suppression test can assess cortisol levels. Low levels of Brain-Derived Neurotrophic Factor (BDNF) are associated with depression. Inflammation is also linked to depression.
Depressed Brain: Neurological Issues
- Structural Differences: High cortisol and low BDNF are correlated with decreased dendritic branching in the prefrontal cortex, hippocampus, and amygdala, potentially reducing volume/plasticity. Decreased neurogenesis (birth of new cells) in the hippocampus is also seen.
- Decreased Plasticity: Reduced dendritic branching and cell birth contribute to less HPA regulation, decreasing plasticity. Antidepressant treatment aims to restore these parameters.
Antidepressant Treatments
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Electroconvulsive Therapy (ECT): Induces seizures via electricity to "reboot" the brain. Fast-acting and effective, but short-lived effects, time-consuming, potential memory loss.
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Tricyclics (TCAs): Examples include imipramine (Tofranil). Block serotonin and norepinephrine reuptake. Side effects include confusion, memory impairment, sedation and potential cardiotoxicity (especially in overdose). Long-lasting effect (up to 4 days, longer for elderly.). Often used as a baseline to measure efficacy against new antidepressants.
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Monoamine Oxidase Inhibitors (MAOIs): Originally developed for tuberculosis treatment. Inhibit MAO (monoamine oxidase) activity, either irreversibly or reversibly. Requires dietary restrictions, as MAO metabolizes tyramine. Potentially cardiotoxic if dietary restrictions are not followed in conjunction with adrenaline-like medicines. May be effective in patients resistant to other treatments. Example: Selegiline transdermal patch (Emsam).
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Selective Serotonin Reuptake Inhibitors (SSRIs): Inhibit serotonin uptake and not other monoamines. Potential side effects: "serotonin syndrome" (cognitive disturbances, autonomic/neuromuscular issues, agitation). Discontinuation syndrome can also occur.
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Dual-Action Antidepressants: Target serotonin and norepinephrine reuptake. Include venlafaxine (Effexor), active metabolite desvenlafaxine (Pristiq). and duloxetine (Cymbalta). Duloxetine also approved for chronic pain conditions (fibromyalgia, nerve pain). Potential side effects include sexual dysfunction or blood pressure issues.
Monoamine Hypothesis (and Beyond)
- Monoamine Mechanisms: Some antidepressants also: increase BDNF, decrease oxidative stress, increase allopregnanolone, and increase hippocampal neurogenesis, enhancing neuroplasticity.
Future of Treatment
- New Antidepressant Needs: Faster onset, better efficacy and fewer side effects are sought.
- Emerging Techniques: NMDA receptor antagonists are investigated, as they may induce a burst of glutamate to stimulate synaptic plasticity; and also anti-inflammatory drugs.
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Description
Test your knowledge on the treatment and underlying mechanisms of Major Depressive Disorder (MDD). This quiz covers symptoms, the stress response, chemical imbalances, and neurological issues associated with depression. Enhance your understanding of how these factors interplay in the context of MDD.
