Chapter 7: Drugs to treat Depression and Bipolar Syndrome

What is the most prevalent mental illness in US?
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Selective Serotonin Reuptake Inhibitors (SSRIs) work by ______ reuptake of serotonin into the ______synaptic terminal. By inhibiting reuptake, SSRIs allow released serotonin to __________ in the synpatic cleft and continues to exert effects for longer durations.1. Blocking 2. Presynaptic terminal 3. remainWhat is the first popular drug choice in treating depression?SSRIsSerotonin-Norepinephrine Reuptake Inhibitors (SNRIs) work by?Decreasing reuptake of serotonin and norepinephrine WITHOUT an noticeable effect on dopamine synapsesSNRI are also effective in treating?Chronic Pain (oestoarthritis, peripheral neuropathies, and fibromyalgia)Tricyclics work by?Blocking reuptake of amine neurotransmitter of amine NT into the presynaptic terminal. NOT SELECTIVETricyclics are bad because of?Non-selectivity allows more interactions and a harmful overdose could occur.This enzyme is located at amine synpases, and helps removed released transmitters through enzymatic destruction. What is this enzyme?Monoamine Oxidase (MAO)Monoamine oxidases are not the drug of choice for depression due to a higher incidence of side effects. These effects can worsen with foods that contain?TyramineMAO Type A is forTreating depressionMAO Type B is forTreating parkinsons (prolong effects of dopamine)Bupropion (Wellbutrin) acts primarily as a?Dopamine and Norepinephrine reuptake inhibitorPharmacokinetics of Antidepressants (ADME)A - by mouth D - varies, will reach brain M - liver E - biotransformed and renal excretionWhat is the most common side effect of SSRIs and SNRIs?GI symptomsPositives of SSRIs and SNRIs?1. Cause less sedation 2. Less cardiovascular problemsNegatives of SSRI and SNRIs are that they could cause fatal adverse effect "Serotonin Syndrome". What causes this syndrome? Why is it fatal?1. Taking high doses or combining two or more antidepressants 2. Due to the inhibitory reuptake of serotonin, it can accumulate in the brainWhat is the major issue with Tricyclics?SedationTricyclics have the ______ potential for lethal overdose, because high doses can cause?Highest Fatal cardiac arrhythmiasMAO inhibitors tend to produceCNS excitationAntidepressants affect chronic pain by their actions on?CNS monoamine neurotransmitters (modulates effects)What amine NT plays in an important role in regulating pathways for inhibiting pain?SerotoninBipolar I is classified asalternating episodes of mania/major depressionBipolar II is classified asdepressive episodes are interspersed with less severe manic symptomsBipolar disorder is caused by?Imbalance between inhibitory neurotransmitters (Serotonin, GABA) and excitatory ones (norepinephrine, dopamine, glutamate, aspartate)Treatment of bipolar disorder is done first by?Preventing the start, then giving drugs as mood stabilizersWhat is the primary drug for treating bipolar disorder?LithiumLithium works by?Preventing neuronal degeneration and sustaining neuronal functioning of brain, and increase brain-derived neurotrophic factorPharmacokinetics of LithiumA - readily in GI tract D - completely to all tissues M - NOT metabolized (harmful) E - through excretion in urineHigh does of lithium range1 to 1.5Maintenance dose of lithium range0.6 to 1.2What is a major issue with lithium usage?Accumulation in bodyIf a patient is taking lithium to treat bipolar disorder comes to you with changes in behavior is this a reason to be concerned?Yes, may indicate drug is reaching toxic levelsWhen does an appreciable improvement of symptoms when taking anti-depressant medications occur?1 month