NURS 660 Psychopharm - Stahl Chapter 7: Antidepressants
Questions With Complete Solutions
what percentage of symptoms improve with a single antidepressant? correct answer: 20-30%
Note: this is why we often prescribe multiple together whereas with schizophrenia using just 1 SGA is usually the rule.
in general what percentage of improvement is considered a response with antidepressants? what is the goal for tx? correct answer: 50%
Goal: complete remission of symptoms.
- due to the ineffectiveness of antidepressants, if multiple aren't used aggressively and early, remission probably will not ever be reached.
what is remission? correct answer: asymptomatic for several months
what is recovery? correct answer: asymptomatic for at least 6 months
what is relapse? correct answer: depression returns before full remission of sxs or within first several months after remission
what is a recurrence? correct answer: depression returns after a recovery (after 6 months of being asymptomatic) what are the most common residual sxs to prevent remission and
what are the least common? correct answer: most common
- insomnia
- fatigue
- painful physical complaints
- problems concentrating
- lack of interest
least common
- depressed mood
- SI
- psychomotor retardation
what percentage of pts respond to 1st antidepressant after 3 months vs 2nd vs 3rd vs 4th? correct answer: 1st: 33% respond, 67% don't
2nd: 20% respond, 47% don't
3rd: 6-7% respond, 40% don't
4th: 6-7% respond, 33% don't
what is considered a nonremitter? what percentage of pts are nonremitters? correct answer: someone who doesn't respond after 4 different trials of antidepressants. - 33% of people are nonremitters
what proportion of remitters relapse when comparing those that remitted at 1st trial vs 2nd vs 3rd vs 4th? correct answer: 1st: 33% at 12 months
2nd: 50% at 6 months
3rd: 50% at 6 months
4th: 30% at 3 months, 70% at 6 months Conclusion: this means that the protective nature of remission almost disappears once it takes 4 treatments to achieve remission.
How do older adults vs young adults differ in their response to antidepressants? correct answer: Older adults: if their first episode starts at 65 or older and their presenting sxs are lack of interest or cognitive dysfunction rather than depressed mood they respond slower and not as robustly, but they won't develop SI with antidepressants.
Younger adults: if younger than 25, they benefit more but have greater risk of suicidality.
why do antidepressants stop working? correct answer: when there is an acute increase in monoamine, receptors on the postsynaptic neuron downregulate and desensitize overtime. Thus the monoamine has no receptors to bind to and the antidepressant wears off.
why do people get SEs with antidepressants? correct answer: in depressed pts, there is an upregulation of receptors on the postsynaptic neuron. When monoamines are acutely increased there are also increased receptors able to bind, this overloads them with NT. Once the receptors downregulate and desensitize due to increased monoamine, the SEs go away because the neuron has returned to a normal state. This is also why it takes weeks for antidepressants to work, as genes turn off to downregulate receptors they also increase the synthesis of BDNF. whats the neurotransmitter receptor hypothesis of antidepressant
action? correct answer: depression is caused by upregulation of monoamine receptors. So antidepressant efficacy is due to downregulation it causes in the receptors. This is the reason for the delayed clinical effects of antidepressants and development of tolerance to antidepressant SEs.
what role does the somatodendritic area of the neuron play in depression? correct answer: in addition to monoamines being low at the synapse and thus antidepressants work on the presynaptic neuron (SERT) but also at the somatodendritic end of the NE neuron. NE is deficient at the presynaptic somatodendritic area as well which causes upregulation in the receptors there possibly altering how NE is transmitted down the
axon. This is supported because when SSRIs are given 5HT rises much more in the somatodendritic area in the midbrain raphe instead of areas where axons terminate.
what end of the neuron responds to antidepressants first? correct answer: somatodendritic area of 5HT neuron increases first, these are the 5HT1A receptors. When they are stimulated, 5HT1A autoreceptors are stimulated. Over time, autoreceptors downregulate and are desensitized. When this happens 5HT can no longer turn off its own release, causing a flurry of 5HT release from axons and increase neuronal impulse flow. This causes the postsynaptic 5HT receptors to desensitize as well and sends info to its nucleus to downregulate or desensitize its receptors as well.
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