False: Whilst the majority believe that the improvement in pain in patients with psychogenic pain and somatoform pain disorder is not related to changes in mood (Sadock & Sadock 2005, p. 1822), some believe that the pain relief is partly related to the alleviation of the accompanying depression (King 2004, p. 206).

True: Depression is associated with decreased REM latency and increased total REM sleep. Tricyclic antidepressants increase REM latency and reduce total REM sleep (Johnstone et al 2004, p. 788; King 2004, p. 203; Wright et al 2005, p. 306).

False: Clomipramine is a potent serotonin reuptake inhibitor and an anticholinergic, and its metabolite N-desmethylclomipramine is a potent noradrenaline reuptake inhibitor. Hence, it would be unsuitable for studies of noradrenaline neurotransmission (King 2004, p. 197).

True: Duloxetine is an SNRI, i.e. a serotonin and noradrenaline reuptake inhibitor. It works as an antidepressant at a dose of 60 mg/day. It is used in moderate to severe stress incontinence in women at a dose of 20–40 mg twice daily (BNF 2005, 4.3.4).

True: However, some types of bifrontal electrode placement may not be as efficacious as bifrontotemporal placement. Moreover, the advantage in terms of less cognitive impairment is yet to be confirmed (King 2004, p. 282; Sadock & Sadock 2005, p. 2976).

False: Cognitive impairment including dementia is not a contraindication to ECT for the treatment of coexistent depression. However, pre-existing cognitive impairment would increase the risk of adverse cognitive effects such as post-treatment delirium and prolonged confusion (Johnstone et al 2004, p. 647; Sadock & Sadock 2005, p. 2981).

True: Short- and long-term retrograde amnesia and long-term anterograde amnesia for personal and impersonal events are side-effects of ECT. However, short-term retrograde amnesia could partly be caused by the depression itself. The long-term retrograde amnesia is difficult to evaluate (Gelder et al 2006, p. 568; Scott 2005).

True: The post-ECT EEG shows greater slowing with bilateral ECT than with unilateral ECT. It may be detectable for several weeks after a course of ECT.

False: There is no evidence that the concurrent administration of antidepressant drugs increases either the response rate or the speed of response (Sadock & Sadock 2005, p. 2980).

False: The speed of response to ECT depends on the extent to which the administered stimulus is suprathreshold, and not on the electrode placement.

Hence, bilateral ECT is no more rapidly effective than unilateral ECT. However, patients who do not improve with unilateral ECT may improve with bilateral ECT (Scott 2005).

False: Memory problems are usually worst towards the end of a course of ECT. Memory begins to improve after ECT is stopped and usually recovers fully within 6 months (Scott 2005).

True: CBT has been shown to be equivalent to pharmacotherapy and superior to waiting list for unipolar depressive disorders of moderate severity (Gelder et al 2006, p. 258; Johnstone et al 2004, p. 323).

False: The prevalence of sexual side-effects in male patients on clomipramine are: decreased libido = 21%, erectile dysfunction = 20%, ejaculatory failure = 42% (Crenshaw & Goldberg 1996, p. 276).

True: Meta-chlorophenyl piperazine (mCPP) is a metabolite of nefazodone. It is an agonist at 5-HT_2C and 5-HT_1A receptors and an antagonist at 5-HT_2A and 5-HT₃ receptors (King 2004, p. 230).

True: Mirtazapine is a histamine 1, a₂, 5-HT₂ and 5-HT₃ receptor antagonist. Antagonism of presynaptic a₂ receptors enhances the release of noradrenaline and serotonin.

Blockade of 5-HT₂, 5-HT₃ and H₁ receptors enhances sedation and appetite (Anderson & Reid 2002, p. 71; King 2004, p. 227; Sadock & Sadock 2005, p. 2852).

True: Mirtazapine blocks a₂ adrenergic, 5-HT₂, 5-HT₃ and histamine 1 receptors. Inhibition of alpha 2 adrenergic receptors enhances the release of noradrenaline and serotonin. Antagonism of 5-HT₂ and 5-HT₃ receptors enhances the availability of serotonin to act on 5-HT₁ receptors. Thus mirtazapine acts as an indirect 5-HT_1A receptor agonist. Blockade of 5-HT₂ and 5-HT₃ receptors and the indirect stimulation of 5-HT_1A receptors minimize sexual dysfunction (Anderson & Reid 2002, p. 71; King 2004, p. 227; Sadock & Sadock 2005, p. 2852.

False: Moclobemide is a reversible MAO-A inhibitor. It is much less likely to provoke tyramine reaction than conventional MAOIs. However, tyramine reaction is possible with high doses (600 mg/day) or if a large quantity of tyramine is ingested (Anderson & Reid 2002, p. 69; King 2004, p. 194).

True: SSRIs increase extracellular fluid concentration of 5-HT. This causes negative feedback and activation of 5-HT_1A autoreceptors that inhibit cell firing, resulting in decreased release of 5-HT from the synaptic terminal.

Pindolol is a non-selective b-adrenoceptor antagonist. It blocks b₁ and b₂ as well as 5-HT_1A autoreceptors.

Therefore, pindolol can potentiate the ability of SSRIs to facilitate 5-HT neurotransmission. For this reason, pindolol has been used with SSRIs in treatment-resistant depression. Pindolol may accelerate, though may not augment, antidepressant effect of SSRIs (Sadock & Sadock 2005, p. 2726; Stahl 2000, p. 278).

False: Reboxetine is a potent and selective noradrenaline reuptake inhibitor. Other than a mild sympathomimetic activity it has no other actions of significance. It has no actions on neuroreceptors (Anderson & Reid 2002, p. 70; King 2004, p. 215).

True: Stimulation of 5-HT_2A receptors in brainstem sleep centres may disrupt slow-wave sleep and cause nocturnal awakening. It can cause or worsen anxiety, restlessness, akathisia, agitation and insomnia. It may also cause myoclonus during the night (King 2004, p. 461; Stahl 2000, p. 230).

False: The catch here is that TCAs may be used to treat peripheral neuropathy.

True: TCAs increase REM latency, decrease total REM sleep, cause distressing dreams, decrease the number of awakenings, increase stage IV sleep, cause daytime sedation and prolong reaction times. This may be due to the blockade of H₁, a₁ adrenergic and muscarinic cholinergic receptors (Johnstone et al 2004, p. 273; King 2004, p. 203).

False: In TCA overdose, the anticholinergic activity reduces gastric motility and absorption. Therefore, gastric lavage may be useful for several hours after TCA overdose (Gelder et al 2006, p. 543; Johnstone et al 2004, p. 283).

False: Venlafaxine has a half-life of 5 hours. The active metabolite of venlafaxine, o-methylvenlafaxine, has a half-life of 10 hours (Johnstone et al 2004, p. 280).

False: The actions of venlafaxine are dose-dependent. At doses below 150 mg, venlafaxine blocks reuptake of serotonin. At 150–300 mg, venlafaxine blocks reuptake of 5-HT and noradrenaline. At doses above 300 mg, venlafaxine blocks reuptake of 5-HT, noradrenaline and dopamine (Johnstone et al 2004, p. 281; King 2004, p. 211).