Deck 9: Antidepressants and Mood Stabilizers

Question 1

One side effect of tricyclic antidepressants which is least likely to occur is

A)psychological dependence
B)death resulting from overdose
C)disorientation and mental sedation
D)cardiovascular dysfunction

Answer 1

A

Question 2

What is the relative efficacy of antidepressant drug therapy for adults diagnosed with clinical depression?
e.g., SSRIs, MAOIs, or another drug within the same class, or some combination of antidepressant medications.Tolerability of side effects of the particular antidepressant for the individual may dictate treatment compliance and efficacy.

Answer 2

Individual medications within the category of FDA-approved antidepressants typically reduce the symptoms in 50-60% of patients-compared with 20-30% response rate with placebo.However, some individuals who do not respond favorably to one type of antidepressant after adequate dosage and length of treatment may respond favorably to another in a different class, e.g., SSRIs, MAOIs, or another drug within the same class, or some combination of antidepressant medications.Tolerability of side effects of the particular antidepressant for the individual may dictate treatment compliance and efficacy.

Question 3

Clinically effective antidepressants in present use differ primarily with respect to their

A)potency in blocking cholinergic activity
B)relative affinity for serotonin and norepinephrine reuptake systems
C)relative ability to reduce monoamine oxidase activity
D)all of the above

Answer 3

D

Question 4

What are the primary clinical differences among the newer antidepressants, called selective serotonin reuptake inhibitors, and one of the oldest classes of antidepressants called the tricyclics?

Question 5

How are the primary mechanisms of most antidepressant drugs potentially related to the "neurotrophic" theory of mood disorders?

Question 6

Briefly describe the "neurotrophic" theory of mood disorders.

Question 7

Give two pieces of evidence that support the monoamine hypothesis of depression and one piece of evidence that seems to conflict with the hypothesis.

Question 8

Lithium carbonate is used primarily for the treatment of

A)depression
B)bipolar disorder
C)anxiety
D)schizophrenia

Question 9

Give two pieces of evidence that support the catecholamine hypothesis of depression and one piece of evidence that seems to conflict with the hypothesis.

Question 10

Research involving treatments that induce acute tryptophan depletion in the brain have found that this type of treatment

A)often induces the core symptoms of depression in normal, healthy humans.
B)often induces symptoms of depression in individuals who have a family history of major depression
C)often reduces the symptoms of depression in individuals diagnosed with major depression
D)both a and b

Question 11

One of the primary differences among the drugs classified as "traditional" tricyclic antidepressants is their

A)relative efficacy in relieving depression
B)tendency to induce anticholinergic side effects
C)relative potency in blocking the reuptake of cyclic AMP
D)none of the above

Question 12

Tolerance development regarding desired effects and psychological dependence has been well established to occur with

A)selective serotonin reuptake inhibitors
B)tricyclic antidepressants
C)monoamine oxidase inhibitors
D)none of these

Question 13

The earliest catecholamine hypothesis of affective disorders suggested that depression results from

A)an excessive amount of norepinephrine activity
B)an excessive amount of dopamine activity
C)a deficiency of norepinephrine and/or dopamine in the brain
D)none of these

Question 14

Why are the monoamine oxidase inhibitors generally considered one of the last types of medications in the pharmacological treatment of clinical depression?

Question 15

With respect to tolerance and dependence, most of the evidence suggests that with chronic use of tricyclic antidepressants

A)tolerance to their antidepressant properties does not develop
B)abrupt drug cessation may precipitate malaise, chills, muscle aches, and hypercholinergic-type effects
C)abrupt cessation of their use does not induce depression
D)all of the above

Question 16

At the present time in the U.S., the most widely prescribed group of antidepressants consist of the

A)tricyclics
B)monoamine oxidase inhibitors
C)lithium and its derivatives
D)selective serotonin reuptake inhibitors

Question 17

In the 1950s, the first effective drugs that specifically reduced the symptoms of depression were developed or discovered.One of these belonged to the class of antidepressants categorized as

A)monoamine oxidase inhibitors
B)tricyclics
C)amphetamines
D)both a and b

Question 18

Which of these is the most commonly diagnosed affective disorder?

A)unipolar depression
B)mania
C)bipolar disorder
D)histrionic depression

Question 19

In patients with major depression, there is some evidence that the difference in efficacy between active medications and placebo may increase after ______ of treatment.

A)8 weeks
B)6 weeks
C)4 weeks
D)2 weeks

Question 20

Depression in unipolar disorder and bipolar disorder may be confused during diagnosis.What potential problems might occur if the decision was made to treat a person with bipolar depression with a standard antidepressant (e.g., tricyclic, SSRI) or to treat a person with unipolar depression with lithium?

Question 21

Monoamine oxidase inhibitors are likely to increase intraneuronal levels of

A)norepinephrine
B)dopamine
C)serotonin
D)all of these

Question 22

Monoamine oxidase inhibitors generally

A)exhibit fewer toxic food interactions than other classes of antidepressant drugs
B)have a higher efficacy rate than tricyclic antidepressants
C)have more anticholinergic side effects than tricyclics
D)none of the above

Question 23

Lithium's primary mechanism of action with respect to its beneficial effects

A)is unknown
B)involves enhancing catecholamine release from axons
C)involves activation of catecholamine receptors
D)involves synthesis of endogenous opioid peptides

Question 24

According to the monoamine deficiency hypothesis of depression, a drug that desensitizes monoamine autoreceptors would be predicted to

A)depress mood
B)enhance mood in depressed people
C)have no effect on mood

Question 25

The monoamine reuptake blocking properties of the tricyclic antidepressants occur ________________________ their mood elevating properties are evidenced.

A)long before
B)shortly before
C)shortly after
D)at about the same time as

Question 26

An alternative to lithium in the treatment of manic-depression is/are

A)antipsychotics
B)carbamazepine (Tegretol)
C)antiseizure drugs
D)all of these

Question 27

Combining antidepressants from different classes in the treatment of depression

A)has been shown to have no value
B)may be useful in certain patients
C)should be done in most patients
D)none of these

Question 28

Recent evidence suggests that monoamine oxidase inhibitors have the greatest efficacy in the treatment of

A)atypical depressions
B)schizophrenics
C)manic patients
D)bipolar depressives

Question 29

What was the major reason for lithium's slow acceptance by psychiatrists in the U.S.as a treatment for affective disorders?

A)its relatively low efficacy rate
B)it was difficult to synthesize
C)its toxicity
D)it is a very rare and expensive element

Question 30

The most significant problem associated with the use of lithium in the treatment of affective disorders is

A)its low therapeutic index
B)its low efficacy rate
C)its high cost
D)the requirement to maintain low sodium intake

Question 31

The FDA has recently required drug companies to provide warnings on the labels of all antidepressants because of evidence that these drugs may induce

A)suicidal ideation or behaviors in a small proportion of depressed patients at the beginning of their treatment
B)parkinsonian-like symptoms in elderly patients
C)hypertensive crises when combined with certain foods or other drugs
D)convulsions in certain patients

Question 32

This neurotransmitter has also been implicated in affective disorders.This is supported by the clinical finding that physostigmine may aggravate depression and reduce mania.

A)acetylcholine
B)serotonin
C)norepinephrine
D)GABA

Question 33

The rapid onset of severe hypertension upon ingesting certain foods is most likely to occur when a person is being treated with

A)tricyclic antidepressants
B)buproprion
C)serotonin uptake inhibitors
D)monoamine oxidase inhibitors

Question 34

Fluoxetine (Prozac) has been shown to

A)be significantly better at relieving the symptoms of depression than tricyclic antidepressants
B)produce less disturbing side effects than those common to tricyclic antidepressants
C)induce suicidal thoughts in a high percentage of depressed people
D)all of the above

Question 35

Tricyclic antidepressants typically

A)reduce catecholamine reuptake
B)enhance catecholamine synthesis
C)enhance catecholamine reuptake
D)enhance catecholamine release

Question 36

Most antidepressants presently on the market differ primarily in terms of their

A)efficacy in relieving depression
B)time before onset of clinical benefits
C)side effect profiles and toxicity
D)all of these

Question 37

The most frequently prescribed antidepressant drugs with relatively low anticholinergic side effects are

A)selective serotonin reuptake inhibitors
B)non-selective dopamine reuptake inhibitors
C)non-selective noradrenergic inhibitors
D)lithium

Question 38

The potency of effective antidepressants differ considerably in terms of their

A)ability to block norepinephrine uptake
B)ability to block serotonin uptake
C)anticholinergic properties
D)all of these

Question 39

Which of the following is an appropriate statement regarding clinical treatment of depression with monoamine oxidase inhibitors (MAOIs)?

A)MAOIs should generally be tried before tricyclics are used
B)MAOIs should generally be tried before selective serotonin reuptake inhibitors are used
C)MAOIs should generally be tried before employing lithium in the treatment of bipolar depression
D)none of the above are true

Question 40

Toxic signs of lithium overdose consist of

A)hyperactivity and constipation
B)hallucinations
C)drowsiness, mental confusion, and muscular weakness
D)inability to perceive pain

Question 41

An advantage of the newer, reversible monoamine oxidase inhibitors (MAOIs) over the older MAOIs is

A)less interaction with exogenous amines that can induce toxic reactions
B)a shorter time period of MAO inhibition after one stops taking the drugs
C)less likelihood of dopamine build up in the brain that could trigger manic symptoms
D)all of these

Question 42

One of the more common side effects associated with the SSRIs is

A)drowsiness
B)sexual dysfunction such as impotence and inability to achieve orgasm
C)cardiac arrhythmias
D)all of these

Question 43

The newest FDA-approved class of antidepressant drugs that don't typically induce sedation or anticholinergic side effects

A)are selective serotonin reuptake inhibitors
B)have been shown to increase the symptoms of obsessive-compulsive disorders
C)have a higher abuse potential than earlier antidepressants
D)all of the above

Question 44

Recent theories attempting to explain the mood stabilizing properties of lithium and antiseizure medications have proposed actions of these drugs that

A)promote neurogenesis and neuronal growth
B)enhance catecholamine activity in the brain
C)suppress acetylcholine activity in the brain
D)enhance secondary messenger systems

Question 45

Support for the hypothesis that deficiencies in monoaminergic neuronal systems result in depression come from observations that

A)reserpine, which can reduce monoamine levels in the brain, may induce symptoms of depression.
B)the time-course of symptom remission in depressed individuals treated with most antidepressants correlates almost perfectly with the time-course of these drugs' pharmacodynamic actions of inhibiting serotonin or norepinephrine reuptake or inhibiting monoamine oxidase activity.
C)virtually all healthy adults, i.e., those with no history of depression personally or within their family, will exhibit the core symptoms of depression upon being administered treatments that reduce the levels of serotonin or norepinephrine in the brain.
D)all of these

Question 46

Antipsychotics (both conventional and atypical) are most appropriately used in the treatment of bipolar disorders

A)when patients are exhibiting symptoms of severe depression
B)at the beginning of drug treatment when patients are exhibiting symptoms of mania
C)after manic symptoms have been reduced with lithium, in order to prevent a subsequent switch into depression
D)none of the above would be appropriate

Question 47

The "neurotrophic" theory of antidepressant efficacy proposes that antidepressants work by

A)enhancing neurotrophic factors that reverse stress-induced damage to various brain regions
B)enhancing the neurotransmission between monoamine-releasing neurons and other neurons
C)reversing the deleterious effects of monoamines on neuronal architecture.

Question 48

The most significant problem associated with the use of lithium in the treatment of affective disorders is

A)its low therapeutic index
B)its tendency to be toxic to the liver
C)its expense as a prescription medication
D)the requirement of maintaining low sodium intake for it to be effective

Question 49

The so-called "serotonin syndrome" is most likely going to occur when SSRIs are combined with

A)tricyclic antidepressants
B)St.John's wort
C)monoamine oxidase inhibitors
D)all of these

Question 50

The use of tricyclic antidepressants for the treatment of depression in the elderly would generally not recommended primarily because of these drugs'

A)antiadrenergic-related side effects
B)antidopaminergic-related side effects
C)cardiovascular side effects
D)antiserotonergic-related side effects

Question 51

The primary benefits of the newer antidepressants developed in the past 15 years over the older tricyclic and monoamine oxidase inhibitor classes of antidepressants is in the area of

A)increased percentage of patients experiencing relief from depression
B)reduced lethal toxicity and side effects
C)both of these
D)none of the above

Question 52

Which of the following phenomena is supportive of the neurotrophic theory of major depression?

A)depressive symptoms are gradually reduced with effective treatments for depression
B)there is a sudden reoccurrence of depressive symptoms when depletions of serotonin or norepinephrine occur in depressed patients whose symptoms have been successfully treated with antidepressants
C)the hippocampus and prefrontal cortices of depressed patients are significantly larger than in normal individuals

Question 53

Which of the following pharmacodynamic properties do drugs effective in the treatment of depression have?

A)selective inhibition of serotonin reuptake
B)noradrenergic reuptake inhibition
C)inhibition of monoamine oxidase
D)all of these

Question 54

Which of the following is NOT one of the three major classifications of antidepressants?

A)monoamine oxidase inhibitors
B)dopamine receptor blockers
C)selective serotonin reuptake inhibitors
D)tricyclics

Question 55

Venlafaxine (Effexor) and duloxetine (Cymbalta) are two of the newest antidepressants to be approved for use in the treatment of depression.These drugs were developed because of their ability to

A)more selectively inhibit monoamine oxidase
B)more selectively enhance monoamine reuptake
C)selectively inhibit the reuptake of both serotonin and norepinephrine
D)selectively inhibit the reuptake of dopamine Chapter 9 Answers to multiple choice questions and

Question 56

Of the antidepressants in clinical use today, as a group they are LEAST likely to differ in terms of

A)the percentage of clinically depressed people that show symptom remission
B)their potency in inhibiting serotonin reuptake
C)their potency in inhibiting norepinephrine reuptake
D)their potency in blocking acetylcholine receptors

Question 57

Although effective in the treatment of depression, these drugs are also one of the most effective treatments for the symptoms of obsessive-compulsive disorder.

A)psychostimulants
B)dopamine receptor antagonists like Haldol
C)selective serotonin reuptake inhibitors
D)all of these

Question 58

When would it be most appropriate to supplement lithium therapy for bipolar disorder with antipsychotic drugs?

A)at the beginning of treatment during a manic episode
B)after a manic episode has been effectively reduced with lithium
C)during a depressive episode
D)when the person begins to show signs of lithium toxicity