mood disorders

high dopamine

schizophrenia

low norepinephrine

depression

low serotonin

depression

low acetylcholine

alzheimer’s

low GABA

anxiety

high glutamate

neuronal death

low glutamate

psychotic thinking

HPA axis

in depressed patients, the normal system of hormonal inhibition fails, resulting in hypersecretion of cortisol

DST

client is given a dose of dexamethasone at bedtime and blood is drawn in the AM to measure cortisol levels (positive results are indicated by non-suppression of cortisol)

serotonin syndrome s/s

shivering, hyperreflexia, increased temp, vitals instability, encephalopathy, restlessness, sweating

MAOI

phenelzine

phenelzine tx

depression & anxiety

phenelzine AE

hypertensive crisis

phenelzine CI

cardiovascular disease, HTN, congestive heart failure, liver disease

tricyclic antidepressant

amitriptyline

amitriptyline tx

depression, pain, insomnia

amitriptyline AE

anticholinergic effects, lethal upon OD, CNS effects, weight gain

amitriptyline CI

MI, stroke, glaucoma, seizures, pregnant

SSRI

paroxetine

paroxetine tx

depression, anxiety, panic, stress, PTSD

paroxetine PE

50-200mg daily, first line treatment, takes 4-6 weeks to work

paroxetine AE

GI symptoms, sexual dysfunction, weight gain, possible serotonin syndrome

SNRI

venlafaxine

venlafaxine tx

depression, panic & anxiety disorders

venlafaxine PE

must be tapered

venlafaxine CI

pregnancy, alcohol use, liver disease

newer antidepressants

bupropion, mirtazapine, trazodone

bupropion PE

no sexual side effects, lowers seizure threshold, avoid w/ eating disorders & some substance use

mirtazapine PE

works. fast, no sexual side effects, increased carb craving

NDRI

bupropion

trazodone tx

sleep

SARI

trazodone

bipolar I

at least one manic episode w/ or w/out one depressive episode

bipolar II

at least one hypomanic episode & one depressive episode

cyclothymic disorder

for at least 2 years, periods of hypomania & periods of dysthymia

anticonvulsants

lithium, valproate, carbamazepine, lamotrigine, oxcarbazepine, topiramate

atypical antipsychotics

risperidone

anti anxiety

benzodiazepines

lithium dose

0.6 - 1.2 mEq/L

valproate AE

GI symptoms, thrombocytopenia

carbamazepine PE

avoid grapefruit juice

carbamazepine AE

nystagmus, blurred vision, leukopenia, agranulocytosis, N/V, Stevens-Johnson syndrome

lamotrigine AE

Stevens-Johnson syndrome

lithium PE

takes 1-2 weeks to work

maintain salt intake & keep balanced diet

2 major long term risks: hypothyroidism & DI

illness w/ fever & excessive sweating may call for a higher dose

increase fluid intake

elevate legs to reduce edema risk

take w/ meals

lithium DI

diuretics, NSAIDs (raise levels)

atypical antipsychotics

can act as mood stabilizers, help w/ psychotic symptoms

milieu management

reduce environmental stimuli, do not escalate pts, establish routines

lithium AE

fine hand tremor, polyuria, thirst, nausea, weight gain