NOT DONE Week 13: Psychotherapeutic drugs

Excitatory or inhibitory?: Norepineprine

Usually excitatory

• can be inhibitory in brain

Excitatory or inhibitory?: Serotonin

both — depends on location in brain

Excitatory or inhibitory?: Dopamine

Inhibitory

• pleasure chemical

Excitatory or inhibitory?: Acetecholine

excitatory

Excitatory or inhibitory?: GABA

inhibitory

Excitatory or inhibitory?: Glutamate

excitatory

What may occur if there is too much dopamine in someone’s brain?

• Hallucinations

• Mania

What drugs increase dopamine?

• Cocaine

• Meth

• Weed

Clinical feature of MDD

• Depressed mood

• Loss of pleasure/interest (anhedonia)

• Insomnia or hypersomnia

• Anorexia or hyperplasia

• Psychomotor retardation or agitation

• Fatigue

• Mental slowing and loss of concentration

• Feelings of guilt, worthlessness, and helplessness

• Thoughts of death/suicide

How long must symptoms of depression be present to diagnose someone with MDD?

symptoms must be present most of the day, nearly every day for at least 2 weeks

NT involved with MDD

• Serotonin

• Dopamine

• Norepinephrine

Conditions that are commonly associated with MDD

• PTSD

• ADHD

• Autism

Serotonin Syndrome

caused by too much serotonin in the brain d/t:

• combining meds with other SSRIs or drugs that impact serotonin

• Saint John’s Wart

• Cocaine and other street drugs

Serotonin Syndrome symptoms — SHIVERS

• Shivering (neuromuscular)

• Hyperreflexia is and myoclonus (muscle spasms)

• Vital sign abnormalities (tachycardia, tachypnea, BP changes)

• Encephalopathy (MS changes, agitation, delirium, confusion)

• Restlessness

• Sweating

Discontinuation syndrome (all antidepressants)

sudden stopping of an antidepressant that starts 2-4 days after stopping and can last 1-2 weeks

Discontinuation syndrome — FINISH

• Flu-like symptoms

• Insomnia

• Nausea

• Imbalance

• Sensory disturbance (sensation of electric shocks in arms, legs, or head)

• Hyperarousal (anxiety, agitation, “rage attacks”)

Tricyclic Antidepressant name

Amitriptyline

TCAs therapeutic uses (2 primary)

• Depression

• Bipolar disorder

TCAs adverse effects

• Anticholinergic

• Act on other receptors and has adverse effects based on which receptor they are acting on:

  • Muscarinic

  • a-1 adrenergic

  • Histamine

  • GABA

• Serotonin syndrome

• Inhibits cytochrome P450 enzymes

Side effects of TCAs acting on muscarinic receptors (5)

• Dry mouth

• Blurred vision

• Tachycardia

• Urinary retention

• Constipation

Side effect of TCAs acting on alpha-1 adrenergic receptors

orthostatic hypotension

Side effects of TCAs acting on histamine receptors

sedation

Side effects of TCAs acting on GABA receptors

lowered seizure threshold

Baseline assessment required for TCAs

• Depressive symptoms and suicide risk

• EKG — bc of cardiac risks

TCAs patient education

• Monitor for suicidal thoughts and symptoms of clinical decline

• Take as prescribed, do NOT stop suddenly even if symptoms improve

• Delayed therapeutic effect

• Get up slowly, withhold medication if BP low or HR is high and notify provider

• Take at night to promote sleep and decrease sedation during daytime

• Monitor for sedation

When should TCAs be taken? Why?

At night to promote sleep and decrease sedation during daytime

Anticholinergic effects of TCAs

• Dry mouth Blurred vision

• Blurred vision

• Photophobia

• Urinary hesitancy

• Constipation

• Tachycardia

Monoamine Oxidase Inhibitors (MAOIs) drug name

Phenelzine

MAOIs MOA

Blocks monoamine oxidase from breaking down NTs, allowing for more NT to act in the brain

• Serotonin

• NE

• Dopamine

MAOIs side effects

• Serotonin syndrome

• Neurological symptoms

  • When taken with tryptophan

• Hypertensive crisis

What may cause a hypertensive crisis in people taking MAOIs?

• Tyramine-rich foods and drinks

  • Fermented

• Phenylalanine

  • Chocolate and caffeine

Selective Serotonin Reuptake Inhibitors (SSRIs)

Blocks the reuptake of serotonin into the presynaptic neuron, allowing for more serotonin in the synapse and more serotonin binding

SSRI drug name

Fluoxetine (Prozac)

SSRIs primary therapeutic use

primarily used to treat functional depression/major depression

SSRIs other uses

• OCD

• Bulimia nervous

• Premenstrual dysphoric disorder (PDD)

• GAD

• Panic disorder

• Social phobia (off-label)

• PTSD (off-label)

SSRI side effects (fewer than other antidepressants)

• First few weeks: Insomnia, Nausea, Loose BMs, Headache

• S