SB L1 - Monoamines 1 - Hypothesis Revisited Flashcards
3 core elements of anxiety disorders
negative cognition
physiology
avoidance behaviour
existing anxiety treatments
BZ brspirone SSRIs B-blockers Atypical antipsychotics CBT
How do BZa work/ what is the problem?
at GABA-A-R - fast acting but dependence problems
Dianosis of depression according to DSM criteria
Depressed mood most of the day or diminised interest/pleasure in everyday activity
+ 4 or more symptoms from the list
3 Causes of depression?
Biological vulnerability (e.g. gender, genetics) Exogenous stressors (e.g. early life trauma) Mood regulatory circuits (e.g. connectivity, chemistry)
What gender is more likely to get depression?
Females
3 classes of antidepressants and how they have evolved?
MAOIs - now have selective to overcome cheese reaction
TCAs - 5HT selective (SSRIs) and NA targetting (SNRI). Dual acting on DA/NA (bupropion)
Receptor blockers - mirtazipine, nefazodone
All available drugs on the market target ……..
monoamines
Role of NA
attention, mood, sleep,
loss of pleasure, drive, appetite
Role of DA
loss of pleasure, drive, appetite,
Role of 5HT
anxiety, obsessions, negative cognition
mood, sleep,
loss of pleasire
5 Limitations of existing antidepressants
Efficacy Tolerabiltiy Time to onset Discontinuation effects Saftey
Existing antidepressants:
efficacy issues
q
Existing antidepressants:
efficacy issues
Existing antidepressants:
tolerability issures
S/e profile deters use - emotional blunting and detachment with SSRIs
Existing antidepressants:
time to onset
4-6 week before therapeutic benifit
Existing antidepressants:
discontinuation effects
must taper off use
Existing antidepressants:
safety issues
risk of suicide is controversial - lack of efficacy or treatment response where previously could not take action?
Ideal antidepressant properties
Response
Remission
Increased time between episodes
Rapid effect
Ideal antidepressant properties
Response
Remission
Increased time between episodes
Rapid effect
Pharmacological activity of buspirone
agonist of 5-HT1AR
What gene linked with expression of 5-HT1A
- Ref
Polymorphisms in the human 5-HT1A receptor promoter regulating expression levels
(Lesch & Gutknecht, 2004)
Evidence of importance of 5HT1A receptor in humans
-Ref
Decreased 5-HT1A receptor expression in panic disorder patients
(Neumeister et al. 2004)
Advantages of buspirone over BZs?
as effective
as fast acting
no withdrawl symtpoms
