MSN 672, Quiz 2 () Questions and
Verified Answers, 100% Guarantee Pass
Response
50% or more improvement of symptoms related to depression
Partial Response
less than 50% improvement in depressive symptoms
Remission
100% improvement in depressive symptoms
Recovery
Remission that is maintained for at least 6 months
Relapse
return to depressive state shortly after remission or prior to remission
Recurrence
return to depressive state after about 1 year of remission or after patient has
recoverd
What is a top indicator in remission?
1/3 of patients reach remission on ANY antidepressant.
Not what antidepressant you use, but when you use it. Early tx = more likely to
reach remission/recovery
Most common residual symptoms
insomnia, fatigue, painful physicalcomplaints, problems concentrating, and lack of
interest
Relapse Rates
,Relapse rates less for those that reach remission• Likelihood of relapse increases
with number of treatmentsit takes to reach remission• Relapse rate for patients
that do not remit is ~60% at 12months after one treatment to 70% after months
after 4treatments• For patients reaching remission: 33% at 12months after
onetreatment to 70% at 6months after 4 treatments
Common Features of Antidepressants
All work on monoamines• Block one or more transporter for serotonin,
norepinephrine and/ordopamine• Monoamine hypothesis of depression• Most
take 3-8 weeks to be maximally effective• Receptor sensitivity?• Most have
equivalent response rates (50-70%) and remissionrates (35-50 %)• All have
serotonin or NE side effects• Black box warning for suicidal thoughts in C&A
SSRI- how it works
increase in serotonin cause 5HT1A receptors (inhibitory) to downregulate and
desensitize= more 5HT release at axon=downregulation/desensitization of
postsynaptic receptors=reduction in symptoms 4-6 weeks later
SSRI examples
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)
SSR- Fluoxetine (Prozac)
Blockade of SERT plus 5HT2C antagonist action
NET inhibition with high doses
5HT2C antagonism disinhibits release of DA and NE
Inhibitor at CYP 2D6 and 3A4
Long half life- less likely for withdrawal symptoms
SSRI- Fluoxetine (Prozac) Tx
, Tx children and adults- MDD, OCD
Tx in adults ONLY-PMDD, Bulimia (at high doses for NET), Panic disorder,
Tx Resistant Depression (TRD), Bipolar depression (in combination with
olanzapine—Symbyax for TRD and BD)
Safe
Fairly well tolerated
Most evidence of all SSRIs for C&A
more energizing SSRI
SSRI: Fluoxetine (Prozac) dosing & side effects
Dosing• Start 10-20 mg/morning
5-10 mg for age > 60 (or small children)
Can increase after week one
Max 80mg
Side effects• Activation, agitation• Fatigue, psychomotor retardation,
hypersomnia• GI issues, headache
SSRI: Shared Properties
Selective, potent inhibition of serotonin reuptake• Inhibition of the serotonin
transporter (SERT)
5HT rises due to blockade of SERT
Immediate blockade of SERT causes initial serotonin increase only in
somatodendritic area of serotonin neuron
Explains immediate side effects
Increased serotonin eventually desensitizes 5HT1A autoreceptors
SSRI - Sertraline (Zoloft)
Dopamine transporter (DAT) inhibition and sigma-1 receptor-binding/sigma
agonist
DAT < SERT inhibitory actions
DAT inhibitory properties
Verified Answers, 100% Guarantee Pass
Response
50% or more improvement of symptoms related to depression
Partial Response
less than 50% improvement in depressive symptoms
Remission
100% improvement in depressive symptoms
Recovery
Remission that is maintained for at least 6 months
Relapse
return to depressive state shortly after remission or prior to remission
Recurrence
return to depressive state after about 1 year of remission or after patient has
recoverd
What is a top indicator in remission?
1/3 of patients reach remission on ANY antidepressant.
Not what antidepressant you use, but when you use it. Early tx = more likely to
reach remission/recovery
Most common residual symptoms
insomnia, fatigue, painful physicalcomplaints, problems concentrating, and lack of
interest
Relapse Rates
,Relapse rates less for those that reach remission• Likelihood of relapse increases
with number of treatmentsit takes to reach remission• Relapse rate for patients
that do not remit is ~60% at 12months after one treatment to 70% after months
after 4treatments• For patients reaching remission: 33% at 12months after
onetreatment to 70% at 6months after 4 treatments
Common Features of Antidepressants
All work on monoamines• Block one or more transporter for serotonin,
norepinephrine and/ordopamine• Monoamine hypothesis of depression• Most
take 3-8 weeks to be maximally effective• Receptor sensitivity?• Most have
equivalent response rates (50-70%) and remissionrates (35-50 %)• All have
serotonin or NE side effects• Black box warning for suicidal thoughts in C&A
SSRI- how it works
increase in serotonin cause 5HT1A receptors (inhibitory) to downregulate and
desensitize= more 5HT release at axon=downregulation/desensitization of
postsynaptic receptors=reduction in symptoms 4-6 weeks later
SSRI examples
Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram (Lexapro)
SSR- Fluoxetine (Prozac)
Blockade of SERT plus 5HT2C antagonist action
NET inhibition with high doses
5HT2C antagonism disinhibits release of DA and NE
Inhibitor at CYP 2D6 and 3A4
Long half life- less likely for withdrawal symptoms
SSRI- Fluoxetine (Prozac) Tx
, Tx children and adults- MDD, OCD
Tx in adults ONLY-PMDD, Bulimia (at high doses for NET), Panic disorder,
Tx Resistant Depression (TRD), Bipolar depression (in combination with
olanzapine—Symbyax for TRD and BD)
Safe
Fairly well tolerated
Most evidence of all SSRIs for C&A
more energizing SSRI
SSRI: Fluoxetine (Prozac) dosing & side effects
Dosing• Start 10-20 mg/morning
5-10 mg for age > 60 (or small children)
Can increase after week one
Max 80mg
Side effects• Activation, agitation• Fatigue, psychomotor retardation,
hypersomnia• GI issues, headache
SSRI: Shared Properties
Selective, potent inhibition of serotonin reuptake• Inhibition of the serotonin
transporter (SERT)
5HT rises due to blockade of SERT
Immediate blockade of SERT causes initial serotonin increase only in
somatodendritic area of serotonin neuron
Explains immediate side effects
Increased serotonin eventually desensitizes 5HT1A autoreceptors
SSRI - Sertraline (Zoloft)
Dopamine transporter (DAT) inhibition and sigma-1 receptor-binding/sigma
agonist
DAT < SERT inhibitory actions
DAT inhibitory properties
