Deck 18: Affective Disorders: Antidepressants and Mood Stabilizers

Question 1

Which statement about affective disorders is false?

A) They are among the most common forms of mental illness.
B) They date back to the time of ancient Greece and Hippocrates.
C) They are linked more to environmental causes than to brain factors.
D) They include major depression and bipolar disorder.

Answer 1

C

Question 2

Which of the following best describes reactive depression?

A) A long-term depressive state that cannot be explained by a person's circumstances
B) A chemical imbalance
C) Depression characterized by periods of mania alternating with periods of despondency
D) A depression that occurs after a troubling life event, such as divorce

Answer 2

D

Question 3

Depression

A) is most prevalent in older adults.
B) affects men and women equally.
C) will not improve on its own; therapy is required.
D) affects approximately 15% to 20% of the population at any given time.

Answer 3

D

Question 4

A recently depressed person who suddenly is making major real estate deals and finds less need for sleep may be experiencing the _______ period of _______.

A) manic; bipolar disorder
B) manic; insomnia
C) excitability; reactive depression
D) excitability; an anxiety disorder

Question 5

Which statement about bipolar disorder is true?

A) It rarely occurs in people over the age of 50.
B) During the manic period a person is susceptible to suicide.
C) It doesn't appear to have a strong hereditary component.
D) The time of onset is usually between the ages of 20 and 30.

Question 6

Which statement about risk factors for mood disorders is false?

A) Psychiatric disorders develop due to genetic factors alone.
B) In the case of affective disorders, environmental triggers alone are enough to cause serious mood changes.
C) The genetic factors involved in mood disorders indicate that an individual may be more susceptible to a disorder, not that they will definitely develop it.
D) Environmental stress doesn't appear to play a role in mood disorders.

Question 7

Which statement about the role of heredity in the affective disorders is true?

A) No single dominant gene for these disorders has yet been identified.
B) Adoption studies provide the strongest evidence for a genetic basis to the affective disorders.
C) Twin studies show that the monozygotic-dizygotic twin difference in concordance rates is greater for severe depression than for bipolar disorder.
D) Linkage studies attempt to study the incidence of a disorder in people of similar demographic groups.

Question 8

Which statement about stress is false?

A) It often precedes the first episode of depression
B) Depressed patients have altered stress hormone levels
C) Researchers can describe a typical "stress response" because everyone responds to life stresses in pretty much the same way
D) The involvement of stress is one factor that links the disorders of depression and anxiety

Question 9

Which event occurs during stress activation of the hypothalamic-pituitary-adrenal (HPA) axis?

A) NE and ACh regulate the release of corticotrophin-releasing factor (CRF) from the hypothalamus.
B) ACTH blocks the release of cortisol from the adrenal gland.
C) Cortisol feeds back to increase HPA activation.
D) Glucocorticoids feedback to stimulate the hippocampus.

Question 10

Researchers know that depressed individuals have an abnormal stress response involving the HPA axis because these individuals show

A) reduced release of ACTH.
B) reduced size of pituitary and adrenal glands.
C) higher CRF levels in cerebrospinal fluid (CSF) and elevated levels of cortisol.
D) fewer CRF cells evident in postmortem hypothalamic tissue.

Question 11

What is a dexamethasone challenge?

A) Depressed individuals are given a synthetic glucocorticoid to see if it shuts the HPA axis down.
B) Depressed individuals are given a synthetic CRF to try to "jump start" the HPA axis.
C) Depressed individuals are given a form of ACTH to shut the HPA axis down and allow it time for recovery from stress over-responding.
D) Depressed individuals are given a glucocorticoid blocker to regulate an out-of-control system.

Question 12

Which sleep pattern would you expect to see in a depressed individual?

A) Significant increase in stages III and IV slow-wave sleep
B) Short period of sleep onset
C) Long, deep sleep with few awakenings
D) Increased REM sleep early in the night and intense eye movement.

Question 13

The gut-brain axis describes

A) the way foods affect mood.
B) the interaction of the CNS with the gut enteric nervous system.
C) how vitamin deficiencies can lead to mood disorders.
D) the hormones that trigger hunger and satiety.

Question 14

The microbiome of the gut has been shown to affect _______ function though interaction with the _______ nerve, which innervates the gut, heart, and throat muscles.

A) peripheral nervous system; glossopharyngeal
B) peripheral nervous system; trigeminal
C) CNS; vagus
D) CNS; accessory

Question 15

Animal models show that the _______ gene may play a role in acute mania associated with bipolar disorder, and animal models _______ this finding.

A) TIME; support
B) TIME; refute
C) CLOCK; support
D) CLOCK; refute

Question 16

The monoamine hypothesis is supported by all of the following findings except

A) the drug reserpine depletes vesicles of monoamine transmitters and causes depression.
B) people with depression have extraordinarily high levels of MHPG and 5-HIAA in their urine, blood, and CSF.
C) TCAs reverse symptoms of depression.
D) MAOIs reverse symptoms of depression.

Question 17

Which statement about new research into biochemical models for mood disorders is false?

A) The monoamine hypothesis needs to be updated with information that explains the slow onset of the clinical effects of the drugs.
B) PET scans and MRI can be used to discriminate between people with and without mood disorders in order to contribute to new models.
C) Animal models are no longer useful in the search for modern biochemical models for human conditions.
D) New models will have to consider multiple neurotransmitter systems and how they interact.

Question 18

Which research finding confirms a role for serotonin dysfunction in mood disorders?

A) Decreased numbers of postsynaptic 5-HT₂ receptors are found in depressed patients.
B) Low 5-HIAA turnover is found in depressed individuals.
C) Rapid tryptophan depletion in treated depressed patients improves symptoms.
D) Challenge studies indicate that the 5-HT receptors in depressed individuals are highly sensitive.

Question 19

Animal studies on the acute and chronic effects of antidepressants on serotonin have shown that

A) the autoreceptors are activated acutely, causing a decrease in synthesis and release of 5-HT.
B) the reuptake transporters remain open for the duration of the drug's action.
C) tolerance to the drug occurs at the autoreceptors sporadically, resulting in reduced 5-HT release.
D) serotonin occupancy of serotonin autoreceptors activates cell firing following chronic antidepressant treatment.

Question 20

Which statement about the norepinephrine and serotonin is true?

A) Noradrenergic pathways from in the LC and serotonergic pathways from in the raphe nuclei are non-overlapping.
B) Noradrenergic pathways from in the LC and serotonergic pathways from in the raphe nuclei are capable of modulating each other.
C) Serotonergic pathways from in the LC and noradrenergic pathways from in the raphe nuclei are non-overlapping.
D) Serotonergic pathways from in the LC and noradrenergic pathways from in the raphe nuclei are capable of modulating each other.

Question 21

Which statement regarding the glucocorticoid hypothesis of depression is false?

A) The amygdala normally inhibits the hypothalamic-pituitary-adrenal (HPA) axis, whereas the hippocampus activates it.
B) High cortisol levels cause loss of cells and reduced neurogenesis in the hippocampus.
C) Behavioral characteristics of depression can be reduced in animals by administration of CRF.
D) ECT and antidepressant drugs may exert some of their clinical benefits by increasing CRF.

Question 22

Which of the following supports the neurotrophic hypothesis of depression?

A) The loss of dendritic branches and spines in the hippocampus and PFC and reduced neurogenesis in the hippocampus may be due to low BDNF.
B) Acute antidepressant treatment increases BDNF in both animals and humans.
C) Chronic stress increases BDNF in the hippocampus in rats.
D) BDNF is enhanced by upregulation in the cAMP cascade, as occurs with treatments for depression.

Question 23

Chronic social defeat stress causes an increase in histone _______, which leads to a decrease in BDNF gene expression by tightening the structure of chromatin. Antidepressant treatment results in a(n) _______ and enhanced BDNF expression.

A) acetylation; decrease in histone acetylation
B) acetylation; increase in histone methylation
C) methylation; decrease in histone methylation
D) methylation; increase in histone acetylation

Question 24

Which of the following would you expect to find in an fMRI of a depressed person?

A) Increased numbers of DA receptors in the striatum.
B) Increased neural connections in the pathways of the default mode network DMN
C) Low glucocorticoid levels in hypothalamus
D) Increased neurogenesis and growth of dendritic spines and branches

Question 25

Which of the following is/are primarily used for treating major depression?

A) Selective serotonin reuptake inhibitors (SSRIs)
B) Lithium therapy
C) Benzodiazepines
D) Neuroleptics

Question 26

Which statement concerning the use of antidepressant medication in general is true?

A) Placebo-controlled studies show that antidepressant medications are effective in about 80% of the people that use them for depression.
B) Antidepressant drugs have predictable outcomes and side effects that make it relatively easy for a psychiatrist to choose a medication for a given patient.
C) The therapeutic effects of antidepressants involve changes in the brain that can take up to several weeks to develop.
D) The maintenance period of drug treatment should be no longer than 4 to 5 months.

Question 27

Which statement about MAO inhibitors is true?

A) The first MAOI, iproniazid, was discovered by accident while investigating treatments for tuberculosis.
B) They can be used without dietary restrictions.
C) They increase the metabolism of norepinephrine, dopamine, and serotonin.
D) These drugs have little use in the treatment of depression given the availability of safer drugs, and no use in the treatment of other disorders.

Question 28

What effect of MAOIs at the synapse is correlated with their therapeutic effectiveness?

A) MAO is released, thereby elevating the number of transmitters available for release.
B) The normal amount of transmitter in the presynaptic terminal is properly regulated by the drug, which acts as an enzyme.
C) The synapse adapts by increasing receptors for the amine transmitters.
D) Postsynaptic changes occur in second-messenger systems, up-regulating cAMP.

Question 29

Which of the following is not a problem or side effect of MAOIs?

A) Enhanced activity of cytochrome P450 enzymes
B) Overeating of carbohydrates
C) Interaction with drugs that affect the sympathetic nervous system
D) Elevated tyramine levels when combined with certain foods

Question 30

Which food should be avoided by people taking MAOIs?

A) Aged cheese
B) Eggs
C) Bananas
D) Peanut butter

Question 31

Which statement about tricyclic antidepressants is true?

A) They enhance the function of the presynaptic transporter protein for serotonin and/or norepinephrine.
B) They cause short-term adaptive changes at the synapse that are related to their therapeutic effects.
C) All drugs in this class have similar reuptake-blocking potencies.
D) They are reliably safe for people with cardiac conditions.

Question 32

All of the following are potential side effects of the tricyclic antidepressants except

A) sedation.
B) confusion.
C) hypertension.
D) urinary retention.

Question 33

The greatest danger of the tricyclic antidepressants is

A) stroke.
B) cardiac arrest.
C) psychosis.
D) migraine.

Question 34

What is the major advantage of the second-generation antidepressants over the MAOIs and the TCAs?

A) They are more effective in treating depression.
B) They work faster than the older classes of drugs.
C) They produce different and less harmful side effects than the older medications.
D) They are less selective in their action; hence they can be used for a number of conditions.

Question 35

All of the following are side effects of the selective serotonin reuptake inhibitors (SSRIs) except

A) blurred vision.
B) insomnia.
C) headache.
D) movement disorders.

Question 36

Which side effect is a frequent reason for individuals terminating SSRI use?

A) Anxiety
B) Insomnia
C) Sexual dysfunction
D) Muscle rigidity

Question 37

Which statement about serotonin syndrome is false?

A) It can occur when SSRIs are combined with other serotonin agonists.
B) It is characterized by agitation and disorientation.
C) Symptoms include exaggerated autonomic nervous system activity.
D) While frightening, the syndrome is not life-threatening.

Question 38

_______ would be considered a third-generation antidepressant.

A) Remeron (a dual NE/5-HT modulator)
B) Zoloft
C) A CRF receptor antagonist
D) Wellbutrin

Question 39

Which statement regarding intravenous ketamine as a treatment for depression is false?

A) The dose required to reduce depression symptoms is much higher than that needed for anesthesia.
B) It reduces symptoms in 75% of patients who are resistant to other treatments.
C) Its effects typically last 1-3 months.
D) In addition to blocking NMDA type glutamate receptors, it enhances AMPA receptor response to glutamate.

Question 40

Which of the following is a benefit of the drug esketamine over racemic ketamine in the treatment of depression?

A) It has high bioavailability such that intravenous administration is not necessary.
B) It is longer-acting than racemic ketamine so intravenous administration is required less frequently.
C) It has fewer drug interactions than racemic ketamine.
D) It has a faster onset of action than racemic ketamine.

Question 41

Which statement about lithium is true?

A) It has very few side effects and very few patients stop taking the medicine once they start.
B) It is taken for the maintenance period of 6 to 8 months and should then be safely withdrawn.
C) It has antidepressant qualities.
D) It dramatically increases the time between recurring episodes of mania and depression.

Question 42

Which of the following is not a way that lithium acts on the synapse?

A) It increases catecholamine activity
B) It increases 5-HT and 5-HIAA
C) It affects second-messenger systems
D) It influences brain neurotrophic factors

Question 43

A side effect of lithium is

A) decreased thirst and urination.
B) impaired concentration and memory.
C) anxiety.
D) weight loss.

Question 44

Alternatives to lithium as treatments for bipolar disorder include

A) Tegretol and Depakote.
B) Gabitril and l-DOPA.
C) Vanatrip and Vivactil.
D) Zoloft and Paxil.

Question 45

Distinguish between reactive depression, major depression, and bipolar disorder in terms of symptoms and incidence.

Question 46

Describe the diathesis-stress model of depression. How does the model work?

Question 47

Evaluate the role of the following risk factors in depression: hereditary factors, stress, and biological rhythms. Briefly discuss the role of melatonin receptor therapy for depression as it relates to altered biological rhythms.

Question 48

What is the dexamethasone test for cortisol levels, and what is its significance?

Question 49

Describe the gut-brain axis and its proposed role in health and depression. Include the involvement of the HPA in your answer.

Question 50

Why is the Clock protein of interest in studies on bipolar disorder?

Question 51

Describe evidence from studies measuring 5-HT turnover, tryptophan levels, receptor binding, and response to various drug challenges that supports a role for serotonin dysfunction in mood disorders.

Question 52

Describe the monoamine hypothesis of mood disorders and several pieces of evidence that support it. In which ways is the hypothesis weak or incomplete?

Question 53

Name and describe the two neurobiological models of depression and provide supportive evidence for each. Which types of novel treatments are suggested by these models?

Question 54

Describe the epigenetic changes produced by chronic stress and explain how these changes affect gene expression of BDNF. What might these findings tell us about the pathophysiology of mood disorders? What new treatments do these findings suggest?

Question 55

Compare the acute and chronic effects of antidepressant drugs on the 5-HT synapse in order to explain why therapeutic efficacy takes several weeks to become evident.

Question 56

Identify the two older classes of medications used to treat major depression. Describe their mechanism of action at the synapse and their major side effects.

Question 57

Which two groups of drugs were discussed as examples of the second-generation antidepressants in the textbook? How do they differ from the older medications used for depression? For each group, indicate the mechanism of action and the major side effects.

Question 58

Describe the mechanism of action of at least three third-generation antidepressants.

Question 59

Describe the evidence supporting a role for glutamate receptors as targets for antidepressants.

Question 60

Provide evidence that indicates lithium is a very effective drug for bipolar disorder. How does it work at the synapse? Why must blood levels of lithium be monitored on a regular basis? Discuss what happens if levels are too high or too low.