Module 8: Approaches to Treatment Flashcards
(29 cards)
Clinical Trials in the 1980s and 1990s indicated that 80-90% of people using SSRIs went into remission from depression. What was the level in the 2000s?
60-70%
Which neurotransmitter does Ketamine act on?
Glutamate
Describe deep brain stimulation.
The process by which electrodes are surgically implanted in a specific brain region and stimulated via an electrical pulse.
Successful long-term reduction of depressive symptoms has been achieved by stimulation of the Subgenual Cingulate Gyrus and Nucleus Accumbens using what method?
Deep brain stimulation.
What are the five key types of psychotropic drugs were covered?
Antidepressants, antipsychotics, Anxiolytics, psychostimulants, and mood-stabilising drugs.
What are the four most common antidepressants?
monoamine oxidase inhibitors (MAOIs), Tricyclics, Specific Seratonin Reuptake Inhibitors (SSRIs), and Ketamine.
Explain the basics of monoamine oxidase inhibitors(MAOIs).
Antidepressant. Primary drug is Iproniazid, which was originally used to treat tuberculosis. It inhibits activity of monoamine oxidase and increases activity of neurons that utilise noradrenaline and serotonin.
Generally less effective than more recent drugs for severe depression, can be useful when other antidepressants aren’t working.
Explain the basics of Tricyclics.
Antidepressant. Named after their chemical structure which includes three carbon rings. believed to act by blocking the reuptake of dopamine, noradrenaline, and serotonin, though actions of some drugs in this class remain unknown. effective in treatment of mild to severe depression, limitations include high number of side effects, including toxic effects on cardiovascular system.
Explain the basics of Specific Seratonin Reuptake Inhibitors(SSRIs).
Antidepressant. Selectively inhibit the reuptake of serotonin. As effective as tricyclics in treatment of mild depression, and includes fewer side effects, safer for patients with glaucoma and in overdose. Now also used in treatment of anxiety and OCD.
What is the controversy regarding antidepressants?
Use of SSRIs such as Prozac have been linked to acts of violence and suicide.
Seroxat along with all other SSRIs with the exception of Prozac are now banned for prescription to under 18s in UK.
Explain the effectiveness of antidepressants.
Modest, high relapse rate fo 60% when medication ceases, benefits wane whilst still taking drug, SSRIs tend to work better with women over men.
Explain the basics of Ketamine.
Antidepressant. Alternative to serotonin-related treatments. Acts on glutamate(learning, motivation, plasticity), may restore connections between synapses caused by long term depression. Immediately effective, Intravenous administration of Ketamine hydrochloride lifted depressive symptoms within 2 hours. Eskatamine recently licensed in the UK as a nasal spray. Limitations include possible danger of addiction, psychotic side effects, and relief may come down to simple drug euphoria.
What are the two main antipsychotics?
Phenothiazines and Atypical third generation drugs.
Explain the basics of phenothiazine.
Antipsychotic. originally developed to calm patients before surgery. works by blocking dopamine receptors, reduce feelings of aggression and anxiety within hours but takes several days/weeks to reduce other symptoms. Effective in treating positive symptoms of schizophrenia, no effect on negative symptoms. Strong side effects may cause patients to discontinue medication or relapse.
Explain atypical third-generation drugs.
Antipsychotic. Partial agonists, drugs which have high affinity for a receptor (in this case dopamine receptors) but activate it less than the related neurotransmitter. raise dopaminergic activity in the pre-frontal cortex and lower activity in key areas of the limbic system such as the nucleus accumbens, therefore more effective in treating positive and negative symptoms of schizophrenia.
What are the two main anxiolytics?
Benzodiazepines and beta-blockers.
Explain benzodiazepines.
Anxiolytic. used to reduce severe anxiety. Acts by facilitating the activity of GABA(inhibitory neurotransmitter related to fear and anxiety). Can only be prescribed for a short period of time, highly addictive tolerance and dependence. Withdrawal effects can be severe, only offers symptom relief, does not impact underlying condition.
Explain beta blockers.
Anxiolytic. Most commonly used in the treatment of high blood pressure, blocks the effects of stress hormones adrenaline and noradrenaline. Only offers symptoms relief, does not impact underlying condition. Similar efficacy as benzodiazepines on anxiety and panic attack frequency, but side effects less severe and not believed to be addictive.
Explain Methylphenidate (ritalin).
Psychostimulant. Used in treatment of ADHD. Acts as dopamine and/or noradrenaline reuptake inhibitors, as these hormones are important in regulation of attention and executive function. short-acting and administered 2-3 daily. Effective in providing short-term sustained attention, lowered activity level, and reduced impulsivity. Side effects include irritability, loss of appetite, disturbed sleep, and impaired socialisation (the “zombie effect”).
Why are psychostimulants useful in ADHD over depressants?
They depress the central nervous system, reducing alertness and control, thus having a negative effect on executive function. They stimulate parts of the brain that allow inhibition of hyperactive and impulsive behaviour, and unlike depressants, they don’t reduce functioning of other parts of the brain.
What are neurophysiological techniques?
Can be used to measure or modify brain activity.
How can brain activity be measured?
electroencephalography (EEG) or magnetoencephalography (MEG).
How can brain activity be modified?
Electroconvulsive Therapy (ECT), Deep Brain Stimulation (DBS), Transcranial Direct Current Stimulation (tDCS) or Transcranial Magnetic Stimulation (TMS)
Explain Electroconvulsive Therapy(ECT).
patient is given anaesthesia, then electrodes are placed on scalp, most often on the nondominant hemisphere side, followed by 70-150 volt shock which triggers a seizure. Involves 3 treatments a week until max improvement is seen, which is usually 6-12 treatments. Possible actions are an increase in GABA and neuropeptide Y. Many limitations, as it may create an association with being given anaesthetic and may induce epileptic fit. Long term may result in brain damage and retrograde amnesia. high relapse rate, but may be more effective if used along with antidepressants. originally intended for schizophrenia but has proved more successful in depression.
