Agents antidepressant drugs 2010Bb

Agents antidepressant drugs 2010Bb - ANTIDEPRESSANTS...

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ANTIDEPRESSANTS
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Lecture Objectives I. Familiarize with different types of Mood Disorders II. Examine Theories of Depression Stress, Genetics, Neurotransmitters III. Current Antidepressant Therapy: MOA, adverse effects 1. Tricyclic antidepressants 2. Monoamine oxidase inhibitor antidepressants 3. Serontonin reuptake antidepressants 4. Serotonin/noradrenaline reuptake antidepressants 5. Third Generation…. IV. Examine new theories & implications: possible pharmacotherapy V. Examine Bipolar Disorder 1. Drug Therapy for Mood stabilization (Lithium)
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I. Mood Disorders 1. Unipolar Mood Disorder or Depression (MAJOR DEPRESSIVE DISORDER= MDD) more prevalent in females, onset 30s, recurrent P ersistent sadness A ppetite changes S leep trouble L ow energy W orthlessness, guilt I ndecisiveness S uicidal ideation
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I. Mood Disorders 2. Bipolar Mood Disorder Alternation between depression and mania 25% of MDD, equal prevalence between sexes, onset in 20s Mania: » Grandiosity » Decreased need for sleep » Racing thoughts » Euphoria » Impulsivity
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3. Other Types of Depression DYSTHYMIA: Moderate severity with no evidence of a MDD episode, repetitive low feeling SEASONAL AFFECTIVE DISORDER SAD, seasonal pattern to episodes POSTPARTUM DEPRESSION The levels of estrogen and progesterone, the female reproductive hormones, increase tenfold during pregnancy but drop sharply after delivery ATYPICAL DEPRESSION Increased appetite, extreme reactivity to environment, excessive sleeping Feeling blue
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II. Major Depressive Disorder (MDD) Etiology: Abnormalities in neurotransmission: 1. Abnormalities in Hypothalamic Pituitary Adrenal axis ( cortisol/ACTH) 2. Genetics 3. Multifactorial 4. The AMINES: Norepinephrine, Serotonin possibly Dopamine possibly Acetylcholine
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2. Genetics/ Familial link: 1 st degree relatives are at much higher risk (chromosome 18)
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3. Multifactorial etiology Changes in neurotransmitter in specific brain regions Alterations in signal transduction cAMP and CREB Gene transcription Neuronal plasticity Synaptogenesis Cell death Disorder can be difficult to treat effectively
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4. Monoamine Hypothesis of Depression reduced serotonin and norepinephrine levels in depressed and suicide victims (blood and CSF ) post-mortem studies show elevation in cortical 5-HT 2 binding (R up-regulation) drugs which reduce NE/5-HT result in depression/suicidal tendencies (reserpine) drugs which elevate serotonin and NE (MAO-I, amphetamine) also alleviate symptoms DEPRESSION RESULTS FROM A CNS DEFICIENCY OF MONOAMINE FUNCTION (NORADRENERGIC AND/OR SEROTONINERGIC)
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Stahl Essential Psychopharmacology NORMAL DEPRESSED
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Stahl Essential Psychopharmacology MAO inhibitors Tricyclics
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Current Antidepressants in use (Table 25.1 Kalant et al.) Class Action Example Tricyclic (MDD) Inhibit neuronal uptake of 5-HT and NE Amitryptiline (Elavil) Imipramine MAO inhibitors
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  • Fall '10
  • arnot
  • Selective serotonin reuptake inhibitor, Major depressive disorder, Antidepressant, NE, serotonin reuptake inhibitors

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Agents antidepressant drugs 2010Bb - ANTIDEPRESSANTS...

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