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Questions and Answers
What is the primary function of the hypothalamic-pituitary-adrenal (HPA) axis?
What is the primary function of the hypothalamic-pituitary-adrenal (HPA) axis?
What is the name of the gene that promotes the growth and survival of neurons?
What is the name of the gene that promotes the growth and survival of neurons?
What is the estimated percentage of depression vulnerability that can be attributed to genetic factors?
What is the estimated percentage of depression vulnerability that can be attributed to genetic factors?
What is the process of generating new neurons from neural stem cells or progenitor cells?
What is the process of generating new neurons from neural stem cells or progenitor cells?
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What is the role of thyroid hormones in the brain?
What is the role of thyroid hormones in the brain?
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What is the region of the brain where neurogenesis continues throughout adulthood?
What is the region of the brain where neurogenesis continues throughout adulthood?
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What is the term for the flexibility of the brain to change and adapt?
What is the term for the flexibility of the brain to change and adapt?
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What is the neurotransmitter involved in mood regulation?
What is the neurotransmitter involved in mood regulation?
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What is the main advantage of Electroconvulsive Therapy (ECT) compared to medication?
What is the main advantage of Electroconvulsive Therapy (ECT) compared to medication?
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Which of the following is a contraindication for Electroconvulsive Therapy (ECT)?
Which of the following is a contraindication for Electroconvulsive Therapy (ECT)?
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What is a common side effect of Electroconvulsive Therapy (ECT)?
What is a common side effect of Electroconvulsive Therapy (ECT)?
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What is the primary advantage of Repetitive Transcranial Magnetic Stimulation (rTMS) over Electroconvulsive Therapy (ECT)?
What is the primary advantage of Repetitive Transcranial Magnetic Stimulation (rTMS) over Electroconvulsive Therapy (ECT)?
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What is the outcome of the Treatment with Exercise Augmentation for Depression (TREAD) study?
What is the outcome of the Treatment with Exercise Augmentation for Depression (TREAD) study?
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What is the mechanism by which exercise helps to reduce stress levels?
What is the mechanism by which exercise helps to reduce stress levels?
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What is the usual dosage of mirtazapine?
What is the usual dosage of mirtazapine?
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What is a common side effect of mirtazapine?
What is a common side effect of mirtazapine?
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What is trazodone used for?
What is trazodone used for?
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What is a rare side effect of trazodone?
What is a rare side effect of trazodone?
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What is vilazodone used for?
What is vilazodone used for?
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What is vortioxetine used for?
What is vortioxetine used for?
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What is a CYP2D6 inhibitor?
What is a CYP2D6 inhibitor?
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What is a contraindication for bupropion?
What is a contraindication for bupropion?
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What is the recommended approach to stopping SSRI antidepressants?
What is the recommended approach to stopping SSRI antidepressants?
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What is the main advantage of selective serotonin reuptake inhibitors (SSRIs) as first-line antidepressants?
What is the main advantage of selective serotonin reuptake inhibitors (SSRIs) as first-line antidepressants?
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What is the characteristic of the dose-response curve of SSRIs?
What is the characteristic of the dose-response curve of SSRIs?
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What is the maximum dose of Citalopram that should be prescribed to avoid a high risk of QT prolongation?
What is the maximum dose of Citalopram that should be prescribed to avoid a high risk of QT prolongation?
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What is the usual dose range for Sertraline?
What is the usual dose range for Sertraline?
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What is the primary enzyme responsible for metabolizing Escitalopram?
What is the primary enzyme responsible for metabolizing Escitalopram?
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What is the common side effect of SSRIs that can be moderate in severity?
What is the common side effect of SSRIs that can be moderate in severity?
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Which of the following SSRIs has a high risk of anticholinergic effects?
Which of the following SSRIs has a high risk of anticholinergic effects?
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Which antidepressant is administered intranasally and has rapid onset of action?
Which antidepressant is administered intranasally and has rapid onset of action?
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Which antidepressant is approved for the treatment of postpartum depression?
Which antidepressant is approved for the treatment of postpartum depression?
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What is a common side effect of Esketamine?
What is a common side effect of Esketamine?
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Which antidepressant is available in extended-release tablets?
Which antidepressant is available in extended-release tablets?
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Which population may have a less prominent depressed mood compared to other symptoms?
Which population may have a less prominent depressed mood compared to other symptoms?
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Which medications are often considered first-choice in elderly patients?
Which medications are often considered first-choice in elderly patients?
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What is a recommendation for initial dosing in elderly patients?
What is a recommendation for initial dosing in elderly patients?
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What is a common side effect of Brexanolone?
What is a common side effect of Brexanolone?
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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.
