Medicines to Treat Mental Health Issues - Lecture Notes
Medicines to Treat Mental Health Issues
Professor Emilio Badoer
School of Health and Biomedical Sciences, RMIT University
Email: emilio.badoer@rmit.edu.au
Lecture Structure
Lectures divided into various sections, each with:
Specific learning outcomes
Revision questions for feedback and understanding
Drugs for Mental Health Issues
Lecture topics include:
Epilepsy
Parkinson’s Disease
Depression
Anxiety and Sleep Disorders
Psychoses
Dementia
Section I: Treatment of Seizures (Focus on Epilepsy)
Reading: Chapter 23 from Pharmacology in Nursing (Edition 4) by Broyles et al.
Learning Outcomes:
By the end of this section, students should be able to:
Discuss the symptomatology of epilepsy
Describe seizure types
Explain the mechanism of action for anti-epileptic drugs
Identify indications and adverse effects of pharmacological therapy
Discuss drug interactions
Overview of Epilepsy
Chronic disorder with recurrent seizure episodes
Higher prevalence in childhood and older adults
Causes include: genetics, stroke, brain injury
Seizure type determined by site of neuronal discharge and spread
Seizure Types:
Partial Seizures
Start in one brain area, localized to one hemisphere
No loss of consciousness
Symptoms: motor, altered perception, mood changes
Generalized Seizures
Involves both hemispheres
Symptoms: whole body spasm, loss of consciousness
Absence Seizures
Common in children, characterized by staring spells
Status Epilepticus
Continuous seizures lasting longer than 5 minutes
Medical emergency with high morbidity/mortality
Common causes: untreated epilepsy, stroke, CNS tumors, infections
General Treatment Guidelines:
Assess seizure recurrence risk and severity
Begin with one anti-epileptic drug at low doses
Titrate dose gradually, adding a second drug if needed
Gradually withdraw any drug no longer needed
Antiseizure Agents: Mechanisms of Action
Sodium Channel Inhibition: Reduces membrane excitability
Calcium Channel Inhibition: Reduces excitability of neurons
GABA Transmission Alteration: Enhances inhibitory effects
Examples of Antiseizure Drugs:
Carbamazepine
Indications: partial seizures, generalized tonic-clonic seizures
Adverse Effects: drowsiness, ataxia, nausea
Pharmacokinetics: half-life ~30 hours
Phenytoin
Indications: partial and tonic-clonic seizures, status epilepticus
Adverse Effects: nausea, gum overgrowth, ataxia
Pharmacokinetics: narrow therapeutic window
Ethosuximide
Indications: absence seizures
Adverse Effects: nausea, drowsiness
Valproate
MOA unclear; inhibits GABA breakdown
Adverse Effects: weight gain, liver damage
Benzodiazepines
Indications: all seizures, status epilepticus
Adverse Effects: sedation, memory loss
Antiseizure Therapy in Special Populations
Elderly: Increased risk of drug interactions
Pregnancy: Risk-benefit analysis essential due to teratogenic effects
Section II: Treatment of Parkinson's Disease
Reading: Chapter 22 from Pharmacology in Nursing (Edition 4) by Broyles et al.
Learning Outcomes:
Discuss symptomatology and mechanisms of action for Parkinson’s treatment
Describe pharmacological therapy adverse effects
Overview of Parkinson’s Disease
Progressive disorder typically occurring between ages 50-80
Neurological symptoms include:
Resting tremors
Bradykinesia
Muscle rigidity
Shuffling gait
Treatment: Levodopa (L-DOPA)
Primary treatment to restore dopamine levels
Administered with Carbidopa to enhance effectiveness
Adverse Effects: dyskinesias, mood changes
Additional Treatments
Dopamine agonists, Monoamine oxidase inhibitors, COMT inhibitors
Section III: Treatment of Depression
Reading: Chapter 19 from Pharmacology in Nursing (Edition 4) by Broyles et al.
Learning Outcomes:
Discuss depression symptoms, treatment mechanisms, and drug interactions
Overview of Depression
Presents with profound sadness, loss of interest, fatigue
Causes: life events, medications, co-morbidities (e.g., Parkinson’s)
Medications:
SSRIs
Examples: fluoxetine, sertraline
Mechanism: Inhibits serotonin reuptake
SNRIs
Examples: venlafaxine, duloxetine
Mechanism: Inhibits reuptake of serotonin and norepinephrine
Side Effects and Drug Interactions
Common side effects: anxiety, dizziness, sexual dysfunction
Antidepressants may interact with other medications
Section IV: Treatment of Anxiety Disorders
Reading: Chapter 18 from Pharmacology in Nursing (Edition 4) by Broyles et al.
Overview of Anxiolytics
Benzodiazepines are the primary anxiolytics
Indications include anxiety and sleep disorders, seizure disorders
Mechanism of Action
Enhances GABA activity by increasing receptor affinity
Potential Side Effects
CNS depression, dependence, withdrawal symptoms
Antipsychotic Treatment
Major treatment for schizophrenia: Antipsychotics
Positive symptoms respond well, but negative symptoms do not
Antipsychotic Medications
Olanzapine
Risperidone
Mechanisms include D2 and serotonin receptor antagonism
Side effects: sedation, weight gain, dry mouth
Treatment of Dementia
Reading: Chapter 21 from Pharmacology in Nursing (Edition 4) by Broyles et al.
Overview of Dementia
Global decline in brain function, prevalent in the elderly
Common causes: Alzheimer's disease, vascular dementia, Lewy body dementia
Treatment Options
Acetylcholinesterase Inhibitors
E.g. Donepezil; increases acetylcholine levels in the brain
Memantine
NMDA antagonist; reduces excitotoxicity
Adverse Effects
Nausea, confusion, dizziness
Revision Questions
Cover key concepts and assess understanding
Examples:
Which anti-seizure agent inhibits calcium channel function?
What neurotransmitter is important in Parkinson's disease?
Which antidepressants target serotonin reuptake?
Note: The above structure captures key knowledge and applications for mental health pharmacology, key drugs, their mechanisms, and expected effects/adverse effects.