T3L6 affective disorders neurobiology and treatment Flashcards
factors for major depressive disorder
- adverse childhood experience
- current stress
- genetic factors
lead to decrease serotonin and noradrenaline function
also hypothalamic-pituitary-adrenal axis
see s5`
aetiology of depression
- multifactorial
- not understood
- genetic factors, previous mood disorders, childhood adversity, psychological presdisposition
monoamine function in depression
all antidepressants work on serotonergic/ noradrenergic systems
serotonin dysfunction in depression
- decreased serotonin concs in depression
- reduced serotonin transporter in post mortem suicide studies
- the limbic system
uses and interractions of noradrenaline, serotonin and dopamine
see s13
pie
1st gen antidepressants
- monoamine oxidase inhibitors eg phenelzine
- tricyclic antidepressants
eg amytryptiline
2nd gen antidepressants
- SSRI eg citalopram
- SNRI eg venlafaxine
- alpha2 and 5HT2c agonist eg mirtazapine
- dopamine-noradrenaline reuptake inhibitor
SSRIs
- efficacy equal to tricyclics
- large spectrum of diseases- OCD, PTSD, panic, social anxiety
- low toxicity and sadfe in overdose
side effects: GI issues, sexual dysfunction, headache, irritation
side effects of other antidepressants
Tricyclics: Constipation, orthostatic hypotension, dry mouth, drowsiness, cardiac toxicity in overdose
MAOi: Dry mouth, GI side effects, headache, drowsiness, insomnia, dizziness, food interactions (hypertension crises)
Venlafaxine: nausea,vertigo, headache, insomnia.
Mirtazapine: drowsiness, sedation, hypotension, increased appetite and weight gain
HPA dysfunction in mood disorders
s20/21 diagrame
inflammation and depression
- raised plasma cytokine levels (IL-6, TNF-a) and inflammatory markers
- high comorbitity between chronic inflammation and depression
- administering cytokines provokes depression
- microglial activation in brain of depressed people
neural system involved in depression
^ activity: fear stimuli
- amygdala
- ventral striatum
- prefrontal cortex
v activity: +ve stimuli
- ventral striatum
neural systems in depression
s25
bipolar disorder heritability
is
5 factors into bipolar
- catechamines
- oxidative stress
- stress hormones
- inflammation
- neurotrophins
s28
bipolar long and short term treatment
short term treatment:
- reduce severity and shorten duration of acute syndrome- remission of symptoms
long term:
- prevention of new episodes and control chronic mood symptoms
4 drugs categories for bipolar
- antipsychotics
- rapid antimanic effect
- long term adverse effects on weight and glucose regulation
- may cause EPSE - lithium
- in food and water
- pilz
- antisuicidal
- efficacy of impulsive and violent behaviour
- strongest evidence for prevention of relapses of any polarity
- narrow therapeutic index - anticonvulsants
- eg valproate, carbamazepine - antidepressants
treatment of bipolar:
- depressive episodes
- manic episodes
depressive episodes:
- antipsychotics
- fluoxetine/olanzapine combination
- antidepressants and antimanics co-prescribed
manic episodes:
- dopamine antagonists
- valproate
- discontinue antidepressants
bipolar long term treatment
preventing new episodes:
lithium initially
alternatives if lithium poorly tolerated or ineffective:
- valproate
- dopamine antagonist
- carbamazepine
adverse effects of long term treatments
- weight gain
- metabolic syndrome
- liver damage eg valproate
- kidney and thyroid dysfunction
