08. Chap 6.1, 6.2, 6.3 Antidepressants and lithium

Define psychotropic medications

Medications used to improve mood and behavior

What are the primary goals of sedative-hypnotic and anti-anxiety drugs? (2)

Relax the pt and promote normal sleep

Decrease anxiety without excessive sedation

Define benzodiazepines (BZDs)

A type of sedative-hypnotic drug, usually used for sleeping or anti-anxiety

What is the most common suffix for sedative-hypnotic drugs?

-pam or -lam

What are some of the most famous name brands of anti-anxiety drugs? (2) How does their affect change at larger doses?

Valium and Xanax

Become sleeping pills at higher doses

How do BZDs increase sleepiness and decrease anxiety?

They increase the inhibitory effects of GABA, the most important inhibitory neuron in the CNS

How do BZDs work with GABA to cause more neuron inhibition?

BZDs and GABA bind to the same receptors and allow more chloride ions to go into the cell, causing more inhibition to the cell

Do BZDs replace GABA neurotransmitters?

No, they just help GABA to increase inhibition

What are some newer sedative-hypnotic drugs (brand names) that still bind to GABA receptors in the brain? (2)

Ambien

Lunesta

What is a sedative-hypnotic drug that binds to melatonin receptors in the brain? (1) (brand name)

Rozerem

What is an anti-anxiety drug that binds to serotonin receptors in the CNS? (1) (brand name)

BuSpar

Can antidepressants be used as anti-anxiety medications?

Yes, similar in neurochemistry. Might use Cymbalta, Lexapro or Zoloft

What are alternative anti-anxiety agents that might be prescribed to pts? (3)

Antipsychotics

Anti-seizure medications

Antihistamines

What are some of the drawbacks of long-term use of sedative-hypnotic drugs? (6)

Hangover effect after they are used

Anterograde amnesia

Complex behaviors (ex. sleep walking)

Rebound effect

Tolerance and dependence

Possible link to AD

What are some non-drug strategies that may eventually replace sedative-hypnotics and anti-anxiety drugs? (5)

Regular exercise

Less caffeine and alcohol

Pre-bedtime routine

Counseling and support groups

Meditation and breathing exercises

What is the most common form of mental illness?

Depression, an incapacitating sadness

What is the neurochemical basis of depression?

Caused by a defect in the CNS biogenic amine neurotransmitters, including norepi, dopamine and serotonin

What is the strategy that all antidepressant drugs use to combat depression?

To increase the effect of norepi, dopamine and serotonin in the brain

How do SSRIs and SNRIs work?

Selective serotonin and norepi reuptake inhibitors don't allow the cell to reuptake neurotransmitters, keeping it in the synaptic cleft longer

What are tricyclic antidepressants?

Antidepressants that prolong the effects of all three neurotransmitters

What are MAO inhibitors?

Drugs that prolong the effects of all three neurotransmitters

How do antidepressant drugs get more "mileage" out of neurotransmitters? (2 ways)

Either inhibiting reuptake back into the cell OR decreasing it's breakdown in the cleft

How are antidepressant drugs linked to BDNF?

Increased neurotransmitter activity may increase BDNF, stimulating growth in the hippocampus

What are the primary adverse affects of tricyclic antidepressants? (5)

Sedation

Anticholinergic effects

CV problems

Seizures

Increased risk of fatal overdose

What are the primary adverse affects of MAO inhibitors? (2)

CNS excitation

Increased BP, esp with drugs and foods that increase catecholamines

What are the primary adverse effects of SSRIs and SNRIs? (2)

Generally better tolerated

May increase seizures

More GI problems

What is serotonin syndrome? What are the main symptoms? (5)

Occurs when serotonin receptors are overstimulated

Increased HR and BP

Confusion and hallucinations

Agitation

Sweating

Shivering

How long do antidepressants take to start working? How long until their peak effects begin?

Begin working after 1-2 weeks

Full effects reached at 6-8 weeks

Why is it important to know that it might take 6-8 weeks for antidepressants to take full effect?

Because pts might feel worse during this time period and might have more suicidal tendencies

How is ketamine used as an antidepressant?

Creates a dissociative effect by blocking NMDA receptors, decreasing the effects of excitatory amino acids (glutamate)

What type of depression has the best effect to ketamine? Why?

Best for severe depression

Effects are rapid, within one hour

Are antidepressants often used for chronic pain?

Yes, prescribed off-label, pts are told that they will help improve sleep

What is the most common treatment for bipolar disorder?

Lithium

Why is lithium a potentially dangerous substance for the body?

Because it cannot be degraded by the body, so it has to be transported out by the kidneys only

What are some of the symptoms of lithium toxicity? (6)

Tremor

Fatigue

Weakness

Dizziness

Blurred vision

Slurred speech

What are (2) alternative drugs that might be used for bipolar disorder instead of lithium?

Antiseizure drugs

Antipsyhcotics