4. Mood Stabilizers Flashcards
What are the 5 different classes of mood stabilizers?
Include their drugs
- Monoamine oxidase inhibitors (MAO-i)- trancylcypromine, moclobemide
- Nonselective reuptake inhibitors- imipramine, amitriptyline, venlafaxine
- Serotonin selective reuptake inhibitors- fluoxetine, citalopram, paroxetine
- Noradrenaline selective reuptake inhibitors- desipramine, notriptyline
- Nonselective release enhancers- mirtazapine
What is major depressive disorder?
Symptoms?
Heterogenous (different genes) genetic disorder with onset at anytime of life
Typically recurring
Affects 10% of pop
Symptoms- emotional (sad frustrated irritable apathetic- stop caring)
Cognitive (inappropriate negative thoughts and ideas, impaired concentration)
Neurovegetative- loss of appetite, loss of libido, loss of energy, lack motivation, loss of interest in everything, neuroendocrine abnormalities, sleep disorder, no pleasure
Slides 7-9
What are 5 antidepressant interventions?
- Insulin-induced hypoglycemic convulsions- overdriving the brain, works to reset the networks (historic)
- Electro-convulsive therapy- still used today, currently safe and effective
- Monoamine oxidase inhibitors (MAO-i)
- Neurotransmitter reuptake inhibitors (nonselective reuptake inhibitors NSRIs, selective noradrenaline reuptake inhibitors, selective serotonin reuptake inhibitors SSRIs)
- Atypical antidepressants
What are monoamine oxidase inhibitors (MAO-i)?
What is MAO, two types
MAO is a mitochondrial enzyme that helps prevents buildup of excessive intracellular levels of neuroactive amines (is the chemical part of BBB)
2 isoforms MAO-A and MAO-B
Tranylcypromine
Moclobemide
What are the 2 isoforms of monoamine oxidase (MAO)?
MAO-A: found in neurons, liver, GI tract, highest affinity for serotonin, less affinity for noradrenaline, dopamine and trace amines like tyramine
MAO-B: found in neurons, liver, platelets, highest affinity for dopamine, less affinity for noradrenaline and tyramine
MAO-B inhibitors in Parkinson’s
Slide 11
What are nonselective reuptake inhibitors (NSRIs)?
Inhibit both noradrenaline and serotonin reuptake (more neuromodulators act on receptors)
Broad spectrum
Older drugs, tricyclic antidepressants
Imipramine
Amitriptyline
Venlafaxine
Slide 13
What are selective noradrenaline reuptake inhibitors?
No description in slides
Desipramine
Nortriptyline
Slide 14
What are selective serotonin reuptake inhibitors (SSRIs)?
Inhibit serotonin reuptake
Fluoxetine (Prozac)
Paroxetine (Paxil)
Citalopram (Celexa)
Slide 15
What are atypical antidepressants?
Heterogenous group of drugs
Could be selective serotonin reuptake inhibitor, could be non selective, could be MAO inhibitor
Effect the reuptake of serotonin in the brain (as well as partial agonist or antagonist of some receptors
Amoxapine Nefazodone Trazodone Bupropion MIRTAZAPINE
What are 3 other disorders antidepressants are used for?
Panic disorder- looks like anxiety
Obsessive-compulsive disorder- predominant symptom is anxiety
Generalized anxiety disorder- classic anxiety
Slide 19
Look at case study slide 21
Ok
What are the 5 drugs used to treat bipolar disorder?
Lithium Carbamazepine Lamotrigine Valproic Acid Atypical Antipsychotics
What is mania?
State of neurological abnormality, where there is an elevated or irritable mood, arousal, and/or energy levels
It is opposite to depression
Enhanced, productive, get a lot accomplished
What is bipolar disorder?
Mood swings that cycle between depression and mania
Cycle length varies from hours to years in different patients (any time period of depressive and mania states
What is the treatment guideline for bipolar disorder?
20-40% of patients do not respond to lithium or tolerate its adverse effect
Therefore-> anticonvulsants: valproate, carbamazepine, or lamotrigine
Atypical antipsychotics may be used for treatment of acute mania or mixed episodes
Antidepressants may precipitate mania, and this combo therapy of olanzapine with fluoxetine can be used for the treatment of depression associated with bipolar disorder
Slide 30
