Steps in an Action Potential
When one nerve cell is activated it sends information like a neurotransmitter down through the axon via a vesicle which protects it and keeps it all there which then brings it to the edge of the presynaptic neuron which goes pew and sends it into the synaptic gap and then the receptors are what takes in the neurotransmitter, reuptake when the presynaptic nerve RECYCLES the neurotransmitter that is existing in that presynaptic gap
a neuron from the axon terminal of which an electrical impulse is transmitted across a synaptic cleft to the cell body or one or more dendrites of a postsynaptic neuron by the release of a chemical neurotransmitter.
Presynaptic Neuron
a chemical substance that is released at the end of a nerve fiber by the arrival of a nerve impulse and, by diffusing across the synapse or junction, causes the transfer of the impulse to another nerve fiber, a muscle fiber, or some other structure.
Neuotransmitters
store various neurotransmitters that are released at the synapse.
Vesicles
cell’s gatekeeper. It’s the outer layer that surrounds a cell, letting substances in - or keeping them out.
Cell Membrane
a junction between two nerve cells, consisting of a minute gap across which impulses pass by diffusion of a neurotransmitter.
Synapse
Nerve cell on the receiving end of an electrical impulse from a neighboring cell
Post Synaptic Neuron
proteins that are on the surface of each cell. They act as little receivers (or ears) that listen to the messages of the chemical messenger molecules as they float in the intercellular fluid surrounding every cell.
Receptor Site
the process by which the presynaptic terminal of a neuron reabsorbs and recycles the molecules of neurotransmitter it has previously secreted in conveying an impulse to another neuron.
Reuptake
the space between neurons at a nerve synapse across which a nerve impulse is transmitted by a neurotransmitter
The gap between the presynaptic gap and the post synaptic nerve, its where the neurotransmitters go and then the receptors receive it
Synaptic Gap
o Responsible for communication and integration in the nervous system
Neuron
Input to the neuron
Dendrites
Output of the neuron
Designed to carry information
Branch to connect to go to different neurons
Axon
End; make the connection with the other neuron.
Axon Terminal
BODY -> DRUG
How the body moves or processes the drug
How your body effects the drug
Pharmacokinetics
ADME of Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Max concentration when drug in blood stream
Peak Concentration
When med in blood stream is at its lowest, wait to take next dose of meds
Trough Levels
Amount of time required to reach a stable concentration level in blood stream, the amount entering your body is equal to the amount leaving your body
Half-Life
Amount of time required for drug to be stable in blood stream amount entering is equal to amount exiting
Steady State
Concentration in liquid portion of the blood
Therapeutic index: window having meds concentrated rather than toxic
Plasma Levels
Minimum concentration much be reached for effectiveness and not exceeded
Therapeutic Window
DRUG -> BODY
How the drug affects the body
“Start low and go slow”
Work your way up to see what’s the best dosage
too much could be toxic
Pharmacodynamics
Something that “mimics” an already occurring neurotransmitter in the body, chemical process already occurring in the body
Agonist
It blocks
Antagonist
An averse side effect
-discomfort
EgoDystonic
Signals to others? Symptom/side effect that other people see as aversive but person experiencing doesn’t care.
El se siente SYN symptoms pero tu los ves
EgoSyntonic
The root of the pathology, physiological root to pathological symptoms
Pathophysiology
What you want to address with meds
“target” of the medication
Target Symptoms
Toxic effect of med on the body, having aversive effects to the point of lethality
Toxicity
drugs used to treat bipolar II
First-line agents: Mood stabilizers (Lithium, Carbamazepine, Divalproex, Lamotrigine, Quetiapine)
2nd-generation antipsychotics
- Good for Acute Depressive
- Acute mania - mood stabilizer + antipsychotic (remove antipsychotic when mania resolves)
periodic treatment for Bipolar
Anti-Depressants/ Anti Psychotics
Long term treatment for Bipolar
Medication
Mood Stablizers -> Neuroprotective effects
Dry mouth, blurred vision, constipation, urinary retention, intestine paralysis, etc.
Parasympathetic Nervous System
Anticholinergic
Sweating, sexual dysfunction, orthostatic hypotension (drop in bp upon rising), etc.
Norepinephrine
Adrenergic
Sedation, weight gain, etc.
Antihistaminic
- Mild, moderate (adjustment disorder w/depressed mood), or severe (MDD)
- Response to psychosocial stressors
- Acute/intense; insidious; distant past
- Lack physiological symptoms
- No impact on sleep
Reactive Depression
Medical illness
- Ex. Chronic pain, thyroid issues
- Female sex-hormone fluctuation
- Post-partum, menopause
Medications and recreational drugs
- Alcohol, birth control
Endogenous biological depressions (genetic)
Biological Depression
Start as reactive which lead to physiological symptoms that influence the brain
Large % of depressions seen clinically
Start as reactive -> various physiological symptoms -> adversely influence brain functioning
Psychological and biological symptoms
Reactive-Biological Depression
Subtype characterized by symptoms:
- Reactive dysphoria
- Profound fatigue, low energy
- Hypersomnia
- Increased appetite and weight gain
- Marked sensitivity to interpersonal rejection/separation
Atypical Depression
Which type of medication is NOT most suitable to treat bipolar
Antidepressants
Consequences of taking antidepressants to treat bipolar
may induce mania
When to refer depressed clients for Medication Treatment
Greif becomes Clinical Depression
- SXS: Early morning awakening; serious weight loss; anhedonia; agitation
MD has vegetative sxs
- SXS: Sleep disturbance; appetite disturbance; fatigue; decreased sex drive; agitation or psychomotor retardation; anhedonia
MD has atypical sxs
- SXS: Pronounced fatigue; hypersomnia; increased appetite and weight gain; rejection sensitivity; reactive dysphoria
Dysthymia presents with sustained sxs
- SXS: Low energy; anhedonia
Daily functioning markedly impaired
Presence of sever Suicidal impulses of psychotic sxs
MD or Dysthymia fails to respond to psychotherapy
How to counteract effects of SSRI’s on sexual dysfunction
Antidote - adding to prescribed med (Wellbutrin, gingko biloba, cyproheptadine, Viagra, etc.)
Substitution (buproprion, mirtazapine, nefazodone);
Atypical Anti-depressants
Common Neurotransmitters that play a role in Anti-Depressants
SSRIs (Prozac/Fluoxetine, Zoloft/Sertraline, Paxil/Paroxetine, Celexa/Citalopram, Lexapro/Escitalopram)
SNRIs (Effexor/Venlafaxine, Cymbalta/Duloxetine)
Serotonin norepinephrine reuptake inhibitor
TCAs (Tofranil/Imipramine, Elavil/Amitriptyline)
MAOIs (Nardil/Phenelzine, Parnate/Tranylcypromine)
Atypicals (Wellbutrin/Bupropion [dopamine-norepinephrine reuptake inhibitor], Serzone, BuSpar/Buspirone)
NRIs (Strattera, Vestra [not available in US])
Stimulants (Ritalin, Dexedrine)
Adjunctive agents
FDA approved for mania and mixed mania
- Aripiprazole, Asenapine, Cariprazine, Olanzapine, Quetiapine, Risperdone, Ziprasidone
FDA approved for bipolar depression
- Lurasidone, Quetiapine, Olanzapine + Fluoxetine (Symbyax)
Less risk for extrapyramidal side effects
Serious side effects:
- seizures, cardiac arrhythmias, hypertension, metabolic syndrome (increased weight, type II diabetes, hyperlipidemia)
2nd generation Anti-psychotics
Treatment of Bipolar
Pharmacotherapy** + psychotherapy + psychoeducation
Treatment team (psychiatrist + therapist + patient’s family)
Inpatient/outpatient
Complicated course of illness; symptom severity/presentation
Medication regimens:
- Multiple mood stabilizers
- Concurrent antidepressants
- Other adjunctive agents:
- Benzodiazepines
- Antipsychotics
Resistance/poor response to treatment is common
Problematic side effects of depression
Activation - acute onset side effect within first few hours of starting drug or increasing dose - every time I take this I’m going to feel this each time
Low dose tranquilizer (lorazepam)
Common patient-initiated discontinuation
Switching - provoked into a manic state (after several weeks of taking antidepressant)
Sexual dysfunction - is it because of the drug or due to bipolar?
-Wellbutrin; Viagra
Weight gain
-Remeron
Anorexia
Elderly
o Used to treat Depression
o SNRI
o Blocks reuptake of serotonin norepinephrine, and dopamine into presynaptic neurons
Effexor
o Atypical Anti-depressant
o Primary use for depression
o Used to augment current SSRI - use to combat sexual dysfunction
“ Fewer sexual side effects
Wellbutrin
type of drug
Primary for MDD but has other uses
Median grade sedative, antianxiety properties, mood improver
- Premature ejaculation, women undergoing cancer Tx to combat hot flashes
Fewer drug interactions compared to other SSRI’s
Zolaft
type of drug
Anticonvulsant / mood stabilizer
GABA
manic episodes
Depakote
Type of drug
Treats Manic/Depressive bipolar
interferes with the production and uptake of chemical messengers by which nerves communicate with each other (neurotransmitters).
affects the concentrations of tryptophan and serotonin in the brain.
increases the production of white blood cells in the bone marrow
Lithium
augment antidepressants
should only be taken in the morning
stimulants
off label treatment of depression
effective in improving energy and cognition with little to no sexual dysfunction
NRI
use when other antidepressants have failed in treating MD and Panic D/O
MAO
Dual action
may be more effective than SSRI’s for SEVERE depression but have additional side effects
SNRI
cleaner
fewer side effects
reacts only with serotonin
SSRIS