Neuronal Communication and Antidepressants

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Questions and Answers

What is the primary function of neurotransmitters at the synapse?

To block receptor stimulation

To return to the dendrite after use

To build connections between neurones

To stimulate receptors on the post-synaptic membrane (correct)

Which neurotransmitter is specifically reuptaken by SSRIs?

Dopamine

Serotonin (correct)

Acetylcholine

Norepinephrine

Which of the following SSRIs is noted for its potential to prolong the QT interval?

Fluoxetine

Paroxetine

Citalopram (correct)

Sertraline

What additional action do tricyclic antidepressants (TCAs) have besides blocking serotonin and norepinephrine reuptake?

They block acetylcholine and histamine receptors Signup and view all the answers

Which of the following medications is considered a first-line choice for children and adolescents?

Fluoxetine Signup and view all the answers

What side effect is commonly associated with paroxetine?

Weight gain Signup and view all the answers

How do SNRIs differ from SSRIs in their mechanism of action?

They block the reuptake of serotonin and noradrenaline Signup and view all the answers

Which SSRI is noted for having helpful anti-anxiety effects and is considered safe for patients with heart disease?

Sertraline Signup and view all the answers

What is a primary concern when using tricyclic antidepressants (TCAs)?

Dangerous side effects on the heart Signup and view all the answers

Which antidepressant is particularly indicated for patients with diabetic neuropathy?

Duloxetine Signup and view all the answers

What issue is commonly observed in younger patients when starting antidepressants?

Worsening of agitation and anxiety Signup and view all the answers

How should discontinuation of antidepressants be managed to minimize symptoms?

Reduce the dose slowly over several weeks Signup and view all the answers

What is a known benefit of mirtazapine in certain patients?

It may improve appetite in those with depression Signup and view all the answers

What risk is associated with venlafaxine overdose?

Higher risk of death from overdose Signup and view all the answers

Which medication is used as a third-line treatment option after inadequate responses to other antidepressants?

Vortioxetine Signup and view all the answers

What is a potential side effect of vortioxetine?

Nausea in the initial weeks Signup and view all the answers

What should be monitored within two weeks of starting an antidepressant?

Initial worsening of agitation or suicidal thoughts Signup and view all the answers

What approach should be taken when switching from an SSRI to mirtazapine?

Cross-taper over several weeks Signup and view all the answers

Study Notes

Neuronal Communication and Antidepressants

Neurones communicate at synapses, where neurotransmitters like dopamine, serotonin, noradrenaline, and GABA are released.
Neurotransmitters stimulate receptors on the post-synaptic membrane, creating a response.
Reuptake returns neurotransmitters to the pre-synaptic axon terminal.

Antidepressant Mechanisms

Selective serotonin reuptake inhibitors (SSRIs) block serotonin reuptake, increasing serotonin levels in synapses.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) block reuptake of both serotonin and noradrenaline.
Tricyclic antidepressants (TCAs) block serotonin and noradrenaline reuptake, and also block other receptors like acetylcholine and histamine causing side effects.

Types of Antidepressants and Side Effects

SSRIs: Sertraline, citalopram, escitalopram, fluoxetine, paroxetine
- Sertraline: Helpful for anxiety, safer in heart disease, higher risk of diarrhea.
- Citalopram: Can prolong QT interval, dose-dependent risk, less safe in heart patients.
- Escitalopram: Similar to citalopram, less safe in heart patients.
- Fluoxetine: Long half-life (4-7 days), first-line in children/adolescents.
- Paroxetine: Potential weight gain, higher risk of discontinuation symptoms.
SNRIs: Duloxetine, venlafaxine
- Similar side effects to SSRIs.
- Increased blood pressure, contraindicated in uncontrolled hypertension.
- Venlafaxine: Potentially higher risk of death from overdose..
- Duloxetine: Used for neuropathic pain, especially diabetic neuropathy.
TCAs: Amitriptyline, nortriptyline
- Commonly used in low doses for neuropathic pain.
- High risk of death from overdose, Arrhythmias (tachycardia, prolonged QT interval).
- Severe anticholinergic side effects (e.g., dry mouth, constipation, urinary retention).
Mirtazapine:
- Key side effects are sedation, increased appetite, weight gain.
- Best taken at night; helpful for loss of appetite and poor sleep, used in older patients.
Vortioxetine:
- Third-line treatment,
- Serotonin reuptake inhibitor and serotonin receptor modulator.
- Helpful anti-anxiety effects, low risk of sexual dysfunction or discontinuation symptoms.
- Nausea possible initially.

Starting and Managing Antidepressants

Initial worsening of symptoms (agitation, anxiety, suicidal thoughts) is possible, especially in younger patients.
Monitor patients closely within two weeks (one week for ages 18-25).
Note response typically happens in 2-4 weeks.
Dose adjustment or switching may be needed for inadequate response.
Switching strategies dependent on the meds. Some medications can be directly switched, others require cross-tapering.
Discontinuation should require slow reductions over at least four weeks.
Long-term treatment (at least 6 months, 2 years for recurrent depression) is important.

Serotonin Syndrome

Excessive serotonin activity, often from high doses or multiple antidepressants.
Symptoms range from mild to severe and potentially life-threatening.
Severe symptoms: Confusion, seizures, severe hyperthermia, respiratory failure.
Management: Supportive care, medication withdrawal is critical.

Treatment Tips

Consult with healthcare professionals for diagnosis and treatment.
Check the guidelines for proper antidepressant swaps.
Use the provided website for further knowledge.

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Description

This quiz explores the mechanisms of neuronal communication at synapses, focusing on neurotransmitters such as serotonin and their role in mental health. Additionally, it covers various types of antidepressants, including SSRIs, SNRIs, and TCAs, detailing their functions and potential side effects.