Module 8: Approaches to Treatment Flashcards
Clinical Trials in the 1980s and 1990s indicated that 80-90% of people using SSRIs went into remission from depression. What was the level in the 2000s?
60-70%
Which neurotransmitter does Ketamine act on?
Glutamate
Describe deep brain stimulation.
The process by which electrodes are surgically implanted in a specific brain region and stimulated via an electrical pulse.
Successful long-term reduction of depressive symptoms has been achieved by stimulation of the Subgenual Cingulate Gyrus and Nucleus Accumbens using what method?
Deep brain stimulation.
What are the five key types of psychotropic drugs were covered?
Antidepressants, antipsychotics, Anxiolytics, psychostimulants, and mood-stabilising drugs.
What are the four most common antidepressants?
monoamine oxidase inhibitors (MAOIs), Tricyclics, Specific Seratonin Reuptake Inhibitors (SSRIs), and Ketamine.
Explain the basics of monoamine oxidase inhibitors(MAOIs).
Antidepressant. Primary drug is Iproniazid, which was originally used to treat tuberculosis. It inhibits activity of monoamine oxidase and increases activity of neurons that utilise noradrenaline and serotonin.
Generally less effective than more recent drugs for severe depression, can be useful when other antidepressants aren’t working.
Explain the basics of Tricyclics.
Antidepressant. Named after their chemical structure which includes three carbon rings. believed to act by blocking the reuptake of dopamine, noradrenaline, and serotonin, though actions of some drugs in this class remain unknown. effective in treatment of mild to severe depression, limitations include high number of side effects, including toxic effects on cardiovascular system.
Explain the basics of Specific Seratonin Reuptake Inhibitors(SSRIs).
Antidepressant. Selectively inhibit the reuptake of serotonin. As effective as tricyclics in treatment of mild depression, and includes fewer side effects, safer for patients with glaucoma and in overdose. Now also used in treatment of anxiety and OCD.
What is the controversy regarding antidepressants?
Use of SSRIs such as Prozac have been linked to acts of violence and suicide.
Seroxat along with all other SSRIs with the exception of Prozac are now banned for prescription to under 18s in UK.
Explain the effectiveness of antidepressants.
Modest, high relapse rate fo 60% when medication ceases, benefits wane whilst still taking drug, SSRIs tend to work better with women over men.
Explain the basics of Ketamine.
Antidepressant. Alternative to serotonin-related treatments. Acts on glutamate(learning, motivation, plasticity), may restore connections between synapses caused by long term depression. Immediately effective, Intravenous administration of Ketamine hydrochloride lifted depressive symptoms within 2 hours. Eskatamine recently licensed in the UK as a nasal spray. Limitations include possible danger of addiction, psychotic side effects, and relief may come down to simple drug euphoria.
What are the two main antipsychotics?
Phenothiazines and Atypical third generation drugs.
Explain the basics of phenothiazine.
Antipsychotic. originally developed to calm patients before surgery. works by blocking dopamine receptors, reduce feelings of aggression and anxiety within hours but takes several days/weeks to reduce other symptoms. Effective in treating positive symptoms of schizophrenia, no effect on negative symptoms. Strong side effects may cause patients to discontinue medication or relapse.
Explain atypical third-generation drugs.
Antipsychotic. Partial agonists, drugs which have high affinity for a receptor (in this case dopamine receptors) but activate it less than the related neurotransmitter. raise dopaminergic activity in the pre-frontal cortex and lower activity in key areas of the limbic system such as the nucleus accumbens, therefore more effective in treating positive and negative symptoms of schizophrenia.