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What are common biological symptoms of depression?
What are common biological symptoms of depression?
Which psychotherapy approach is most appropriate for treating mild depression?
Which psychotherapy approach is most appropriate for treating mild depression?
What is the primary mechanism of most antidepressants in treating depression?
What is the primary mechanism of most antidepressants in treating depression?
Which class of antidepressants includes Bupropion and Reboxetine?
Which class of antidepressants includes Bupropion and Reboxetine?
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What is the duration of the continuation phase in the treatment of depression?
What is the duration of the continuation phase in the treatment of depression?
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What is the primary mechanism of action for Tricyclic antidepressants (TCA)?
What is the primary mechanism of action for Tricyclic antidepressants (TCA)?
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Which of the following is NOT classified as a Tricyclic antidepressant?
Which of the following is NOT classified as a Tricyclic antidepressant?
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What are the implications of the pharmacokinetics of TCAs regarding elderly patients?
What are the implications of the pharmacokinetics of TCAs regarding elderly patients?
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In the classification of antidepressants, which group primarily affects serotonin?
In the classification of antidepressants, which group primarily affects serotonin?
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What is a common side effect caused by the antimuscarinic effects of TCAs?
What is a common side effect caused by the antimuscarinic effects of TCAs?
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Which of the following pathways are involved in the mechanism of depression onset?
Which of the following pathways are involved in the mechanism of depression onset?
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How long does the antidepressant action of TCAs typically take to manifest?
How long does the antidepressant action of TCAs typically take to manifest?
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Which neurotransmitter is least affected by Tricyclic antidepressants?
Which neurotransmitter is least affected by Tricyclic antidepressants?
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What is a key consideration when choosing an antidepressant drug for a patient?
What is a key consideration when choosing an antidepressant drug for a patient?
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Which of the following accurately describes the mechanism of lithium's action in treating bipolar disorder?
Which of the following accurately describes the mechanism of lithium's action in treating bipolar disorder?
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What is the recommended duration for continuing an effective antidepressant regimen?
What is the recommended duration for continuing an effective antidepressant regimen?
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Which side effect is most commonly associated with the long-term use of lithium?
Which side effect is most commonly associated with the long-term use of lithium?
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Which class of antidepressant is typically preferred due to better tolerance and safety in overdose?
Which class of antidepressant is typically preferred due to better tolerance and safety in overdose?
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What are the physical side effects associated with lithium use?
What are the physical side effects associated with lithium use?
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In urgent situations, what alternative treatment may be considered for patients not responding to medication?
In urgent situations, what alternative treatment may be considered for patients not responding to medication?
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Which statement about antidepressants is true regarding their efficacy and side effects?
Which statement about antidepressants is true regarding their efficacy and side effects?
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What is the primary characteristic of depression as a mood disorder?
What is the primary characteristic of depression as a mood disorder?
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Which phase of pharmacological treatment for depression typically lasts for 6-12 months?
Which phase of pharmacological treatment for depression typically lasts for 6-12 months?
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In treating moderate depression, what combination of therapies is generally recommended?
In treating moderate depression, what combination of therapies is generally recommended?
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Which of the following describes a biological symptom of depression?
Which of the following describes a biological symptom of depression?
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What is the recommended treatment for individuals with severe depression?
What is the recommended treatment for individuals with severe depression?
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What characteristic allows carbamazepine to be effective in treating bipolar disorder?
What characteristic allows carbamazepine to be effective in treating bipolar disorder?
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Which of the following is a teratogenic effect associated with valproate use?
Which of the following is a teratogenic effect associated with valproate use?
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What is a common use of olanzapine in the treatment of bipolar disorder?
What is a common use of olanzapine in the treatment of bipolar disorder?
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Which class of drugs is known to be effective against both mania and depression in bipolar disorder?
Which class of drugs is known to be effective against both mania and depression in bipolar disorder?
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Which statement accurately describes a potential cardiovascular side effect of Tricyclic antidepressants (TCAs)?
Which statement accurately describes a potential cardiovascular side effect of Tricyclic antidepressants (TCAs)?
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What distinguishes lamotrigine in the treatment of bipolar disorder?
What distinguishes lamotrigine in the treatment of bipolar disorder?
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What is a common neurological side effect of Tricyclic antidepressants?
What is a common neurological side effect of Tricyclic antidepressants?
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Which class of antidepressants is considered to have fewer side effects than Tricyclic antidepressants?
Which class of antidepressants is considered to have fewer side effects than Tricyclic antidepressants?
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Which of the following is an indication for using Imipramine, a Tricyclic antidepressant?
Which of the following is an indication for using Imipramine, a Tricyclic antidepressant?
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Which interaction poses a risk when combining TCAs with alcohol?
Which interaction poses a risk when combining TCAs with alcohol?
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How do SSRIs primarily affect serotonin levels in the brain?
How do SSRIs primarily affect serotonin levels in the brain?
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What is a common adverse effect associated with the antimuscarinic properties of Tricyclic antidepressants?
What is a common adverse effect associated with the antimuscarinic properties of Tricyclic antidepressants?
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Which statement regarding the effectiveness of SSRIs in treating depression is true?
Which statement regarding the effectiveness of SSRIs in treating depression is true?
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What adverse effect is commonly associated with excessive stimulation in MAOIs?
What adverse effect is commonly associated with excessive stimulation in MAOIs?
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Which dietary component primarily poses a risk of hypertensive crisis when taken with MAOIs?
Which dietary component primarily poses a risk of hypertensive crisis when taken with MAOIs?
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Which of the following symptoms is NOT associated with a hypertensive crisis related to MAOI interactions?
Which of the following symptoms is NOT associated with a hypertensive crisis related to MAOI interactions?
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Which medication class is considered when tricyclics fail in treating depression?
Which medication class is considered when tricyclics fail in treating depression?
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What is one of the potential uses of Duloxetine outside of major depressive disorder?
What is one of the potential uses of Duloxetine outside of major depressive disorder?
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Which side effect is least likely to occur with SNRIs?
Which side effect is least likely to occur with SNRIs?
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Which of the following SSRIs, TCAs, and MAOIs combination is most likely to cause serotonergic syndrome?
Which of the following SSRIs, TCAs, and MAOIs combination is most likely to cause serotonergic syndrome?
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What serious consequence may arise from an overdose of SNRIs?
What serious consequence may arise from an overdose of SNRIs?
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Which statement about Bupropion is accurate?
Which statement about Bupropion is accurate?
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What is the primary mechanism of action of Mirtazapine?
What is the primary mechanism of action of Mirtazapine?
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What is a notable side effect of Agomelatine?
What is a notable side effect of Agomelatine?
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Which of the following compounds is known to inhibit the reuptake of multiple neurotransmitters?
Which of the following compounds is known to inhibit the reuptake of multiple neurotransmitters?
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What is the first-line treatment for patients with severe suicidal depression?
What is the first-line treatment for patients with severe suicidal depression?
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Which of the following represents a common characteristic of Atomoxetine?
Which of the following represents a common characteristic of Atomoxetine?
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How does Trazodone primarily achieve its antidepressant effects?
How does Trazodone primarily achieve its antidepressant effects?
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What type of patients is repetitive transcranial magnetic stimulation (TMS) most often applied to?
What type of patients is repetitive transcranial magnetic stimulation (TMS) most often applied to?
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Study Notes
Depression
- A mood disorder affecting cognitive, behavioral, and emotional aspects
- A long-term disease, but can be treated and cured
- Can affect anyone at any time in their life
- Requires treatment by a specialist
- It is a disease, not a weakness
Depression Symptoms
- Emotional Symptoms: Apathy, pessimism, sadness, low self-esteem
- Biological Symptoms: Sleep disorders, loss of motivation, loss of appetite, suicidal thoughts, delayed thinking and action, loss of libido
Other Forms of Depression
- Postpartum depression
- Premenstrual disorder
- Affective emotional disorder
Treatment of Depression
- Prevention
- Psychotherapy (mild depression)
- Psychotherapy + pharmacological treatment (moderate depression)
- Hospitalization (severe depression)
- ECT (Electroconvulsive Therapy)
Pharmacological Treatment of Depression
- Depression associated with decreased neurotransmitter release in the synapse, particularly Dopamine and 5-HT
- Treatment phases:
- Remission phase: takes 2-4 weeks for antidepressants to start working
- Continuation phase: 6-12 months
Tricyclic Antidepressants (TCA)
- Mechanism of action: Block the uptake of amines, inhibit noradrenaline and 5-HT uptake (less effect on dopamine uptake)
- Improves emotional symptoms: enhancement of 5-HT
- Relieves biological symptoms: facilitation of noradrenergic transmission (α receptors)
- Affect other receptors: antimuscarinic effects responsible for various side effects
TCA Pharmacokinetics
- Highly liposoluble drugs
- Good distribution (BBB)
- Taken orally, in progressively increasing doses
- Fixed to plasma proteins
- Hepatic metabolism
- Active metabolites
- Long elimination half-life (10-80 h), even longer in elderly patients
- Developing side effects
TCA Pharmacological Actions
- Antidepressant action seen during the first 4 weeks of treatment
- Improves sleep, appetite, psychomotor activity
- By the fourth week, depressed mood and feelings of despondency and hopelessness improve
- Clinical efficacy limited and varies among individuals
- Different classes of antidepressants have similar efficacy but different side effects
- Choice of drug based on individual aspects including concomitant disease
- SSRIs preferred as better tolerated and less dangerous in overdose
- Antidepressant drugs take several weeks to be effective, avoid changing dose or class prematurely
- MAOIs only prescribed by specialists
- Effective regimen should be continued for at least 2 years
- In urgent situations, specialist may consider electroconvulsive therapy (ECT)
- Anxiolytic (e.g. benzodiazepine), or antipsychotic drugs may be useful in some patients
Bipolar Disorder
- Mental health condition with extreme mood swings, including episodes of mania and depression
- These phases can significantly impact behavior, energy levels, and daily functioning
Treatment of Bipolar Disorder
- Lithium Salts: Lithium carbonate
- Orally administered
- Excreted by kidney
- Narrow therapeutic margin (monitoring of plasma concentration essential)
- Mechanism of action unknown
- Effective in both manic and depressive phases, acting as a stabilizer
- Increases the release of NA and 5-HT in the brain
- May be beneficial in neurodegenerative diseases such as Alzheimer's disease
Lithium Salts ADRs
- Gastric discomfort, nausea, vomiting, diarrhea
- Anorexia
- Weight gain
- Polyuria, thirst (due to inhibition of antidiuretic hormone action)
- Trembling hands
- In chronic administrations: Thyroid disorders, kidney disorders
- In the first months of pregnancy, can induce fetal malformations
Lithium Salts Therapeutic applications
- Drug of first choice in controlling manic phases and preventing bipolar disorder
Depression
- Depression is a mood disorder with cognitive, behavioral, and emotional alterations.
- It is a long-term disease, but one that can be treated and cured.
- Depression can affect anyone at any time in their life.
- It requires specialist treatment and is a disease, not a weakness.
Depression Symptoms
- Emotional: Apathy, pessimism, sadness, low self-esteem.
- Biological: Sleep disorders, loss of motivation, loss of appetite, suicidal thoughts, delayed thinking and action, loss of libido.
- Other forms of depression include postpartum depression, premenstrual disorder, and affective emotional disorder.
Treatment of Depression
- Prevention is crucial.
- Psychotherapy is effective for mild depression.
- Psychotherapy + Pharmacological Treatment is recommended for moderate depression.
- Hospitalization is necessary for severe depression.
- ECT (Electroconvulsive Therapy) can be used for treatment-resistant cases.
Pharmacological Treatment of Depression
- Depression is linked to decreased neurotransmitter release in the synapse, especially dopamine and serotonin.
-
Treatment phases:
- Remission phase: Antidepressants take 2-4 weeks to start working.
- Continuation phase: Requires 6-12 months of treatment.
Tricyclic Antidepressants (TCA)
- Actions: Anxiolytic, sedative, analgesic (particularly for chronic pain associated with depression), used in neuropathic pain treatment.
-
ADRs:
- Cardiovascular: Orthostatic hypotension, palpitations, tachycardia.
- Antimuscarinic Effect: Dry mouth, constipation, urinary retention, nasal congestion, blurred vision.
- Neurological: Tremors in hands and head.
- Other: Weight gain, excessive sweating, photosensitivity, gastrointestinal discomfort.
- Intoxication: Overdose is common due to suicidal tendencies, leading to arrhythmias, convulsions, and coma.
TCA Drug Interactions
- Pharmacodynamic: Enhances the actions of catecholamines and MAOIs.
-
Pharmacokinetic:
- Increases the activity of oral anticoagulants leading to increased bleeding risk.
- Oral contraceptives inhibit TCA metabolism.
- Potentiates the effects of alcohol and anesthetic agents, potentially causing death.
- Interferes with antihypertensive drugs.
TCA Therapeutic Applications
- Depressive syndromes.
- Anxiety syndromes (panic attacks).
- Hyperactivity syndrome: Imipramine.
- Treatment of enuresis: Children over 5 years old (imipramine).
- Pain: Neurogenic (phantom limb syndrome), oncological, headaches.
Selective Serotonin Reuptake Inhibitors (SSRI)
- Mechanism: Inhibits serotonin reuptake in the synapse, increasing serotonin concentration.
- Drugs: Fluoxetine, Paroxetine, Citalopram, Sertraline.
- Commonly prescribed antidepressant: Fewer cardiac side effects than TCAs.
- Less effective than TCAs for severe depression, equally effective for moderate depression.
- Pharmacokinetics: Oral administration, half-life of 15-24 hours.
- ADRs: Orthostatic hypotension, tremors, excitement, insomnia, convulsions (overdose), increased appetite.
Monoamine Oxidase Inhibitors (MAOI)
- Mechanism: Inhibits the enzyme MAO, preventing the breakdown of neurotransmitters like norepinephrine, dopamine, and serotonin.
-
Drug Interactions:
- Tyramine: Consumption of tyramine-rich foods (aged cheese, red wine, beer, cured meats) can lead to hypertensive crisis.
- SSRIs or TCAs: Risk of serotonin syndrome.
- Other drugs: Enhances depressant effects of sympathomimetics, antihistamines, and opioids, increasing the risk of overdose.
- Therapeutic applications: Reserve antidepressant, used when tricyclics and derivatives fail or in cases of atypical depression.
Serotonin and Noradrenaline Reuptake Inhibitors (SNRI)
- Mechanism: Non-selective inhibition of serotonin and norepinephrine reuptake.
- Drugs: Venlafaxine, Desvenlafaxine, Duloxetine.
- Widely used antidepressants, effective for some anxiety disorders.
- Potential uses: Treating perimenopausal symptoms (hot flushes and insomnia), neuropathic pain and fibromyalgia, urinary incontinence.
- Pharmacokinetics: Active orally, slow-release formulation available for venlafaxine to reduce nausea.
- ADRs: Headache, insomnia, sexual dysfunction, dry mouth, dizziness, sweating, decreased appetite, CNS depression (overdose), serotonin toxicity, convulsions, cardiac conduction abnormalities.
- Duloxetine: Reports of hepatotoxicity, contraindicated in patients with hepatic impairment.
Other Noradrenaline Uptake Inhibitors
-
Bupropion:
- Inhibits both norepinephrine and dopamine reuptake.
- No abuse potential.
- Used for nicotine dependence treatment.
- Can induce seizures at high doses.
-
Reboxetine and Atomoxetine:
- Highly selective for norepinephrine reuptake.
- Less effective for depression than TCAs.
- Atomoxetine is used for attention deficit/hyperactivity disorder.
Others: Natural Compounds
-
Hypericum perforatum (St. John's Wort):
- Main active ingredient: Hyperforin.
- Inhibits reuptake of serotonin, dopamine, norepinephrine, GABA, and glutamate.
- Antidepressant and anxiolytic effects.
- Significant drug interactions.
Monoamine Receptor Antagonists
-
Mirtazapine:
- Blocks alpha-2, 5-HT2C (antidepressant effects), and H1 receptors.
-
Trazodone:
- Combines 5-HT2A and 5-HT2C receptor antagonism with serotonin reuptake inhibition.
Melatonin Agonist
-
Agomelatine:
- Agonist of MT1 and MT2 receptors.
- Short biological half-life.
- Used to treat severe depression, usually taken once daily before bed.
- May work by correcting circadian rhythm disturbances.
- Associated with hepatotoxicity.
Electroconvulsive Therapy (ECT)
- Used for patients not responding to antidepressant drugs, especially severe suicidal depression.
- Effective treatment.
- Causes confusion and memory loss lasting for days or weeks.
Repetitive Transcranial Magnetic Stimulation (TMS)
- Less effective than ECT.
Clinical Use of Antidepressants
- Mild depression is often best treated with non-drug measures.
- Antidepressant drugs are advisable for moderate to severe depression.
- Doses should be adjusted to individual patient characteristics.
Lithium Carbonate
- Used for treatment of mania-depressive (bipolar) disorders.
- Improves 70% of cases, taking 1-2 weeks to take effect.
Bipolar Disorder: Antiepileptic Drugs
-
Carbamazepine, Valproate, Lamotrogine:
- Fewer side effects than lithium, effective for bipolar disorder.
- Valproate and carbamazepine are used for acute mania and long-term treatment.
- Lamotrigine prevents recurrence of mania and depression.
- Induce liver enzymes, modifying the actions of other drugs.
- Carbamazepine: Enzyme inducer.
- Valproic acid (valproate): Highly teratogenic, can cause spina bifida.
Bipolar Disorder: Atypical Antipsychotic Drugs
-
Olanzapine, Risperidone, Quetiapine, Aripiprazole:
- Second-generation drugs developed for schizophrenia.
- Antagonists of D2-dopamine and 5-HT2A receptors.
- Effective against mania.
- Used in combination with lithium or valproate for bipolar depression.
- Olanzapine is given with fluoxetine (antidepressant).
- Haloperidol: Indicated for prophylaxis of mania-depressive disease.
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Description
This quiz explores the complexities of depression as a mood disorder, covering its symptoms, treatment options, and various forms. Learn about emotional and biological effects, as well as approaches to therapy and pharmacological interventions. Understand depression as a serious condition that requires professional treatment.
