DEPRESSION – TREATMENT

Amoxapine

Ans:B- Tranylcypromine

Tranylcypromine is a MAOI

• An acute attack of hypertension that can occur in a person taking a monoamine oxidase inhibitor (MAOI) drug who eats cheese, caused by an interaction of the MAOI with tyramine, formed in ripe cheese when bacteria provide an enzyme that reacts with the amino acid tyrosine in the cheese.
• Tyramine is normally broken down in  by an enzyme called MAO (monoamine oxidase).
• When MAO inhibitor (MAOI) medicines are taken, excessive amounts of tyramine enter the bloodstream, leading to the release of adrenaline-like substances (norepinephrine) in the body. Increased blood pressure then occurs.

Ans:B-Fluoxetine

• The new antidepressants are moclobemide, fluoxetine, paroxetine and sertraline.
• They are as effective as the established antidepressants, have fewer adverse effects and are safer in overdose.
• The new drugs are more likely to be taken in an effective dosage for an adequate period of time.

Ans:A-Imipramine

• Tricyclics have significant anticholinergic effects and thus have similar properties to Oxybutynin.
• They also have additional central effects which are not well understood but can be beneficial in preventing bedwetting in a group of children who have not responded to first line treatments.

How is it given? 

• Imipramine is only available as tablets
• To minimise side effects it is best started as a low dose and increased fortnightly to the maximum dose allowed for the age of the child.
• The single daily dose should be given around 3 hours before sleep. A course of treatment should last for 3 months maximum before reducing the dose slowly and stopping it for a week or so to assess progress.

Side effects and contraindications

•  Most children tolerate this medication without experiencing side effects

Ans. is ‘b’ i.e., Amoxapine

o Amoxapine is the only antidepressant which blocks D₂ receptors along with inhibition of NA reuptake —> has mixed antidepressant + neurolepic property.

Ans. is ‘d’ i.e., Both NE uptake inhibition and antimuscarinic action on heart

o The commonest cardiovascular effect of tricyclic antidepressant overdose is sinus tachycardia, which is attributable to the inhibition of norepinephrine reuptake and the anticholinergic action.

Ans. is ‘c’ i.e., Amoxapine

• Amoxapine is the only antidepressant which blocks D₂ receptors along with inhibition of NA reuptake → has mixed antidepressant + neuroleptic property.
• Due to blockade of D, receptors it causes extrapyramidal side effects → Parkinsonism, Tardive dyskinesia, Akathesia, neuroleptic malignant syndrome

Ans. is ‘d’ i.e., Chlorpromazine

Ans. is ‘a’ i.e., Fluoxetine

Ans. is ‘d’ i.e., Pimozide

Ans. is ‘a’ i.e., Muscarinic acetylcholine receptors

“Blurred vision, dry mouth, urinary hesitancy or retention, and constipation represent the most common antimuscarinic complaints”.

Ans. is ‘c’ i.e., Fluoxamine

Antidepressants with no anticholinergic (antimuscarinic) action.

• Bupropion
• Escitalopram
• Fluvoxamine
• Paroxetine
• Trazodone
• Citalopram
• Duloxetine
• Venlafaxine
• Sertaline
• Mirtazapine Fluoxetine is the only SSRI which has some anticholinergic action.

Remember

Antidepressants with no sedative action

• Bupropion
• Citalopram
• Fluvoxamine
• Protriptyline
• Duloxetine
• Escitalopram 
• Venlafaxine

(Note : First 6 drugs are same in both groups)

Ans. is ‘c’ i.e., Venlafaxine

Antidepressants

A. Typical

• Tricyclic antidepressants

1. NA + 5HT reuptake inhibitors :- Imipramine, Trimipramine, Amitriptyline, Clomipramine.
2. Predominantly NA reuptake inhibitors :- Desipramine, Nortriptyline, Amoxapine, Reboxetine.

• Selective serotonin reuptake inhibitors :- Fluoxetine, Paroxetine, Sertaline, Citalopram, Scitalopram.

B. Atypical :- Trazodone, Mianserine, Mitrazapine, Venalafaxin, Duloxetine, Tianeptine, Amineptine, Bupropion.

c. MAO inhibitors :- Tranylcypramine, Meclobemide, Clorgyline.

Ans. is ‘c’ i.e., Doxepine 

Ans.D. Amoxapine

• Amoxapine is the only antidepressant which blocks D₂ receptors along with inhibition of NA reuptake → has mixed antidepressant + neuroleptic property.
• It causes extrapyramidal side effects -Parkinsonism, Tardive dyskinesia, Akathesia, neuroleptic malignant syndrome.

Ans. is’d’i.e., Tremors &’e’i.e., Urinary retention

[Rel KDT Vh/e p. 459; Goodman & Gilman llth/e p. 448]

Adverse effects of TCAs:

• Anticholinergic- Dry mouth, bad taste, urinary retention, blurred vision, palpitations, constipation.
• Sedation, mental confusion, weakness.
• Increased appetite and weight gain.
• Sweating and fine tremor.

Ans. (A) Old age

• Cases of SSRl-associated hyponatremia & the syndrome of the inappropriate antidiuretic hormone have been seen in some patients, especially those who are older or treated with diuretics.