Ch.13 Comprehensive Guide to Antidepressants: Types, Mechanisms, and Effects

What are common symptoms of depression?

Dysphoric mood, loss of interest, sleep disturbance, withdrawal, difficulties in concentration.

How much does depression increase the overall mortality rate?

5x times greater probability of suicide.

How does depression manifest differently in women compared to men?

Women internalize emotions & have more thoughts/ attempts of suicide, men externalize emotions, lack sleep & may abuse alcohol or drugs.

What were early psychiatric hospitals lacking?

Didn't have psychotherapeutic drugs to treat patients w/ mental illness.

What cruel approaches were used in early psychiatric treatment?

Bloodletting, hot irons, flogging, and starvation.

What treatments for depression were studied in the mid-1800s?

Cannabis was studied for depression & mania.

What were some treatments for depression in the first half of the 1900s?

Amphetamines for depression, & carbon dioxide for psychosis.

What is the DSM-V criteria for Major Depressive Disorder?

5+ symptoms must be present during the same 2-week period, including depressed mood or loss of interest.

What are some symptoms included in the DSM-V criteria for depression?

Depressed mood, diminished interest, significant weight change, insomnia or hypersomnia, fatigue, feelings of worthlessness, & recurrent thoughts of death.

What is a major diagnostic consideration for depression?

Symptoms must cause clinically significant distress or impairment in social or occupational functioning.

What is the Monoamine Theory of Depression?

It posits that reduced monoamine activity (5-HT, NE, DA, E) leads to depression.

What is the role of tryptophan depletion in depression?

Used in research to study the effects of reduced serotonin transmission on mood.

What does the Glucocorticoid Theory of Depression suggest?

Chronic stress leads to HPA axis hyperactivity and downregulation of glucocorticoid receptors in the hippocampus.

How do stress hormones interact with monoamine systems in depression?

Stress hormones can encourage dopamine release & structural changes in the brain.

What is the effect of antidepressants on neurotransmission?

They increase activity in 1+ monoamine systems of the brain.

When do therapeutic effects happen w/ antidepressants?

Alleviation takes weeks after treatment begins.

What are 1st Generation Antidepressants?

Monoamine Oxidase Inhibitors (MAOIs) &

Tricyclic Antidepressants (TCAs).

What is the function of monoamine oxidase (MAO)?

MAO is an enzyme that degrades monoamines outside of vesicles.

What is the difference between MAO-A & MAO-B?

MAO-A degrades All monoamines, while MAO-B targets dopamine.

What are newer MAOIs known for?

They're reversible

What do tricyclic antidepressants (TCAs) primarily block?

Reuptake of serotonin (5-HT) & norepinephrine (NE) neurons.

What receptors do TCAs antagonize?

Cholinergic, histamine, & adrenergic receptors.

What is the main mechanism of action for SSRIs ?

They block the reuptake of serotonin.

What is a potential side effect of SSRIs related to receptor binding?

They bind to any 5-HT receptors.

What is the believed mechanism for the antidepressant effects of SSRIs?

5-HT1A receptors.

How long does it typically take for most TCAs to reach maximal blood concentrations?

1-3 hours, some take 8 hours.

how long does it take for SSRIs & SNRIs to reach maximal blood concentrations?

4-8 hours.

How does alcohol affect 1st-generation antidepressants?

It affects their efficacy.

What barriers do antidepressants cross?

Blood-brain & placental barriers.

What is a common side effect of MAOIs?

Tremors, weight gain, blurry vision, dry mouth, and postural hypotension.

What can cause dangerous side effects when taking MAOIs?

Interactions w/ certain food or drugs.

What is serotonin syndrome?

Increase in serotonergic transmission due to drug interactions.

What are common side effects of TCAs?

Anticholinergic effects - can't pee (urinary retention), can't poop (constipation) , can't spit (dry mouth), can't see (blurred vision)

What side effects are associated with SSRIs? (hint the S's)

Stomach issues, sexual dysfunction, swollen (weight gain) headache, & dizziness.

What is a common side effect of SNRIs?

Increased appetite & weight gain.

What effects do all classes of antidepressants have on sleep?

Causes insomnia or sedation

What is the half-life of fluoxetine?

Nearly 4 days, with its active metabolite having a half-life of 7-15 days.

How long may it take for fluoxetine metabolite to be fully eliminated from the body?

Up to 75 days.

What is the half-life of MAOIs?

2-4 hours

What can genetic deficiencies in drug metabolism lead to?

Extremely long half-lives w/ toxic effects.

What is a common side effect of SNRIs due to receptor antagonism?

Dizziness & dry mouth.

What is a common side effect of tricyclic antidepressants?

Drowsiness

Do tricyclics increase total sleeping time?

They don't increase sleeping time.

What effects may 2nd & 3rd-generation antidepressants have on sleep?

Can cause sedation or insomnia.

How do tricyclics affect REM sleep?

Some reduce REM sleep time, (can be beneficial)

What subjective effects do antidepressants typically produce?

They don't produce euphoric or pleasant effects.

What is a challenge in assessing the effects of antidepressants on performance?

It is difficult to separate drug effects from symptoms

What are SSRIs often referred to as in the context of personality?

A 'personality cosmetic' to modify personalities.

What % of people get relief of depression from using antidepressants?

60-70%.

What potential risks are associated w/ Fluoxetine ?

Induced intense, violent, suicidal preoccupations.

What is the FDA Black Box Warning related to SSRIs?

Increased risk of suicidal ideation in children, adolescents, and young adults.

What are common withdrawal symptoms from tricyclic antidepressants?

Restlessness, anxiety, chills, akathisia, and muscle aches.

What are some withdrawal symptoms associated with SSRIs?

Dizziness, light-headedness, insomnia, fatigue, anxiety, and nausea.

What is a common reproductive side effect of antidepressants?

Delayed ejaculation and loss of sexual interest.

What is the therapeutic index of tricyclic antidepressants?

Around 10 to 15.

What are some alternative treatments for depression mentioned?

Herbal remedies, electroconvulsive therapy, deep brain stimulation, exercise, therapy, and ketamine.

What is a significant concern regarding the use of antidepressants during pregnancy?

Potential teratogenic effects and greater risk of miscarriage.

What is the effect of tricyclics on avoidance behavior in nonhumans?

They decrease avoidance behavior at doses that have no effect on escape behavior.

What is a notable effect of SSRIs on adolescents?

They may lack efficacy and increase suicidal ideation.

What are the effects of SSRIs on cognitive tasks?

Some may improve memory and motor performance.

What is the relationship between antidepressants and compliance?

Patients must tolerate drug side effects for an extended period.