Antidepressants, psychomotor stimulants and lithium

mental depression

mental depression

a common illness

characterized by changes in mood and behavior

indications that low NE and 5HT correlate with depression

depression symptoms

low mood, changes in appetite, sleep disturbance, agitation, fatigue, difficulty concentrating

sleep more, but worse sleep

lose interest in things that used to be enjoyed

exogenous or reactive depression

depression caused by external factors such as death or unemployment

major depressive disorder (MMD)

typically more serious depression

requires both psychotherapy and drug treatment

originates from within the individual and may not be associated with recognized causes

may last forever; issue with genetics (biochemical defect)

bipolar mood disorder

depression with periods of hyper excitability and elation (mania)

Depression treatments

Selective serotonin reuptake inhibitors (SSRIs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Tricyclic antidepressants (TCAs)

Monoamine oxidase inhibitors (MAOIs)

Psychomotor stimulants (like amphetamines) have limited use

*typically prescribed early on in diagnosis

Lithium - mood stabilizer for bipolar

SSRIs MOA

increases 5HT concentration in cleft (serotonin)

blocks re-uptake of serotonin

SSRI medication examples

Fluoxetine (Prozac) was the first

Escitalopram (Lexapro)

Citalopram (Celexa)

Paroxetine (Paxil)

Sertraline (Zoloft)

Serotonin syndrome

too much serotonin can cause confusion, fever, tremors, restlessness, coma, and death

SNRI medication examples

Desvenlafaxine (Pristiq)

Duloxetine (Cymbalta)

Venlafaxine (Effexor)

SNRIs also indicated for

general anxiety

chronic pain disorders

fibromyalgia

SNRIs

block NE and serotonin

can see changes in weight and libido

TCAs Side effects

usually not prescribed

increased HR, blood pressure, cause mania, agitation, tremors, lots of toxicity (to heart/liver)

TCA MOA

blocks reuptake of NE and 5HT (serotonin)

sedation anticholinergic, alpha-adrenergic blocking, and antihistamínico effects

MAOIs

infrequently used (due to many drug interactions and SE)

Dietary restrictions: tyra mine (wine, beer, herring, cheese) and decongestants could cause hypertensive crisis

MAOIs medication examples

Isocarboxazid (Marplan)

Phenelzine (Nardil)

Tranylcypromine (Pamate)

Other “antidepressants”

Nefazodone and trazodone (Desyrel)

Bupropion (Wellbutrin)

Nefazodone and trazodone (Desyrel)

Weak SNRIs, potent 5HT2A antagonist

Alpha blockers = PH, sedation, dizziness, GI disturbances, hepatotoxicity

Trazodone associated with priapism

Bupropion (Wellbutrin)

Increase release of NE and DA and inhibit their reuptake

may treat obesity (increased NE = decreased hunger)

SE = similar to others plus agitation, anorexia, increased libido

been used to treat PTSD

commonly prescribed

Psychomotor stimulants use

not really an antidepressant (but elevates mood), narcolepsy, and hyperkinesis in children

*elevates mood while AD kicks in

psychomotor stimulants MOA

increase NE (norepinephrine) and DA (dopamine)

agonist to receptors

stimulate release

inhibit reuptake

can be addictive so only prescribed for 2-4 weeks

Psychomotor stimulants medication examples

amphetamine

Methylphenidate (Ritalin)

Dextroamphetamine (Dexedrine)

Psychomotor stimulants Side effects

increased HR, BP, restlessness, insomnia, and at high doses paranoid psychosis

Lithium use

mood stabilizers (for manic parts of bipolar)

treats mania and bipolar mood disorder

often paired with antidepressants (vasoproate, carbamazepine, and lamotrigine can also treat mania)

Lithium MOA

similar chemical properties to Na, but interferes with nerve conduction decreasing the excitability

(interferes with action potentials)

Lithium Side Effects

nausea and tremors, with OD vomiting, drowsiness, loss of equilibrium, ringing in ears.

Toxic to heart and kidneys and contraindicated with thyroid conditions