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1. What are the main classes of antidepressants and how do they work? Provide an example of a
drug for each class.
Answer: The main classes of antidepressants are selective serotonin reuptake inhibitors (SSRIs),
serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs),
monoamine oxidase inhibitors (MAOIs), and atypical antidepressants. They work by increasing the
availability of neurotransmitters such as serotonin, norepinephrine, and dopamine in the brain,
which are involved in mood regulation. Examples of drugs for each class are fluoxetine (SSRI),
venlafaxine (SNRI), amitriptyline (TCA), phenelzine (MAOI), and bupropion (atypical).
2. What are the common side effects and contraindications of antipsychotics? How can they be
managed?
Answer: The common side effects of antipsychotics include extrapyramidal symptoms (EPS), such
as dystonia, akathisia, parkinsonism, and tardive dyskinesia; metabolic syndrome, such as weight
gain, diabetes, and dyslipidemia; sedation, orthostatic hypotension, anticholinergic effects, such
as dry mouth, blurred vision, constipation, and urinary retention; and neuroleptic malignant
syndrome (NMS), which is a rare but life-threatening condition characterized by fever, muscle
rigidity, altered mental status, and autonomic instability. The contraindications of antipsychotics
include hypersensitivity to the drug, severe cardiovascular or cerebrovascular disease, blood
dyscrasias, liver or kidney impairment, and history of seizures. The management of side effects
and contraindications depends on the type and severity of the adverse reaction. Some general
strategies are dose adjustment, switching to a different drug or class, adding an adjunctive
medication, monitoring vital signs and laboratory tests, providing education and counseling, and
implementing lifestyle modifications.
3. What are the indications and mechanisms of action of mood stabilizers? Name two examples of
mood stabilizers and their therapeutic ranges.
Answer: The indications of mood stabilizers are bipolar disorder, cyclothymia, schizoaffective
disorder, and other conditions that involve mood swings or instability. The mechanisms of action
of mood stabilizers are not fully understood, but they may involve modulating the activity of
neurotransmitters, ion channels, second messengers, and gene expression in the brain. Two
examples of mood stabilizers are lithium and valproic acid. The therapeutic range of lithium is
0.6 to 1.2 mEq/L and the therapeutic range of valproic acid is 50 to 125 mcg/mL.
4. What are the benefits and risks of benzodiazepines in the treatment of anxiety disorders? How
can benzodiazepine dependence and withdrawal be prevented or treated?
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