Pharmacology Lecture 6 Flashcards
(26 cards)
episode
around one week
bipolar 1
at least one manic or mixed episode
can include MDD
bipolar 2
at least one MDD episode and one hypomanic episode
persistent depressive disorder
more than 2 years
but less severe symptoms
4 R’s of trajectory after diagnosis
remission
recovery
recurrence
response
remission
no or minimal symptoms
recovery
6 to 9 months without symptoms
recurrence
new episode after recovery
response
50% symptom improvement
remission one year one treatment
33%
remission after four treamtnes
65%
non-remitters
33%
most common symptoms: insomnia, fatigue, concentration problems
-> apparently harder to treat
optimal risk benefit for medication
between 24 and 64
younger: suicide risk
older: no response risk
relapse rate
increases with n treatment needed for remission
stopping medication one year after remission
50% risk for recurrence
BDNF
brain derive neurotrophic factor
growth factor to keep neurons alive
inhibited by stress
chronic stress
hypercorticolism
overznhibition and atrophy of hippocampus
5HT degradation
MAOB inside cell
MAOA outside
MAOB when too abundant outside
NE and DA commonality
both have precursor tyrosine
DA can in use NET when concentrations are high
monoamine hypothesis evaulation
no evidence from postmortem
no evidence by medication effects
SSRIs effect
increase 5HT in cleft
-> optimal clinical effect
down regulate autoreceptors
-> less side effects
delayed effect in SSRIs
autoreceptor down regulation takes a while
SSRIs secondary effects exampels
fluoxetine
increase DA and NE
-> energizing
paroxetine
increase M1 = muscerineric receptors
-> sedating/calming
TCA
tricyclic antidepressants made of three rings also inhibit NET -> stronger effect = stronger side effects drowsiness decreased blood pressure coma and seizures
