Nervous System

What is acetylcholine (ACh) involved in

• Muscle movement

• Memory/learning

• Attention

Is acetylcholine (ACh) excitatory or inhibitory?

Either excitatory or inhibitory depending on the receptor

Dopamine is involved in…

• Motivation

• Reward

• Pleasure

• Movement

• Mood

What can increased dopamine be associated with

• Increased arousal/anxiety

• Psychosis

What can decreased dopamine be associated with

• Depression

• Movement problems

What is norepinephrine involved in

• Learning

• Memory

• Alertness

• Attention

• Stress response

What can decreased norepinephrine be associated with

Depression

What can increased norepinephrine be associated with

Hyper-vigilance, increased alertness, anxiety

Serotonin is involved in…

• Appetite

• Sleep

• Mood

• Pain

• Vomiting

• CNS function

Decreased serotonin can be associated with…

Anxiety / depression

What does GABA do

Helps calm/regulate the nervous system; decreases neuronal excitability

What is GABA’s main effect on neurons?

Inhibitory (decreased neuronal excitability)

What is major depressive disorder

Persistent depressed/low mood and loss of interest or pleasure

SSRI action in the body

Blocks serotonin reuptake; increases serotonin available in the synapse

SSRI’s are used to treat…

• Depression

• Anxiety/panic disorder

• PTSD

• OCD

• bulimia

SSRI side effects

• Sexual dysfunction

• CNS stimulation

• Weight changes

• Hyponatremia

How long does it take to see effects from SSRI’s

4-6 weeks

What are atypical antidepressants used for

• Seasonal depression

• Smoking cessation

Atypical antidepressant action in the body

Inhibits dopamine and norepinephrine uptake

Common side effects of atypical antidepressants (i.e wellbutrin)

• Dry mouth

• GI distress/nausea

• Weight loss

• Restlessness

• Insomnia

Important serious adverse effects of wellbutrin (bupropion)

Seizures (rare, higher doses)

What do TCA’s do

Block reuptake of norepinephrine and serotonin, increasing their availability in the brain

What are TCA’s used to treat?

• Depression

• Neuropathy

• Fibromyalgia

• Anxiety

• Insomnia

TCA side effects

• Dry mouth

• Constipation

• Tachycardia

• Urinary retention

• Drowsiness

Why can TCA’s be dangerous?

Overdose can cause life-threatening cardiac dysrhythmias (prolonged QT)

What do MAOI’s do

Inhibit monoamine oxidase, decreases breakdown of neurotransmitters (serotonin, norepinephrine, dopamine), and prevents breakdown of tyramine

What are MAOI’s used to treat?

• Depression

• Bulimia

• Other psychiatric conditions

Common MAOI side effects

• CNS stimulation

• Tachycardia

• Dry mouth

• Orthostatic

• Hypotension

• Sexual dysfunction

• GI distress

Major food interactions with MAOI’s

Tyramine-rich foods

Examples of tyramine rich foods

• Aged cheese

• Cured meats

• Fermented foods

• Some alcoholic beverages (red wine)

Generalized anxiety disorder

Excessive, persistent, difficult to control worry/anxiety; disproportionate to the situation and interferes with daily functioning

Action of benzodiazepines

Increases GABA levels in synapses; decreases norepinephrine, increases glutamine

What are benzodiazepines used for?

• Anxiety / panic

• Seizures

• Alcohol withdrawal

benzodiazepine side effects

• Drowsiness

• Dizziness

• Confusion

• Decreased BP

what’s the reversal agent for benzodiazepines?

Flumazenil IV

typical SSRIs used for depression

• Sertraline (Zoloft)

• Fluoxetine (Prozac)

• Escitalopram (Lexapro)

• Citalopram (Celexa)

• Paroxetine (Paxil)

What is buspar (buspirone)

Atypical anxiolytic

Advantages of buspirone compared to benzos

Less dependence and less sedation

Action of buspirone in the body

Decreases dopamine (antagonist), increases serotonin (agonist)

What is buspirone used for

• Panic disorder

• Social disorder

• OCD

• PTSD

Side effects of buspirone

• Dizziness

• Blurry vision

• Drowsiness

• Insomnia

When should a patient taking buspirone contact their doctor

If they develop chest pain, SOB, or feeling like they are going to pass out

Serotonin syndrome

potentially life-threatening drug reaction caused by having too much serotonin in your nervous system

S/s of serotonin syndrome

• Hypertension

• Tachycardia

• Fever

• Tremors

• Agitation

• Diarrhea

• Dilated pupils

• Seizures

What is obsessive-compulsive disorder

Individual has intrusive thoughts (obsessions) and feels the need to repeatedly perform routines or rituals (compulsions) to relieve distress caused by the obsession

OCD treatments

• Cognitive therapy

• SSRIs

• TCAs

Social phobia

Persistent fear of being judged, everyday interactions cause significant anxiety, self consciousness and embarrassment

What % of the population suffers from social phobia

Up to 25%

Social phobia treatment

• Benzos

• MAOIs

• Therapy

Brain signaling pattern described in panic disorder

Too much excitatory “alarm” signaling and not enough inhibitory “breaking”

A panic disorder can often mimic signs of a….