Deck 13: Treatments for Depression and Bipolar Disorder

Question 1

Which is an example of a selective serotonin-norepinephrine reuptake inhibitor?

A) iproniazid
C) fluoxetine
B) venlafaxine
D) desipramine

Answer 1

B

Question 2

According to a U.S. national survey conducted by Kessler and colleagues (2005), the prevalence of major depressive disorder during a lifetime is ____.

A) 6 percent
C) 26 percent
B) 16 percent
D) 36 percent

Answer 2

B

Question 3

According to the DSM, who is most likely to be classified as having a mental disorder?

A) Edith, who has severe cognitive deficits caused by Alzheimer's disease
B) Wilfredo, who after suffering a stroke, has deficits in impulse control
C) Elysse, who no longer gets pleasure from her art and does not eat or sleep in regular patterns, which causes her to be less productive at work
D) Dante, who has been feeling sad since his divorce over a year ago, but still enjoys meeting up with friends and is working towards a promotion at work

Answer 3

C

Question 4

Major depressive disorder is characterized by at least five depressive symptoms that last at least how long?

A) two weeks
C) four weeks
B) three weeks
D) five weeks

Question 5

Which is an example of a tricyclic antidepressant?

A) iproniazid
C) fluoxetine
B) venlafaxine
D) desipramine

Question 6

Which is an example of a selective serotonin reuptake inhibitor?

A) iproniazid
C) fluoxetine
B) venlafaxine
D) desipramine

Question 7

An impairment in normal behavioral, cognitive, or emotional function is referred to as a ____.

A) dependency and substance abuse disorder
B) mental disorder
C) behavioral output deficit
D) coping malfunction syndrome

Question 8

Which statement best reflects the emergence of antidepressant medications in the 1950s?

A) Strong research initiatives were launched in response to an increase in depression-related suicide rates.
B) The emergence of antidepressant drugs was accidental; the first antidepressant medication was in fact developed to treat an infectious disease.
C) Reserpine was a popular recreational drug which was eventually found to lessen depressive symptoms.
D) After World War II PTSD rates were high, spurring the U.S. government to strongly support mood disorder related research.

Question 9

Kenneth was recently diagnosed with major depressive disorder. Which of Kenneth's brain structures are most likely to show a reduction in volume?

A) prefrontal cortex, nucleus accumbens, amygdala
B) prefrontal cortex, nucleus accumbens, hippocampus
C) amygdala, nucleus accumbens, hippocampus
D) hippocampus, prefrontal cortex, amygdala

Question 10

Why do tricyclic antidepressants have unique adverse effects?

A) They are not readily degraded during first pass metabolism.
B) Their elimination rate is very slow.
C) They bind to many receptors throughout the body.
D) They are converted into highly active metabolites.

Question 11

During a lecture on the history of antidepressant drug development, Professor Skinner refers to a cheese effect. What is Professor Skinner discussing with her students?

A) The ineffectiveness of early MAO inhibitors
B) Side effects associated with early MAO inhibitors
C) Depletion of norepinephrine caused by early MAO inhibitors
D) The inability to consume dairy products while on MAO inhibitors because of protein-induced competition with metabolic liver enzymes

Question 12

Antidepressant drug design is still based on which hypothesis?

A) The monoamine hypothesis
C) The excitatory amino acid hypothesis
B) The cholinergic hypothesis
D) The inhibitory amino acid hypothesis

Question 13

One type of depression thought to occur in the elderly is termed ____ depression.

A) vascular
C) cognitive
B) cerebral
D) degenerative

Question 14

Which is an example of a monoamine oxidase inhibitor?

A) iproniazid
C) fluoxetine
B) venlafaxine
D) desipramine

Question 15

Kenneth was recently diagnosed with major depressive disorder. Which of Kenneth's brain structures is likely to show increased activity?

A) nucleus accumbens
C) amygdala
B) prefrontal cortex
D) hippocampus

Question 16

Maya is clinically depressed. In addition to the depression, she is also certain that her ex-husband is poisoning her coffee every morning, despite the fact that he lives over 200 miles away. What type of depression is Maya experiencing?

A) delusional depressive disorder
B) schizoid-like depressive disorder
C) major depression with dysthymic features
D) major depression with psychotic features

Question 17

Joe is prescribed a tricyclic antidepressant. What effect will this have on his neurotransmitter levels?

A) Increased norepinephrine and serotonin levels by blocking their reuptake
B) Increased norepinephrine and serotonin levels by increasing their synthesis
C) Increased dopamine and GABA levels by blocking their reuptake
D) Increased dopamine and GABA levels by increasing their synthesis

Question 18

To limit the cheese effect, drug developers designed ____.

A) irreversible MAO inhibitors that would have less of an effect on tyramine levels
B) reversible MAO inhibitors that had a lower binding affinity for tyramine
C) selective reversible MAO inhibitors that allow greater breakdown of tyramine
D) selective irreversible MAO inhibitors that tightly bind tyramine

Question 19

What leads to the development of the first tricyclic antidepressant drug imipramine?

A) The accidental discovery that drugs used to treat Parkinson's disease were also effective in treating depression
B) A successful attempt to minimize the cheese effect
C) The push for a movement away from MAO inhibitors
D) A failed attempt to develop an antipsychotic drug

Question 20

For the past three years, Emalyn has been feeling depressed nearly every day. She is still productive at work and participates in her regular hobbies, but cannot seem to shake the "blues." What disorder best characterizes Emalyn's mood?

A) minor depressive disorder
C) dysthymic disorder
B) major depressive disorder
D) chronic despair disorder

Question 21

What is one of the main reasons that drug developers are seeking alternatives to SSRIs?

A) Serotonin discontinuation syndrome
C) Serotonin syndrome
B) Sexual side effects
D) SSRI dependency

Question 22

Why does the antidepressant drug bupropion provide an important exception to the serotonin hypothesis of depression?

A) Its use leads to a decrease in serotonin levels.
B) It is the most effective antidepressant, but has the smallest effect on serotonin levels.
C) It increases dopamine and norepinephrine release without affecting serotonin levels.
D) It blocks serotonin receptor activity.

Question 23

According to a study by Maj and colleagues (1996), chronic administration with fluoxetine ____.

A) increases the synthesis of dopamine
B) blocks the degradation of dopamine
C) increases the levels of dopamine receptors
D) modulates dopamine receptors to increase their affinity for dopamine

Question 24

What are the limitations of the pharmacological dissection of mental disorders approach to understanding the neurobiological basis of mental disorders?

A) It relies on circular reasoning.
B) It places too much emphasis on the genetic component of mental disorders.
C) Its focus is placed on the anatomical basis of mental disorders, not the cellular basis.
D) The development of pharmacological therapies based on this approach have been mostly unsuccessful.

Question 25

Dave has used Prozac, an SSRI, for about two years. He decides to suddenly stop using Prozac instead of gradually decreasing his dosage, as recommended by his doctor. What risk does this pose for Dave?

A) Seizure
C) Sleeping disturbances
B) Agitation
D) Cardiovascular dysfunction

Question 26

Chantal's graduate thesis adviser asks her to design an experiment to test novel antidepressants in a rodent model. What experimental test would you suggest that she use?

A) Forced swim test
C) Morris water maze
B) Rotarod
D) Elevated plus maze

Question 27

Bipolar disorder is ____.

A) a more serious form of depression
B) characterized by both depressive and manic mood states
C) characterized by continuous mania that fluctuates in intensity
D) a form of depression accompanied by psychosis

Question 28

The antidepressant effect of which drug provides evidence for the role of dopamine in depression?

A) zimelidine
C) ketamine
B) reserpine
D) fluoxetine

Question 29

Although there are some exceptions, acute antidepressant drug administration tends to ____.

A) increase dopamine levels in the limbic system
B) decrease dopamine levels in the limbic system
C) increase dopamine levels in the prefrontal cortex
D) decrease dopamine levels in the prefrontal cortex

Question 30

Why are placebo controls so important in antidepressant clinical trials?

A) Clinically significant improvements often occur in placebo-treated patients.
B) Antidepressant drugs have a high risk for dependency.
C) Placebos contain the inactive form of the antidepressant and are important for assessing safety risks.
D) Because participants rarely respond to the placebo, it provides a good baseline for comparing antidepressant effectiveness.

Question 31

Papakostas and colleagues (2007) conducted a meta-analysis on clinical depression studies that used either selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) to determine which class was the most effective. What were the results of this meta-analysis?

A) SSRIs are modestly more effective than SNRIs.
B) SSRIs are greatly more effective than SNRIs.
C) SNRIs are modestly more effective than SSRIs.
D) SNRIs are greatly more effective than SSRIs.

Question 32

Regina was recently diagnosed with bipolar disorder. During her manic episodes, she ____.

A) isolates herself from others
C) has very low motivation
B) is more calm and relaxed
D) has rapidly changing ideas

Question 33

What is the evidence to suggest that dopamine plays an important role in depression?

A) Typical antidepressant drugs quickly but modestly increase dopamine levels in the limbic system.
B) Dopamine levels increase with chronic typical antidepressant use, possibly accounting for the delayed treatment response of these drugs.
C) Typical antidepressants target dopamine receptors in the limbic system, albeit with lower affinity than for serotonin or norepinephrine transporters.
D) Typical antidepressants are less effective in transgenic mice that synthesize very low levels of dopamine.

Question 34

Postdoctoral research fellow Imani chronically administers antidepressant drugs to a group of mice. After performing a postmortem analysis on the mouse brains, she finds ____.

A) decreased neuronal proliferation in the hippocampus
B) increased neuronal proliferation in the hippocampus
C) decreased neuronal proliferation in the amygdala
D) increased neuronal proliferation in the amygdala

Question 35

What is an antidepressant drug-induced life-threatening condition characterized by agitation, restlessness, disturbances in cognitive functioning, and possible hallucinations?

A) dopamine syndrome
C) norepinephrine syndrome
B) serotonin syndrome
D) glutamate syndrome

Question 36

What directly lead to a push for the development of selective serotonin reuptake inhibitors?

A) Adverse effects caused by tricyclic antidepressants
B) Need for more effective antidepressants
C) Cheese effect
D) Need to increase serotonin but not norepinephrine levels

Question 37

Which statement best describes the length of response time for antidepressant drugs?

A) All antidepressant drugs have a quick response time.
B) All antidepressant drugs have a lengthy response time.
C) SSRIs and SNRIs have a quick response time; MAO inhibitors have a lengthy response time.
D) SSRIs and SNRIs have a lengthy response time; MAO inhibitors have a quick response time.

Question 38

According to estimates by Fava and Davidson (1996), what percent of patients would be classified as having treatment-resistant depression?

A) 9 to 26 percent
C) 29 to 46 percent
B) 19 to 36 percent
D) 39 to 56 percent

Question 39

Antidepressant drugs that do not selectively block either serotonin reuptake, norepinephrine reuptake, or both, are termed ____ antidepressant drugs.

A) novel
C) progressive
B) non-canonical
D) atypical

Question 40

Why is the selective serotonin reuptake inhibitor (SSRI) zimelidine (Zelmid) no longer in clinical use and instead, the SSRI fluoxetine (Prozac) so widely prescribed?

A) Zelmid has a very low binding affinity for selective serotonin reuptake inhibitors; Prozac has a very strong binding affinity.
B) Zelmid was withdrawn from the market because of adverse effects; Prozac is one of the safest antidepressants.
C) Zelmid was found to increase norepinephrine levels in addition to serotonin; Prozac selectively increases serotonin levels.
D) Zelmid is habit forming; Prozac is not habit forming.

Question 41

One of the most common treatment approaches for bipolar disorder involves a combination of both an ____.

A) anxiolytic drug and an anticonvulsant drug
B) anxiolytic drug and an antidepressant drug
C) atypical antipsychotic drug and an anticonvulsant drug
D) atypical antipsychotic drug and an antidepressant drug

Question 42

According to the National Institute of Mental Health, in 2006 the lifetime prevalence of any type of bipolar disorder in the United States was about____ percent.

A) 0.4
C) 14
B) 4
D) 24

Question 43

Aside from the few drugs that treat both depressive and manic symptoms (mood stabilizers), bipolar disorder is treated with drugs typically used for ____.

A) seizures and neurodegeneration
B) seizures and psychotic symptoms
C) movement disorders and neurodegeneration
D) movement disorders and psychotic symptoms

Question 44

The most common incorrect diagnosis for bipolar disorder is ____.

A) obsessive compulsive disorder
C) extreme manic disorder
B) schizophrenia
D) depression

Question 45

Why is it critical to carefully monitor lithium dosing in patients?

A) Bipolar disorder patients are often non-compliant.
B) Lithium has a high potential of abuse at high doses.
C) The therapeutic index is very broad.
D) The therapeutic index is very narrow.

Question 46

What is an example of a pharmacogenetic factor that may affect the efficacy of antidepressant drugs?

A) Splice variant of monoamine oxidase
B) Shorter variation of a serotonin transporter gene
C) Trinucleotide repeat contained within a dopamine receptor gene
D) Mutation within ligand binding domain region of norepinephrine gene

Question 47

Lithium targets which enzyme?

A) monoamine oxidase
C) glycogen synthase kinase
B) d-amino acid oxidase
D) glutathione synthase

Question 48

According to the text, what is true of lithium's effectiveness in treating bipolar disorder?

A) It has a greater effect on depressive symptoms than on manic symptoms.
B) It has a greater effect on manic symptoms than on depressive symptoms.
C) It has equal effectiveness for treating both depressive and manic symptoms.
D) Although once the gold standard, today lithium is considered weakly effective in treating bipolar disorder.

Question 49

What is an adverse effect caused by therapeutic doses of lithium?

A) renal failure
C) increased urination
B) muscle rigidity
D) seizure

Question 50

Which type of bipolar disorder exhibits depression and episodes of less-severe mania?

A) Type I bipolar disorder
C) Type III bipolar disorder
B) Type II bipolar disorder
D) Type IV bipolar disorder

Question 51

What have neuroimaging studies revealed about bipolar disorder?

A) Brain lesions typically affect only manic but not depressive episodes.
B) Brain lesions in the right hemisphere produce both manic and depressive episodes.
C) Brain lesions in the left hemisphere produce manic episodes; lesions in the right hemisphere produce depressive episodes.
D) Brain lesions in the right hemisphere produce manic episodes; lesions in the left hemisphere produce depressive episodes.

Question 52

Research suggests that anticonvulsant drugs treat bipolar disorder through what mechanism of action?

A) GABA agonism; Na+ channel inhibition
B) GABA agonism; K+ channel inhibition
C) GSK-3 inhibition; Na+ channel inhibition
D) GSK-3 inhibition; K+ channel inhibition

Question 53

Researchers have developed animal behavioral procedures that, although not resembling depression, accurately predict antidepressant efficacy. Discuss three such models, providing a description of each model and using specific examples from the text to support the utility of these tests in testing antidepressant drugs.

Question 54

After undergoing an MRI scan, bipolar disorder patient Tiana finds out that she has a UBO (unidentified bright object). What does this mean?

A) She is displaying excessive areas of activity in cortical white matter.
B) She is displaying excessive areas of activity in cortical gray matter.
C) She is displaying decreased areas of activity in cortical white matter.
D) She is displaying decreased areas of activity in cortical gray matter.

Question 55

Which type of bipolar disorder exhibits depression and episodes of severe mania?

A) Type I bipolar disorder
C) Type III bipolar disorder
B) Type II bipolar disorder
D) Type IV bipolar disorder

Question 56

What was the first mood stabilizer found to be effective for the treatment of bipolar disorder?

A) Cadmium
C) Tritium
B) Lithium
D) Chromium

Question 57

Why is it thought that a Val66Met polymorphism existing on the gene for BDNF may lead to decreased treatment responses to antidepressants (Horstmann & Binder, 2009; Shimizu, Hashimoto, & Iyo, 2004)?

A) This may accelerate dopamine metabolism.
B) This may increase serotonin transporters levels.
C) This may enhance the expression of GSK-3.
D) This may lead to reduced levels of the TrkB receptors.

Question 58

The authors of the text conclude that lithium's efficacy for bipolar disorder derives from its ____.

A) actions on glutamate neurotransmission
C) neuroprotective effects
B) potent serotonin reuptake inhibition
D) ability to increase dopamine levels

Question 59

Who is credited with discovering lithium's effectiveness in treating bipolar disorder?

A) Albert Hofmann
C) Timothy Leary
B) Warren Johnson
D) John Cade

Question 60

Describe the role of pharmacogenetics in modulating a patient's responsiveness to antidepressant medication. Use specific examples, as discussed in the text, to illustrate your points.