AFFECTIVE DISORDERS Flashcards

1
Q

what are affective disorders

A

disorders of mood rather than cognitive function

unipolar // bipolar (low-high manias)

endogenous (no obvious reason) // reactive (post trauma)

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2
Q

animal models of depression

A
  • forced swim test (mouse will give up and drown)
  • tail suspension test (give up fighting urger quicker)
  • learned helplessness (stop looking for food)
  • olfactory bulbectomy (removal of sensory neurons)
  • maternal deprivation
  • chronic mild stress
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3
Q

Monoamine Hypothesis

A

mood disorders result from an imbalance in signals generated by NE + 5-HT (serotonin) dependent pathways

anxiety - too much // depression - less activity

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4
Q

evidence of Monoamine Hypothesis

A

. TCAs - block NE + 5-HT reuptake =(+) mood
. MAOI - increase storage or NE + 5-HT =(+) mood
. tryptophan - increases 5-HT synthesis =(+) mood
. ECT - increases CNS repsonses to NE + 5-HT =(+) mood

. Reserpine - inhibits NE + 5-HT storage =(-) mood
. a-Methyltyrosin - inhibits NE synthesis =(-) mood
. Methyldopa - inhibits NE synthesis =(-) mood

Tryptophan depletion = decreases brain 5-HT synthesis
- induces relapse in SSRI treated patients

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5
Q

counterevidence to Monoamine Hypothesis

A

. amphetamines inhibit reuptake of NE + Dopamine
= no effect on depression
. antidepressant actions of MAOI, TCAS, SSRIs
=delayed effects
. some antidepressant drugs have no effects on adrenergic/serotonergic transmission
.ECT has in some cases shown to reduce NE+5-HT in CNS of patients = improves depression

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6
Q

what keeps cells alive

A

BDNF - brain-derived neuro factor

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7
Q

potential targets for treatment of affective disorders

A
  1. (+)enzymes involved in NE + 5-HT synthesis
  2. (-)enzymes involved in NE + 5-HT metabolism
  3. (+) transporters of vesicular storage of NE + 5-HT
  4. (-) NE + 5-HT reuptake transporters
  5. postsynaptic receptors (activate agonists)
  6. autoreceptors
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8
Q

what route does all uptake happen via

A

uptake 1

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9
Q

drugs used to inhibit unipolar depression

A
  1. MAOI
  2. TCAs
  3. SSRIs
  4. SNRIs
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10
Q

monoamine oxidase

A

metabolizes NE + 5-HT + dopamine
A = specifity for NE + 5-HT
B = degrades dopamine
most MAOI are nonspecific - bind to both // actions on A responsible for therapeutic action of drugs in treating depression

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11
Q

MAOIs

A

PHENELZINE
noncompetitive IRREVERSIBLE inhibition of MAO
= increases 5-HT, NE, Dopamine

side effects: dry mouth, blurred vision, constipation, urinary retention, tachycardia, arrhythmias, orthostatic hypotension

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12
Q

why are interactions of MAOIs with SSRIs/food fatal

A

tyramine breakdown product of amino acid degredation

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13
Q

Tricyclic Antidepressants (TCAs)

A

AMITRIPTYLINE
inhibits uptake 1 for both NE + 5-HT

side effects: dry mouth, blurred vision, constipation, urinary retention, tachycardia, arrhythmias, orthostatic hypotension + sedative effect

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14
Q

Selective Serotonin Reuptake Inhibitors (SSRIs)

A

FLUOXETINE
. selective inhibition of serotonin reuptake receptors in presynaptic 5-HT neurons
. advantage over MAOI/TCAs - lack of noradrenergic PNS effect = no tyramine toxicity

side effects: nausea, diarrhea, anorexia, insomnia, sexual dysfunction, increased sweating

Other uses: anxiety disorders, panic attacks, PTSD, OCD

MAOI interaction: hypothermia, muscle rigidity, cardiovascular collapse

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15
Q

where are 5-HT1 R found

A

on cell body/dendrites = somatodendritic receptors
= inhibitory - limit opening of Na+ channel = slow AP
- less release of serotonin

take SSRI - increase amount of serotonin = more stimulation // opposite effect: increase somatodendritic 5-HT1 = decrease activity of AP

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16
Q

Serotonin - NE Reuptake Inhibitors (SNRIs)

A

DULOXETINE
. selective inhibition of serotonin + NE reuptake receptors in presynaptic neurons
. advantage over TCAs -more selective = fewer side effects
. other uses: anxiety disorders, chronic nerve pain

side effects: nausea, diarrhea, anorexia, insomnia, sexual dysfunction, increased sweating

17
Q

what are the roles of other antidepressants:
. mirtazapine

. L-tryptophan/5-HT

. St John’s wort

A

. blocks inhibitory actions caused by alpha2 heteroreceptors/5-HT = increasing NE + 5-HT release
fewer side effects / faster acting than TCAs

. increases synthesis of serotonin

. contains hyperforin - Uptake 1 Inhibitor
fewer side effect // serious drug interactions - ability to induce drug-metabolizing liver enzymes in P450

18
Q

what is the most effective drug treatment for BIPOLAR Disorder

A

LITHIUM

  1. inhibits inositol synthesis – IP3 dependent pathways
  2. blocks 5-HTa1 autoreceptors = prevent inhibition
  3. enhance glutamate reuptake (too much =mania)
  4. inhibit activity of glycogen synthase kinase 3 (effects on neurite outgrowth/axonal spreading

LOW TI = kidney damage, thyroid enlargement, muscle tremors, vomiting, diarrhea, weigh gain, hair loss

19
Q

what are 4 antimania drugs

A
  1. lamotrigine
  2. carbamazepine
  3. valproate
  4. gabapentin
    - also used to treat epilepsy
20
Q

why do we use drug cocktails

A

attempt to improve depression/mania when one medication is not enough

aripiprazole: D2 partial agonist, 5HT1a partial agonist
antipsychotic
side effects: restlessness, uncontrolled movements