L8 - Flashcards
Bipolar Disorder
- BP1 and 2
- cyclothymia
BP1 - manic episodes & significant depression
BP2 - extreme depression and hypomania (less severe form of mania)
Cyclothymia - similar to BPD but lower extremes & less swings
Lithium Treatment
- calms manic patients
- modulates GABA , glutamate , and interferes with cAMP
- S/E : thirst , tremor , confusion
Major Depressive Disorder
- key symptoms : persistent sadness, loss of pleasure, fatigue
associated symptoms : disturbed sleep, poor concentration, low self confidence, suicidal , agitation, guilt
MDD must have:
- symptoms present for 2 weeks at significant level
<4 - not depressed
4 - mild depression
5-6 - moderate
>7 - severe
Depression Monoamine Hypothesis
depression results from deficient monoamine transmission
- treated with monoamine oxidase inhibitors.
- depression comes from low levels of amines (NA , 5-HT , DA)
Problems : drugs act fast (hours) but takes weeks or months to see change
Neuromodulation
- Volume Transmission
- synaptic transmission fast & precise e.g. glutamate
Neuron has long axons, releasing at different places. = slow transmission
- G-coupled protein receptors
- transports monooamines
Noradrenergic - locus coeruleus
Dopaminergic - VTA + SN
Serotonergic - raphe nucleus
Depression Treatments
1st CBT - interpersonal therapy, meditation
2nd Antidepressants - SSRI’s, SNRI’s, MAOI’s , TCA’s
- sertraline 50mg
3rd Electroconvulsive - shock therapy + vagus nerve stimulation
Antidepressants
- SSRI’s , MAOI’s , TCA’s
SSRI’s
- selective serotonin reuptake inhibitors
- sertraline (depression) Fluoxetine (BDD)
-MAOI’s - inhibit monoamine oxidase to allow amine build up (5-HT, D, NA)
-TCA’s inhibit presynaptic a2 receptors allowing NA build up
-SSRI’s, SNRI’s & TCA’s block these amine reuptake molecules to stop amine degradation
SSRI’s Overview
-S/E
-Contraindications
MOA : selectively bind to serotonin reuptake transporters in synapse to allow serotonin to build up
-well tolerated
-associated with bleeding risk
- sertraline for patients with CV issues, never citalopram (QT prolongation)
TCA’s
- amitryptaline , clomipramine
- S/E come from binding to a2
similar efficacy to SSRI’s, but more S/E
- antimuscarinic effects, cardiotoxic, weight gain
- used for nerve pain and depression
MAOI’s
- block monoamine oxidase
- tranylcypromine , phenelzine
block the enzyme that breaks down important monoamines (NA, 5-HT, D)
- only given by specialist
- has hepatotoxicity
- Food Reaction : tyramine enters nerve and displaces NA from vesicle causing large NA release & vasoconstriction
- leads to hypertensive headaches
- MAO releases tyramine and degrades in gut which can increase this
- so watch tyramine levels
Anxiety Overview
- irrational fear in the presence or absence of obvious stimuli that they cant get rid of
Pathology
- inc. adrenaline acts on organs
- Limbic System, altered sensitivity of GABA
- SoB , choking , palpitations , tremors , dry mouth , nausea , specific phobia
Generalised Anxiety Disorder
- Diagnosing
GAD-7 & DSM5 : used to assess severity
- persistent anxiety and uncontrollable worry for at least 6 months
Treating Anxiety
- Benzodiazepines
- only use for short term
- diazepam, lorazepam, midazolam
positive allosteric GABAa receptor modulator.
- inc. the opening of GABAa channels
- there is a specific mutation in a2 leading to lasting effect of BDZ’s
S/E : ED , dependence , interactions
Treating Anxiety
- SSRI’s
- 5-HT drug targets
5-HT1a : anxiety, alcoholism, sexual funct
5-HT1c : anxiety , migraine pain
5-HT1d : migraine pain
5-HT2 - anxiety , depression , schizo neg symptoms
5-HT3 : migraine , emesis , schizo
5-HT4 : anxiety and schizo
- no tolerance buildup
- used in depression and panic disorder too
- temp. worsening of symptoms and effects in 4-6 weeks
SSRI’s action
- Buspirone 5-HT1a agonist
SSRI’s dont cause weight gain
- safe in overdose
Buspirone - 5-HT1a agonist
- helps anxeity , alcoholism
- treats GAD
S/E - nausea and headache, ED
