Rehab Essentials - Antidepressants, Anti-anxiety drugs, others,

What is the primary goal of sedative-hypnotic and antianxiety drugs?

Relax the patient promote normal sleep and decrease anxiety without excessive sedation

What neurotransmitter do benzodiazepines enhance? Inhibit?

Enhance: Dopamine, Serotonin, Norepinephrine

Inhibit: GABA

What is GABA?

The primary inhibitory neurotransmitter in the CNS

How do benzodiazepines reduce neuronal excitation?

By increasing chloride ion conductance through GABA-A receptors

What ion enters the neuron when GABA-A receptors are activated?

Chloride (Cl-)

What effect does increased chloride conductance have on neurons?

Hyperpolarization making action potentials harder to generate

What are sedative-hypnotics?

Drugs that cause excessive sedation and promote sleep

Name sedative-hypnotic benzodiazepines

Estazolam Quazepam Temazepam Triazolam

What are Z-drugs?

Not BZD, function similar for sedation

Zolpidem and Zaleplon

Are Z-drugs benzodiazepines?

No but they bind GABA receptors and increase chloride conductance

One advantage of Z-drugs over benzodiazepines?

Less rebound insomnia and fewer withdrawal problems

Which drug affects GABA but is not a benzodiazepine?

Eszopiclone

Which sedative-hypnotic works on melatonin receptors?

Ramelteon

What is anterograde amnesia?

Inability to remember events after taking the drug

What complex behaviors are associated with Ambien?

Sleepwalking and sleep-driving

How does alcohol interact with sedative-hypnotics?

It reinforces sedative effects

What is rebound insomnia?

Worsening sleep or anxiety after stopping the drug

Why are older adults at higher risk with sedative-hypnotics?

Falls cognitive effects and adverse reactions

Why should sedative-hypnotics be avoided in older adults?

They treat symptoms not causes and have significant adverse effects

Name non-drug strategies for anxiety and sleep

Exercise counseling relaxation reducing anxiety sources

What effect do anti-anxiety drugs have at higher doses?

Cause sedation and can act as sleeping pills

Common benzodiazepine anxiolytics

Diazepam Chlordiazepoxide Lorazepam Alprazolam

What class of drug is buspirone?

Azapirone

How does buspirone work?

Stimulates serotonin receptors in the CNS

One benefit of buspirone?

Less sedation and dependence

One drawback of buspirone?

Slow onset and moderate efficacy

Which patients benefit most from buspirone?

Older adults with mild anxiety

Why are antidepressants used for anxiety?

Anxiety often coexists with depression

Examples of antidepressants with anxiolytic effects

Paroxetine Venlafaxine

Advantage of antidepressants for anxiety?

Fewer side effects and less addiction risk

Alternative drugs used for anxiety

Quetiapine Gabapentin Antihistamines

How is depression defined clinically?

Incapacitating sadness with neurochemical changes

Current theory of depression?

Deficiency of CNS biogenic amine neurotransmitters

Which neurotransmitters are implicated in depression?

Norepinephrine dopamine serotonin

General drug strategy for treating depression?

Increase or prolong neurotransmitter effects

What does SSRI stand for?

Selective Serotonin Reuptake Inhibitor

Examples of SSRIs

Fluoxetine Paroxetine Sertraline Citalopram Escitalopram Fluvoxamine

What does SNRI stand for?

Serotonin Norepinephrine Reuptake Inhibitor

Examples of SNRIs

Desvenlafaxine Duloxetine Venlafaxine

What neurotransmitters do tricyclic antidepressants affect?

Serotonin norepinephrine epinephrine

Common naming feature of tricyclic antidepressants?

Often end in ine

Why are MAO inhibitors last resort drugs?

High risk of dangerous interactions and side effects

How do antidepressants increase neurotransmitter effects?

Inhibit reuptake or prevent breakdown

What percentage of neurotransmitters are recycled?

60 to 80 percent

What percentage are broken down by MAO?

20 to 40 percent

How do antidepressants affect BDNF?

They increase BDNF production

What is the role of BDNF?

Promotes hippocampal growth and synaptic connections

Major adverse effects of tricyclic antidepressants?

Sedation anticholinergic effects CV problems seizures fatal overdose

Major risks of MAO inhibitors?

CNS excitation hypertension stroke MI

Common SSRI and SNRI side effects?

GI problems and increased seizure risk

What causes serotonin syndrome?

Excessive stimulation of CNS serotonin receptors

Cardiovascular signs of serotonin syndrome?

Increased heart rate and blood pressure

Cognitive signs of serotonin syndrome?

Confusion hallucinations agitation

Musculoskeletal signs of serotonin syndrome?

Dystonia dyskinesia muscle pain shivering

Is serotonin syndrome reversible?

Usually but can be fatal if untreated

When do antidepressants start to work?

One to two weeks

When do antidepressants reach maximal effect?

Six to eight weeks

How does ketamine act as an antidepressant?

Blocks NMDA receptors and reduces glutamate activity

Why is ketamine not widely used?

Abuse potential and side effects

Which antidepressants are used off label for chronic pain?

Amitriptyline Amoxapine

Conditions treated with antidepressants for pain?

Fibromyalgia neuropathic pain headaches low back pain Raynauds

Classic treatment for bipolar disorder?

Lithium

How does lithium work?

Mood stabilizer that prevents manic episodes

Why is lithium dangerous?

Narrow therapeutic window and renal elimination

What lithium level is considered toxic?

Above 2 milliequivalents per liter

Other treatments for bipolar disorder?

Antiseizure drugs and antipsychotics