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Psychopharmacology: SSRIs and SNRIs
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Psychopharmacology: SSRIs and SNRIs

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Questions and Answers

What is the adverse effect of fluvoxamine?

  • Aggression, violence and suicide
  • Bulimia
  • Anorexia, nausea and vomiting (correct)
  • Increased desire to eat

    • What is the contraindication of Duloxetine?

  • Neuropathic pain
  • Cardiac disease
  • Depression
  • Hepatic insufficiency and end-stage renal disease (correct)

    • What is the mechanism of action of Bupropion?

  • Increases serotonin reuptake
  • Blocks presynaptic alpha2-receptors
  • Inhibits noradrenaline and dopamine reuptake (correct)
  • Blocks postsynaptic 5-HT2 receptors

    • What is the side effect of Mirtazapine?

    <p>Sedation and weight gain</p> Signup and view all the answers

    What is the mechanism of action of Nefazodone and Trazodone?

    <p>Weak serotonin re-uptake inhibitors and block postsynaptic 5-HT2 receptors</p> Signup and view all the answers

    What is the adverse effect of SSRIs when combined with MAOI or Melatonin?

    <p>Serotonin syndrome</p> Signup and view all the answers

    What is the mechanism of action of SNRIs?

    <p>Inhibits reuptake of both serotonin and norepinephrine</p> Signup and view all the answers

    What is the side effect of Trazodone?

    <p>Priapism</p> Signup and view all the answers

    What is the type of MAOI that Tranylcypromine is?

    <p>Long acting reversible MAOI</p> Signup and view all the answers

    What is the advantage of SNRIs over TCAs?

    <p>Fewer adverse effects</p> Signup and view all the answers

    What is the blocking action of Alpha1 that leads to postural hypotension?

    <p>Alpha1</p> Signup and view all the answers

    Which of the following is NOT a therapeutic use of Tricyclic Antidepressants (TCAs)?

    <p>Hypertension</p> Signup and view all the answers

    What is the mechanism of analgesic activity of Tricyclic Antidepressants (TCAs)?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a side effect of Tricyclic Antidepressants (TCAs)?

    <p>Tachycardia</p> Signup and view all the answers

    What is the advantage of Lofepramine over other TCAs?

    <p>Less antimuscarinic effects</p> Signup and view all the answers

    What is the treatment of acute toxicity of Tricyclic Antidepressants (TCAs)?

    <p>All of the above</p> Signup and view all the answers

    What is the effect of Tricyclic Antidepressants (TCAs) on alpha2-receptors?

    <p>Down-regulation</p> Signup and view all the answers

    What is the advantage of Selective Serotonin Reuptake Inhibitors (SSRIs) over Tricyclic Antidepressants (TCAs)?

    <p>All of the above</p> Signup and view all the answers

    What is the therapeutic use of Selective Serotonin Reuptake Inhibitors (SSRIs)?

    <p>Mild to moderate depression</p> Signup and view all the answers

    What is the primary characteristic of depression?

    <p>Inability to cope with ordinary stress</p> Signup and view all the answers

    Which of the following is a characteristic of Selective Serotonin Reuptake Inhibitors (SSRIs)?

    <p>Less delay in the onset of action</p> Signup and view all the answers

    Which neurotransmitter is increased in the brain in schizophrenia?

    <p>Dopamine</p> Signup and view all the answers

    What is the mechanism of action of tricyclic antidepressants (TCA)?

    <p>Inhibit the reuptake of NA and 5HT</p> Signup and view all the answers

    Which of the following is a selective serotonin re-uptake inhibitor (SSRI)?

    <p>Fluoxetine</p> Signup and view all the answers

    What is the effect of tricyclic antidepressants on the brain?

    <p>Increase in the concentration of NA and 5HT</p> Signup and view all the answers

    Which of the following is a pharmacological effect of tricyclic antidepressants?

    <p>Anticholinergic</p> Signup and view all the answers

    What is the fate of tricyclic antidepressants after oral administration?

    <p>They are metabolized in the liver and excreted in the urine</p> Signup and view all the answers

    Which of the following is a type of antidepressant drug?

    <p>Mono-amino-oxidase inhibitor (MAOI)</p> Signup and view all the answers

    What is the effect of tricyclic antidepressants on the histamine receptors?

    <p>Blockade of H1 and H2 receptors</p> Signup and view all the answers

    Which of the following tricyclic antidepressants has the strongest sedative effect?

    <p>Amitriptyline</p> Signup and view all the answers

    Study Notes

    Antidepressant Drugs

    • Classification of antidepressants:
      • Tricyclic antidepressants (TCA)
      • Selective serotonin re-uptake inhibitors (SSRIs)
      • Serotonin/norepinephrine re-uptake inhibitors (SNRIs)
      • Atypical antidepressants
      • Monoamine oxidase inhibitors (MAOIs)

    Tricyclic Antidepressants (TCA)

    • Mechanism of action:
      • Inhibit pre-synaptic neuronal reuptake of NA & 5HT, leading to accumulation of these transmitters in the synaptic clefts in the brain
    • Pharmacokinetics:
      • Well absorbed orally
      • High 1st pass effect
      • Pass the blood-brain barrier (BBB)
      • Metabolized in the liver
      • Conjugated with glucuronic acid and excreted in urine
    • Pharmacological effects:
      • Antidepressant
      • Sedation (amitriptyline > imipramine > desipramine)
      • Anticholinergic (amitriptyline > imipramine > desipramine)
      • Antihistamine (H1 & H2 blockers)
      • Alpha1 blocking action, leading to postural hypotension
    • Therapeutic uses:
      • Depression
      • Obsessive compulsive disorders (clomipramine or fluvoxamine is better)
      • Panic and phobic states
      • Chronic pain
      • Nocturnal enuresis (anticholinergic action)
      • Peptic ulcer (doxepin), blocks muscarinic & H2 receptors
      • Attention deficit syndrome in children
    • Side effects:
      • Anticholinergic (atropine-like) action
      • Sympathomimetic effects
      • CNS: sedation, tremors, confusion, delirium, and seizures
      • CVS: postural hypotension, arrhythmia, tachycardia, and cardiomyopathy
      • Weight gain

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    • Advantages:
      • No sedation
      • No anticholinergic effects
      • No postural hypotension
      • No weight gain
      • Less delay in the onset of action
      • Effective in resistant cases to TCA & MAOI
    • Uses:
      • Mild to moderate depression
      • Obsessive compulsive disorders (fluvoxamine)
      • Bulimia (increased desire to eat)

    Serotonin/Norepinephrine Re-uptake Inhibitors (SNRIs)

    • Venlafaxine and duloxetine
    • Treat cases of depression which are resistant to SSRIs
    • Treat depression accompanied by neuropathic pain
    • No activity at adrenergic, muscarinic, or histamine receptors, resulting in fewer adverse effects than TCA
    • Duloxetine is contraindicated in hepatic insufficiency and end-stage renal disease

    Atypical Antidepressants

    • Have action at several different sites
    • Not more efficacious than TCAs or SSRIs, but have different side effects profiles
    • Include:
      • Bupropion
      • Mirtazapine
      • Nefazodone and trazodone

    Bupropion

    • Inhibits noradrenaline and dopamine reuptake
    • Decreases craving for nicotine in tobacco abusers
    • Side effects: dry mouth, sweating, tremor, and seizures at high doses

    Mirtazapine

    • Blocks presynaptic alpha2-receptors, increasing NA and serotonin
    • Blocks 5HT2 receptors
    • May cause sedation and weight gain

    Nefazodone and Trazodone

    • Weak serotonin reuptake inhibitors
    • Block postsynaptic 5-HT2 receptors
    • Both agents block H1-receptors, leading to sedation
    • Trazodone blocks α1, leading to priapism

    Monoamine Oxidase Inhibitors (MAOIs)

    • Hydrazine group: phenelzine, isocarboxazid
    • Non-hydrazine group: tranylcypromine, moclobemide, and clorgyline
    • Selegiline

    Amine Hypothesis of Mood

    • Psychic depression: decrease in concentration of noradrenaline and serotonin in the brain
    • Elevated mood: increase in noradrenaline and serotonin in the brain
    • Schizophrenia: increased dopamine in the brain

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    Description

    This quiz covers the effects and side effects of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) in treating depression, anxiety, and other disorders.

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