SSRIs & Bzs

Question 1

Selective Serotonin Reuptake Inhibitors (SSRIs)

Answer 1

-chem structure- derived from antihistamines.
–chemically related to antipsychotics & TCAs
—-e.g. Fluoxetine=Prozac
from Diphenhydramine- is an SSRIs= Nytol or Benylin (sedating).

-get name from pharmacological action.
Inhibit re-uptake of serotonin from synapse more powerfully than noradrenaline.

SSRIs eg. Fluoxetine -
–Fluvoxamine (Luvox) first reach market in Europe.
Citralopram (cipramil).

Question 2

Clinical effect (how ppl feel when take SSRIs).

Answer 2

• stabilize emotions make you serene- stops ups & downs.
• -makes unstable ppl more stable BUT makes too stable “flat”- feel worse.
• demotivation, “hardening” of personality.

Question 3

Clinical use

Answer 3

Indication- NOT for melancholia or PD- “hospitalized”
-used for mild-moderate “outpatient”.
“Neurotic Depress” depress with anxiety.
-all types of anx- GAD, phobias, panic disorders, PTSD, OCD.
-sexual effects- delay orgasm.

Question 4

Unwanted/side effects (SSRI)

Answer 4

usually mild/temporary.

• main prob is dependency- probs when try stop.
• suicide warning- esp for teens & children- agitation/violent/suicidal fantasy- STOP.

St. John’s Wort- herb, food- trials seems to better SSRIs- similar effects- less side effects & may be more effective.

Question 5

Benzodiazepines

Answer 5

1954- first Chlordiazepoxide - “Libruim”
-Diazepam- “Valium”. -Lorazepam.

-diff chemical type from SRRIS.
It works on GABA NTs- gamma amino butyric acid- main inhibitory NT.
-Bzs may be synthetic versions of natural chemicals.

Question 6

Clinical effects & uses
(7)
S, AA, MR, H, AC, AD, C.

Answer 6

1- Subjective- feel like- mellow, pleasant, soothing, relaxing.

2- Anti-Anxiety- best, fastest, most powerful- esp when anx association with muscle tension.

3- Muscle Relaxants.

4- Hypnotic- sleeping pills e.g. Nitrazepam (Mogadon).
—high doeses–> sleep. Don’t always work- shallow sleep.

5- Anticonvulsants- acute epilepsy.

6- Alcohol & Drug withdrawal- worst of all can die from it.

7- Catatonia.

Question 7

Side Effects- (Bz)

Answer 7

Withdrawal- short term rebound of insomnia & anxiety.
-Temazepam- used a lot deal with withdrawal.

Addiction- addictive dependence- ppl want to take drugs cus like the effects.
–prob susceptible minority 10%?????

Abuse- injection.
-Amnesia, disinhibition- high doses.

Question 8

SSRIs v Bzs

Answer 8

1- similar range of uses
2- diff mode action
3- diff side effects- although similar LT withdrawal effects
4- Bzs more pleasant take, but potentially addictive for the same reason.
5- SSRIs are not addictive- but HARDER to stop taking than Bzs overall.
6- which is best overall? -Bzs are demonized but evidence says Bzs are better.
7- Ideally, tailor drug to person.