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For each of the following, antidepressants, antipsychotics and mood stabilizers◦ Examine their method of action◦ Explore the types of disorders they are used to treat◦ Review the most common medications in those classes
Identify where to get more information for patients
Discuss the benefits and drawbacks to off-label prescribing
Mechanism of action/purpose◦ Altered dopamine neurotransmission is implicated
in
Cognitive control (racing thoughts)
Attentional control
Impulse control
Working memory
Symptoms of excess & insufficiency◦ Excess of dopamine
Unnecessary movements, repetitive tics
Psychosis
Hypersexuality
Nausea
Most antipsychotic drugs are dopamine antagonists
Dopamine antagonist drugs are also some of the most effective anti-nausea agents
Symptoms of excess & insufficiency◦ Insufficient dopamine
Negative symptoms of schizophrenia Pain Parkinson’s Disease Restless legs syndrome Attention deficit hyperactivity disorder (ADHD) Neurological symptoms that increase in frequency with age,
such as decreased arm swing and increased rigidity. Changes in dopamine levels may also cause age-related
changes in cognitive flexibility.
Symptoms of excess & insufficiency◦ Insufficient dopamine
Lack of motivation Fatigue Apathy, Inability to feel pleasure Procrastination Low libido Sleep problems Mood swings Hopelessness Memory loss Inability to concentrate
Medications◦ Most common dopamine antagonists (positive
symptoms) Risperdone, Haldol, Zyprexa
Metoclopramide (Reglan) is an antiemetic and antipsychotic
◦ Most common dopamine AGONISTs (Parkinson’s, Restless Legs) (negative symptoms) Mirapex & Requip
Symptoms of excess◦ Depression◦ Apathy, Emotional flatness or dullness◦ Passivity◦ Insomnia and other sleep problems◦ Difficulty concentrating and learning◦ Poor memory; amnesia◦ Difficulty making decisions and acting on them◦ Sexual dysfunction
Mobilize the brain and body for action.
Norepinephrine release is lowest during sleep, rises during wakefulness, and reaches much higher levels during situations of stress (fight-or-flight)
Increases arousal, alertness, anxiety and restlessness; promotes vigilance, and focuses attention
Excess◦ Anxiety
◦ Increased startle reflex/jumpiness
◦ Impaired concentration
◦ Restless sleep,
◦ Rapid fatigue
◦ Muscle tension/cramps
◦ Irritability/edginess
Alpha-2 agonists often have a sedating effect, and are commonly used as anesthesia-enhancers in surgery, as well as in treatment of drug or alcohol dependence
Stimulants and antidepressants increase dopamine and serotonin as well as increasing levels of norepinephrine.
Medications bind to receptors to effect changes in the brain.◦ D1-D4 Receptors are associated with dopamine◦ 5-HT1-5HT7 with subtypes are associated with
serotonin◦ Alpha receptors are associated with adrenergic receptors
(norepinepherine/noradrenaline; epinepherine/adrenaline)
◦ M1-M3 are muscarinic receptors associated with acetylcholine
◦ H1 receptors are associated with histamines
Higher ACh and NE, together with lower SE, produces ◦ Anxiety, emotional lability, irritability, anger,
aggressiveness, negative rumination, impatience, and impulsiveness
When NE, DA, and SE are low and acetylcholine is high◦ The result is simply depression.
Increasing serotonin ◦ lowers acetylcholine levels, and norepinephrine and
dopamine.
SSRIs◦ Selective serotonin reuptake inhibitors (SSRIs)
decrease serotonin blockers in the brain. sertraline (Zoloft)
fluoxetine (Prozac)
paroxetine (Paxil, Pexeva)
citalopram (Celexa)
escitalopram (Lexapro)
fluvoxamine (Luvox)
trazodone (Oleptro)
SNRIs◦ Serotonin and norepinephrine reuptake inhibitors
(SNRIs)
◦ Options include: desvenlafaxine (Pristiq)
duloxetine (Cymbalta)
venlafaxine (Effexor XR)
◦ Duloxetine offers the added benefit of pain relief in addition to treating depression.
Tricyclics (-tryptaline, -amine)◦ Prescribed when other antidepressants don’t work.◦ Significant side effects◦ TCAs are available as:
amitriptyline clomipramine (Anafranil) desipramine (Norpramin) imipramine (Tofranil) nortriptyline (Pamelor) protriptyline (Vivactil) trimipramine (Surmontil)
Dopamine Reuptake Blocker◦ Bupropion (Wellbutrin) is a mild dopamine and
norepinephrine reuptake blocker
◦ Used for depression, seasonal affective disorder (SAD) and also smoking cessation.
◦ Not advised for eating disorders
MAOIs◦ Monoamine oxidase inhibitors (MAOIs) prevent the
breakdown of norepinephrine, dopamine, and serotonin.
◦ MAOIs have many side effects
◦ MAOIs include:
isocarboxazid (Marplan)
phenelzine (Nardil)
selegiline (Emsam), a transdermal patch
tranylcypromine (Parnate)
Noradrenergic Antagonist ◦ Mirtazapine (Remeron) is used primarily for
depression.
Symptoms◦ Depression can be caused by an imbalance on one
or more neurotransmitters
Side effects
Efficacy in close, blood relatives
Other medications
Health conditions & pregnancy
Anorexia/Feeding Problems
Anxiety/Panic
Anxiety and Stress
Binge Eating
Bipolar Disorder
Body Dysmorphic Disorder
Borderline Personality Disorder
Bulimia
Depression
Fibromyalgia
Generalized Anxiety
Hot Flashes
Intermittent Explosive Disorder
Irritable Bowel
Major Depression
Obsessive Compulsive Disorder
Post Traumatic Stress
Postpartum Depression
Premature Ejaculation
Premenstrual Dysphoric Disorder
Schizoaffective Disorder
Social Anxiety
Somatoform Pain Disorder
Generally known as◦ Major Tranquilizers
◦ Neuroleptics
Block receptors in the brain's dopamine pathways causing a reduction in dopamine stimulation
Antipsychotics, however, fail to significantly improve the negative symptoms and cognitive dysfunction (D3)
Types◦ Aripiprazole (marketed as Abilify)◦ Asenapine Maleate (marketed as Saphris)◦ Clozapine (marketed as Clozaril)◦ Lurasidone (marketed as Latuda)◦ Olanzapine (marketed as Zyprexa)◦ Olanzapine/Fluoxetine (marketed as Symbyax)◦ Paliperidone (marketed as Invega)◦ Quetiapine (marketed as Seroquel)◦ Risperidone (marketed as Risperdal)◦ Ziprasidone (marketed as Geodon)
Agitated State
Agitation
Anorexia
Anxiety
Autism
Bipolar Disorder
Body Dysmorphic Disorder
Borderline Personality Disorder
Depression
Generalized Anxiety
Insomnia
Intermittent Explosive Disorder
Nightmares
Obsessive Compulsive Disorder
Post Traumatic Stress Disorder
Psychosis
Schizoaffective
Disorder
Schizophrenia
Social Anxiety Disorder
Tic Disorder
Tourette's Syndrome
Antipsychotics have many side effects ◦ Drowsiness
◦ Dizziness
◦ Restlessness
◦ Weight gain
◦ Constipation
◦ Nausea/Vomiting
◦ Blurred vision
◦ Low blood pressure
◦ Uncontrollable movements, such as tics and tremors
Clozapine and olanzapine are associated with the greatest effects on weight gain and decreased insulin sensitivity, followed by risperidone and quetiapine
Comprised of a variety of drugs to reduce mood swings (GABA receptor agonist)
Types◦ Mineral (Lithium)◦ Anticonvulsants
Depakote (valporate semisodium)
Lamictal (Lamotrigine)
Tegretol (Carbamazepine)
◦ Atypical Antipsychotics (all) for acute mania
Itching, rash
Excessive thirst
Frequent urination
Tremor (shakiness) of the hands
Nausea and vomiting
Slurred speech
Fast, slow, irregular, or pounding heartbeat
Changes in vision
Seizures
Hallucinations Loss of coordination
Swelling of the eyes, face, lips, tongue, throat, hands, feet
Drug Interaction Checker URL
Review Drugs By Condition and Read Patient Reviews
Antipsychotic Side effect Checklist
There are a variety of different neurotransmitters involved in addiction and mental health disorders
It is not always about increasing a neurotransmitter. Sometimes you need to decrease it.
Human brains try to maintain homeostasis and too much or too little can be bad