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Psyc 330- Drugs and Behavior > Psychotherapeutic Meds pt 3 > Flashcards

Psychotherapeutic Meds pt 3 Flashcards

1
Q

How long does it take to feel the behavioral effects of antidepressants?

A

2-10 weeks

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2
Q

How long does it take for antidepressants to have molecular actions?

A
  • basically immediately
  • monoamine levels elevated within an hour
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3
Q

What is the paradox with antidepressants?

A
  • While based on their PK/PK they elevate monoamine levels within an hour, it takes weeks for the antidepressant effect to actually take place

shows a disconnect between what we expect biologically vs what is actually perceived by the patient

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4
Q

What do antidepressents increase (besides monoamine levels)?

A
  • Neurogenesis by increasing the amount of synaptic connections
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5
Q

How long does neurogenesis take?

A

2-3 weeks

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6
Q

What is BDNF and why is it important?

A
  • Brain derived neurotrophic factor
  • Critical for neurogenesis: “give life to neurons”
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7
Q

What quality may make antidepressents more efficacious?

A

more quickly stimulate neurotrophic factor synthesis or neurogenesis

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8
Q

What is the neurotrophic hypothesis of depression?

A
  • As monoamines increase, signaling cascades are stimulated that increase expression of genes for BDNF
  • This happening repeatedly everyday will eventually promote new receptors, new neurons, and more dendritic sprouts
  • Explains why it takes weeks for mood to be alleviated
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9
Q

Which receptors does ketamine block?

A

blocks NMDA receptors

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10
Q

What happens if you give a mouse ketamine

A

dendritic spines increase

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11
Q

Where are NMDA receptors found?

A

on GABA neuron terminals

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12
Q

What happens when ketamine blocks NMDA receptors?

A
  • By blocking NDMA receptors on GABA neuron terminals, there is less inhibition
  • leads to more chances for action potentials and enhanced neural connection strength
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13
Q

When is ketamine used for depression?

A

Used for treatment resistant depression as a last resort

not overed by insurance

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14
Q

How many people respond to ketamine?

A

only 1/3 have actual relief and improvement in their symptoms

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15
Q

When does mania appear?

A

usually appears in 20s to 30s

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16
Q

What is mania?

A

elevated mood/increased activity

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17
Q

What are the symptoms of mania?

A
  • increased talkativeness
  • racing thoughts/ideas
  • grandiosity
  • decreased sleep
  • excessive movement
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18
Q

What is there a desire for in people with bipolar?

A

to express normal emotions

19
Q

What is the goal of mood stablizers?

A
  • decrease intensity/duration of manic/depressive episodes
  • or prevent them from occuring
20
Q

What is the first line of treatment for bipolar?

A
  • lithium
  • most effective in “typical” bipolar disorder (Bipolar 1)
21
Q

Why are antidepresants commonly used with lithium?

A

because lithium treats mania more so than depression

22
Q

What other drugs are sometimes prescribed with lithium?

A
  • Ca2+ receptor blockers, cholinergic agents, adrenergic blockers
23
Q

What affects effectiveness of particular drug treatment for mania?

A

whether patient experiences only manic symptoms or not

24
Q

How many people have remission due to mood stabilizers?

A
  • 60-80% have partial/complete remission
  • more favorable in people with strong genetial link
25
Q

What did John Cade discover about lithium?

A

calming effect on animals

26
Q

When was lithium approved for US? For what?

A
  • approved for use in US in 1970 (Europe much earlier)
  • For the treatment of mania and to prevent recurrence
27
Q

What does lithium do to normal individuals?

A

possesses negligible effects

28
Q

What about lithium is highly specific?

A

relieves mania without over-sedation

29
Q

What does prophylactic mean?

A

a preventive meausure: lithium is prophylactic because it decreases/prevents future bipolar episodes

30
Q

Lithium PK

A
  • important to monitor on a regular basis until assured of stable levels
  • slow passage through BBB
31
Q

Lithium PK- passage through BBB

A
  • concentraton in cerebrospinal fluid is about half plasma
  • dependent on sodium intake due to ionic balance (Na+ vs Li+)
32
Q

What do lithiums’ intracellular effects culminate in?

A

neuroprotection- promoted in many ways by lithium

this might do nothin in healthy individuals as they are already at the optimal level

33
Q

What does lithium dampen and inhibit?

A
  • glutamate system/NMDA receptors
  • DA system
34
Q

What are the side effects of mild lithium toxicity?

A
  • diarrhea/vomiting
  • drowsiness/confusion
  • muscle weakness
35
Q

What are the adverse effects of lithium?

A
  • tremor
  • weight gain
  • thirst/fluid retention/frequent urination

side effects generally benign

36
Q

What do you need to screen for before starting lithium?

A

need to pre-screen for heart/kidney effects

37
Q

What can happen as a result of lithium having a small therapeutic window?

A
  • drowsiness/confusion
  • blurred vision
  • ataxia
  • seizures
  • cardiovascular issues
  • coma/death
38
Q

What else is lithium effective at treating?

A
  • reccurent hyperactivity in children (not for ADHD under the age of 13)
  • premenstrual syndrome
  • episodic anger/aggression
39
Q

What are other treatments for bipolar disorder?

A
  • benzos
  • anti-epileptics/convulsants
  • anti-depressants
  • ECT

limited evidence for atypical antipsychotics

40
Q

Relapse rate bipolar

A

60-90% within 4-5 years

41
Q

What is the likely cause of relapse?

A

underdosing/noncompliance

42
Q

What greatly reduces relapse rates of bipolar?

A

parallel psychotherapy

43
Q

What is worse than having no treatment for bipolar?

A

abrupt discontinuation of meds

Psyc 330- Drugs and Behavior (40 decks)

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