Anxiolytics and anti-depressants Flashcards
The Limbic system
our moods and emotions are controlled by a loose grouping of different regions of the brain
hypothalamus: maintains homeostasis and motivational drives
amygdala: recognises and responds to emotions.
hippocampus:allows long-term storage of experiences and memory.
nucleus accumbens: involved in reward and pleasure.
cingulate cortex: registers pleasant and painful stimuli, also involved in aggression.
prefrontal cortex: deals with decision making and the expression of mood.
SERT inhibitors
Tricyclic antidepressants: - Desipramine - Imipramine Selective serotonin re-uptake inhibitors: - Sertraline - Citalopram - Fluoxetine (Prozac) SERT inhibitors/5-HT releasers: - Fenfluramine - Methylenedioxymethamphetamine (MDMA, “E”)
Where is serotonin found?
9 main clusters that lie near the midline of the brain stem
Dopamine deficiency of Parkinson’s
loss of dopamine from neurons in the substantia nigra of the mid brain
What are the 2 mood disorders?
major (unipolar) depression bipolar depression triad of symptoms for depression: - low/depressed mood - anhedonia (inability to feel pleasure) - decreased energy/fatigue
What are the symptoms of mania?
elation, talkativeness, creativity, fullness of energy and confidence
Fight or flight reaction to stress
- Stress causes the hypothalamus to produce corticotropin-releasing hormone (CRH).
- CRH activates the sympathetic nervous system and acts as a signal to the pituitary gland to produce adrenocorticotrophic hormone (ACTH), which in turn signals the adrenal gland to secrete cortisol.
- These cause the physiological changes necessary for a heightened response to stress.
- Cortisol also feeds back on glucocorticoid receptors in the hypothalamus and hippocampus
Treatment of depression
counselling psychotherapy eg. CBT MAOI's Tricyclic drugs SSR'Is 3rd generation anti-depressants mood stabilizers ECT - anaesthesia and muscle relaxants must be givem
Monoamine oxidase inhibitors
eg. Phenelzine - treatment of bipolar and depression
Tranylcypromine - treatment of severe depression
- adverse effects:
hypertensive crisis, foods high in tyramine increase BP, Tryptophan supplements or other psychoactive drugs should be avoided as risk of “serotonin syndrome”, weight gain, oedema, sexual dysfunction and sedation
- contraindications:
impaired renal or hepatic function, hypertension, pregnant or lactating women
Tricyclic anti-depressants
eg. Imipramine - treatment of depression
Amitriptyline - treatment of depression
Doxepin - depression and anxiety
- adverse affects:
weight gain, sexual dysfunction, inhibition of liver enzymes, adrenergic effects (avoid with coronary instability), antihistaminergic effects (sedation, avoid other CNS depressants), anticholinergic effects (headache)
Selective Serotonin re-uptake inhibitors
eg. Fluoxetine - depression and OCD
Paraxetine - depression and panic disorders
Sertraline - depression and panic dosorders
Citalopram - depression
- adverse effects:
sexual dysfunction, dependence and withdrawal, drug interactions eg. Benzo’s, Warfarin
- contraindications:
patients with history of mania
Miscellaneous next generation antidepressants
eg, Buroprion - depression
Venlafaxine - depression
Mood stabilisers
eg. Lithium carbonate - prophylaxis and acute mania
Lithium citrate - prophylaxis and acute mania
Carbamazepine - mania, epilepsy
Valproate - mania, epilepsy
-adverse effects:
dizziness, headache, confusion, cardiac dysrhythmias, nephrotoxicity
- contraindications:
patients with renal dysfunction, leukaemia,
dehydration or sodium depletion
Anxiety disorders
Generalised anxiety disorder Panic disorders Phobias Post-traumatic stress OCD treated with anxiolytics
Sedative hypnotics
eg. Thiopental - prep for surgery
Seconbarbital - insomnia, anxiety and acute agitation
Phenobarbital - insomnia, anxiety and seizures
Zolpidem - insomnia
- adverse effects
avoid other CNS depressants, check for suicidal tendencies, drowsiness/hangover effect, tolerance/dependence - seizure on withdrawal
- contraindications:
children under 18, pregnancy/nursing mothers
Benzodiazepines
eg. Diazepam - anxiety and seizures
Alprazolam - anxiety and panic disorders
Temazepam - short term treatment of insomnia
Lorazepam - anxiety, status epilepticus, pre-op sedation, amnesia
do not cause over-sedation and tolerance
- adverse effects:
avoid CNS depressants, anticholinergic effects (dry mouth, headache)
DATE RAPE DRUG
- contraindications:
renal and hepatic dysfunction, glaucoma, pregnancy and lactation
Non-benzodiazepines
eg. Buspirone - anxiety, depression co-therapy
- adverse effects:
avoid other CNS depressants, never take with MAOI’s, anticholinergic effects (dizziness, headache, dry mouth)
Schizophrenia
“Positive” symptoms – hallucinations, delusions, bizarre thoughts
“Negative” symptoms – social withdrawal, flattened mood, apathy
patients unable to separate real from unreal experiences
behaviour often bizarre and inappropriate
3 types of schizophrenia
Disorganised schizophrenia:
- dis-organised, thought disorder; flattened mood
- difficult to understand - speech may be incomprehensible
Paranoid schizophrenia
- experience hallucinations and delusions, but not the other symptoms
Catatonic schizophrenia
- psychmotor disturbances, e.g. catatonic stupor and waxy flexibility
Typical Antipyschotics/neuroleptics
eg. Chlorpromazine - psychosis and schizophrenia, behavioural problems in children
Fluphenazine - psychosis and schizophrenia
Haloperidol - psychosis and severe behavioural problems
Loxapine - mood disorders and schizophrenia
sopamine receptor antagonists
- adverse effects:
parkinsonism (tremor), sedation, hypotension, do not take with other CNS depressants, anti-anti-hypertensives
- contraindications:
CV disease, bone marrow depression, liver/thyroid disfunction, Parkinson’s
Atypical antipsychotics
eg. Clozapine, Amisulpride, Risperidone, Olanzepine - schizophrenia
- adverse effects:
risk of neuroleptic malignancy syndrome, avoid other CNS depressants, photo-sensitivity, GI distress, weight gain
