N324 EXAM 2 UPDATED ACTUAL QUESTIONS AND CORRECT ANSWERS

N324 EXAM 2 UPDATED ACTUAL QUESTIONS AND
CORRECT ANSWERS

Question:
Argument for Theories of Biological Causes of Depression
Answer:
- Antidepressants actually work! So, there must be a biological component, right?
- Predictive power - drugs inhibiting reuptake of NE or serotonin have been proven
effective ’ This theory for biological argument for depression is backwards ’ Normal
identify pathology for disease ’ then treatment ’ Discovered the drugs work ’ then they
looked for how they work

Question:
monoamine deficiency hypothesis
Answer:
- early biological theory of depression
- Early antidepressants blocked reuptake of norepinephrine and serotonin, increasing
availability to the post-synaptic neuron ’ Argument: adding more monoamines to the
brain and makes depression better ’ then people that don't have enough of these are
more susceptible to depression
- PET scan technology has indicated 30% increase in monoamine oxidase in brains of
patients with depression

Question:
monoamines
Answer:
dopamine, norepinephrine, serotonin

Question:
first line antidepressants
Answer:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonon-norepinephrine reuptake inhibitors (SNRIs)
- dual/mixed action reuptake inhibitors

Question:
SSRI examples
Answer:
Fluoxetine (Prozac) Paroxetine (Paxil) Sertraline (Zoloft) Fluvoxamine (Luvox)
Citalopram (Celexa) Escitalopram (Lexapro)

Question:
SNRI examples
Answer:
Venlafaxine (Effexor) Duloxetine (Cymbalta) Desvenlafaxine (Pristiq)

,Question:
dual reuptake inhibitor examples
Answer:
Buproprion (Wellbutrin) - NRI + DRI
- Zyban for people trying to quit smoking Mirtazapine (Remeron) - Noradrenergic and
specific serotonergic antidepressant Trazodone (Desyrel) - Serotonin antagonist and
reuptake inhibitor (SARI)
- Usually for sedating effects; insomnia with depression

Question:
bupropion (Wellbutrin)
Answer:
norepinephrine and dopamine reuptake inhibitor
- activating effects SE: insomnia, weight loss, increase risk of seizures
- less sexual side effects *Zyban for smoking cessation

Question:
mirtazepine
Answer:
noradrenergic and specific serotonergic antidepressant
- blocks A2 adrenergic receptors; increases 5HT and NE release SE: weight gain,
dizziness, headache

Question:
trazodone (Desyrel)
Answer:
serotonin antagonist and reuptake inhibitor
- used for sedating effects; insomnia with depression (for sleep) SE: sedation,
hypotension, serotonin syndrome

Question:
older/miscellaneous class of antidepressants
Answer:
- Monoamine Oxidase Inhibitors (MAOI) --> lots of side effects
- Tricyclic Antidepressants (TCA): used for migraine and pain treatment, less for
depression
- esketamine

Question:
monoamine oxidase inhibitors
Answer:
inhibits the enzyme that breaks down neurotransmitters serotonin, norepinephrine
and dopamine, increasing levels in the brain
- also stops tyramine breakdown, an amino aid that helps regulate BP Result: alleviation
of symptoms of depression *last line treatment; many side effects

,Question:
MAOI examples
Answer:
Phenelzine (Nardil) Tranylcypromine (Parnate) Isocarboxazid (Marplan)

Question:
TCA examples
Answer:
Amitriptyline (Elavil) Clomipramine (Anafranil) Imipramine (Tofranil) *primary for
migraines and neuropathic pain

Question:
esketamine
Answer:
- A controlled substance with FDA approval (since 2019) for treatment-resistant
depression
- Counteracts glutamate; is antagonist of the N-methyl-D-aspartate (NMDA) receptor
- Unclear mechanism of action for depression
- Has been used as a sedative in ED, associated with SA.....

Question:
SSRIs mechanism of action
Answer:
Block absorption (reuptake) of serotonin, thereby intensifying the effects of serotonin
- keeps 5HT in the synapse to continue stimulating receptors
- initial trial period 4-6 weeks
- After approx 4 weeks, density of serotonin receptors drop by up to 25% which is
suspected for some antidepressant effect
- Why? If they are constantly stimulated by serotonin, don't need to work as hard ’ so
there is a reduction in some channels ’ associated with antidepressant effect

Question:
SNRIs
Answer:
- inhibits reuptake of serotonin and norepinephrine in synapse Side effects: nausea,
agitation, insomnia, decreased appetite, sexual dysfunction + hypertension (Norepi
effects stronger)

, Question:
side effects & medication management
Answer:
Getting more sophisticated in how they all work Be aware that there is a range of
systems impacted by antidepressants Sexual side effects
- Sexual dysfunction
- Ejactulatory dysfunction
- Several pathways cause this




Question:
SSRI side effects
Answer:
- Reduced sexual desire/erectile dysfunction: this is a major concern and reason for
discontinuation (decreased libido)
- Drowsiness/sedation or insomnia (fluoxetine can be activating)
- Hypotension, dizziness, tachycardia
- GI side effects

Question:
wellbutrin side effects
Answer:
- Preferred for activating effects Means if you are experiencing a lot of symptoms of
depression causing LOW energy ’ it counteracts this May be given in a small dose in
addition to SSRI
- Less sexual side effects
- Can increase risk of seizures

Question:
discontinuation syndrome
Answer:
- caused by abruptly stopping antidepressants (people think they feel better and want to
stop it)
- Can cause insomnia, nausea, flu-like symptoms
- Can worsen anxiety/depression *Important to taper these medications