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Thyroid Hormones and Mood Regulation
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Thyroid Hormones and Mood Regulation

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Questions and Answers

What is the primary function of the hypothalamic-pituitary-adrenal (HPA) axis?

  • Maintaining homeostasis and responding to stress (correct)
  • Regulating energy metabolism
  • Producing neurotransmitters
  • Regulating mood

    • What is the name of the gene that promotes the growth and survival of neurons?

  • T3
  • T4
  • Serotonin
  • BDNF (correct)

    • What is the estimated percentage of depression vulnerability that can be attributed to genetic factors?

  • 10-20%
  • 20-30%
  • 40-50%
  • 30-40% (correct)

    • What is the process of generating new neurons from neural stem cells or progenitor cells?

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

    What is the role of thyroid hormones in the brain?

    <p>Influencing neurotransmitter regulation</p> Signup and view all the answers

    What is the region of the brain where neurogenesis continues throughout adulthood?

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

    What is the term for the flexibility of the brain to change and adapt?

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

    What is the neurotransmitter involved in mood regulation?

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

    What is the main advantage of Electroconvulsive Therapy (ECT) compared to medication?

    <p>It has a rapid response</p> Signup and view all the answers

    Which of the following is a contraindication for Electroconvulsive Therapy (ECT)?

    <p>Patients with epilepsy</p> Signup and view all the answers

    What is a common side effect of Electroconvulsive Therapy (ECT)?

    <p>Retrograde or anterograde amnesia</p> Signup and view all the answers

    What is the primary advantage of Repetitive Transcranial Magnetic Stimulation (rTMS) over Electroconvulsive Therapy (ECT)?

    <p>It is less invasive</p> Signup and view all the answers

    What is the outcome of the Treatment with Exercise Augmentation for Depression (TREAD) study?

    <p>16 kcal exercise per kilogram per week was associated with greater MDD remission rates</p> Signup and view all the answers

    What is the mechanism by which exercise helps to reduce stress levels?

    <p>Decreasing the production of stress hormones</p> Signup and view all the answers

    What is the usual dosage of mirtazapine?

    <p>Start with 15 mg QHS and titrate to 45 mg daily</p> Signup and view all the answers

    What is a common side effect of mirtazapine?

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

    What is trazodone used for?

    <p>Adjunct therapy</p> Signup and view all the answers

    What is a rare side effect of trazodone?

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

    What is vilazodone used for?

    <p>Depression with anxiety</p> Signup and view all the answers

    What is vortioxetine used for?

    <p>Depression with cognitive decline</p> Signup and view all the answers

    What is a CYP2D6 inhibitor?

    <p>The medication mentioned</p> Signup and view all the answers

    What is a contraindication for bupropion?

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

    What is the recommended approach to stopping SSRI antidepressants?

    <p>Taper off the medication over several weeks</p> Signup and view all the answers

    What is the main advantage of selective serotonin reuptake inhibitors (SSRIs) as first-line antidepressants?

    <p>Their relative safety in overdose and improved tolerability</p> Signup and view all the answers

    What is the characteristic of the dose-response curve of SSRIs?

    <p>Flat dose-response curve</p> Signup and view all the answers

    What is the maximum dose of Citalopram that should be prescribed to avoid a high risk of QT prolongation?

    <p>40 mg/day</p> Signup and view all the answers

    What is the usual dose range for Sertraline?

    <p>50-200 mg/day</p> Signup and view all the answers

    What is the primary enzyme responsible for metabolizing Escitalopram?

    <p>CYP2C19</p> Signup and view all the answers

    What is the common side effect of SSRIs that can be moderate in severity?

    <p>GI upset</p> Signup and view all the answers

    Which of the following SSRIs has a high risk of anticholinergic effects?

    <p>None of the above</p> Signup and view all the answers

    Which antidepressant is administered intranasally and has rapid onset of action?

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

    Which antidepressant is approved for the treatment of postpartum depression?

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

    What is a common side effect of Esketamine?

    <p>Transient psychotomimetic/dissociative effects</p> Signup and view all the answers

    Which antidepressant is available in extended-release tablets?

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

    Which population may have a less prominent depressed mood compared to other symptoms?

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

    Which medications are often considered first-choice in elderly patients?

    <p>SSRIs, Bupropion, and venlafaxine</p> Signup and view all the answers

    What is a recommendation for initial dosing in elderly patients?

    <p>50% of the usual initial dose</p> Signup and view all the answers

    What is a common side effect of Brexanolone?

    <p>Excessive sedation</p> Signup and view all the answers

    Study Notes

    Thyroid Hormones and Mood Regulation

    • Thyroid hormones T3 and T4 play a crucial role in regulating mood
    • They interact with neurotransmitters, influencing serotonin regulation and sensitivity

    Neuroplasticity and Neurogenesis

    • Neurogenesis is the process of generating new neurons (brain cells) from neural stem cells or progenitor cells
    • It occurs in specific regions of the brain, particularly the hippocampus
    • Brain-Derived Neurotrophic Factor (BDNF) promotes the growth and survival of neurons and is involved in neuroplasticity
    • Variations in the BDNF gene have been linked to depression vulnerability

    Genetic Predisposition

    • Heritability estimates suggest that genetics account for around 30-40% of the variance in vulnerability to depression
    • Twin, family, and adoption studies indicate a heritable component to depression

    Neuroendocrine Dysregulation

    • The hypothalamic-pituitary-adrenal (HPA) axis is a complex neuroendocrine system involved in regulating the body's response to stress and maintaining homeostasis

    Non-pharmacologic Treatment

    • Electroconvulsive therapy (ECT) is effective for treatment-resistant cases, catatonic depression, and delusions
    • Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive neurostimulation technique with mild side effects
    • Exercise is a safe and effective augmentation to pharmacotherapy, stimulating the release of endorphins and reducing stress hormones

    Selective Serotonin Reuptake Inhibitors (SSRIs)

    • SSRIs are first-line antidepressants due to their relative safety in overdose and improved tolerability
    • They include sertraline, citalopram, escitalopram, fluoxetine, paroxetine, and fluvoxamine
    • SSRIs have a flat dose-response curve, with a slightly increased benefit in dosing higher than the minimum effective dose

    α2-Adrenergic Antagonist

    • Mirtazapine (Remeron) enhances central noradrenergic and serotonergic activity by antagonizing central presynaptic α2-adrenergic auto and hetero receptors
    • It blocks histamine receptors, resulting in sedative properties
    • Mirtazapine should be considered for patients experiencing sexual dysfunction following antidepressant treatment

    Mixed Serotonergic Effects (Mixed 5-HT)

    • Trazodone (Oleptro) is used as an adjunct therapy, inhibiting 5-HT reuptake and blocking 5-HT2, α1-adrenergic, and H1 receptors
    • Vilazodone is useful in depression with anxiety, and vortioxetine is useful in depression with cognitive decline

    Second-Generation Antipsychotics

    • FDA-approved for augmentation of antidepressant treatment in refractory cases
    • They include aripiprazole, brexpiprazole, cariprazine, olanzapine, quetiapine, and risperidone

    New/Investigational Agents with Novel Mechanisms

    • Esketamine is approved for treatment-resistant depression, with rapid onset and intranasal formulation
    • Brexanolone is approved for postpartum depression, administered via intravenous infusion
    • Axsome (dextromethorphan-bupropion) treats major depressive disorder in adults

    Special Populations

    • Elderly: SSRIs are often first-choice, with bupropion, venlafaxine, and mirtazapine also effective and well-tolerated
    • Pediatrics: not mentioned
    • Pregnancy: not mentioned

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    Description

    This quiz explores the role of thyroid hormones T3 and T4 in regulating mood, energy metabolism, and neurotransmitter regulation. It covers the interaction between hormonal and neurotransmitter regulation in the brain.

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