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CHAPTER 14

CHAPTER 14. Antidepressants, Psychomotor Stimulants, and Lithium. Mental Depression. Exogenous or reactive depression usually occurs in response to some external factor or adverse life event

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CHAPTER 14

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  1. CHAPTER 14 Antidepressants, Psychomotor Stimulants, and Lithium

  2. Mental Depression • Exogenous or reactive depression usually occurs in response to some external factor or adverse life event • Endogenous depression usually originates from within the psyche of the individual and the causes are less well understood • Bipolar mood disorder involves alternating cycles of depression and mania

  3. Causes of Mental Depression • Exact causes not well understood • Mental depression appears to involve the development of low levels of the brain monoamine neurotransmitters, serotonin (SER) and norepinephrine (NE) • This explanation is referred to as the “Monoamine Theory of Mental Depression”

  4. Treatment of Depression • Treatment involves a combination of psychotherapy and antidepressant drugs • Antidepressant drugs act to increase NE and SER levels in the brain • Tricyclic antidepressants (TCA) and selective serotonin reuptake inhibitors (SSRI) are the two most important antidepressant drug classes • Monoamine oxidase inhibitors (MAOI) are less frequently used and require dietary restriction

  5. Monoamine Oxidase Inhibitors (MAOI) • Monoamine oxidase is the enzyme that metabolizes the monoamines NE and SER • Inhibition of MAO increases SER and NE levels and functional activity in the brain • Requires 2–4 weeks for maximum effects • Foods containing tyramine must be avoided • Tyramine stimulates the release of NE and may cause a hypertensive crisis • MAOIs are indicated for patients who cannot tolerate TCAs and SSRIs

  6. Tricyclic Antidepressants (TCA) • Mechanism of action of TCAs is to block reuptake of NE and SER into nerve endings • Blockage of reuptake increases NE and SER levels and stimulation of NE and SER receptors • Requires 2–4 weeks for maximum effect • TCAs are divided into secondary amines which increase NE more than SER and are less sedating than tertiary amines which increase SER more than NE

  7. Autonomic Effects of TCAs • TCAs possess anticholinergic activity which can cause dry mouth, visual disturbances, constipation, and urinary retention • TCAs also possess alpha blocking activity that can lower blood pressure • TCAs can also affect cardiac rhythm and may cause cardiac arrhythmias

  8. Selective Serotonin Reuptake Inhibitors (SSRI) • Selectively block the reuptake of SER • Cause little if any anticholinergic and alpha blocking effects • Are generally not sedating, and in some cases cause CNS stimulation • Common adverse effects include nausea, agitation, restlessness, and less frequently seizures

  9. Atypical Antidepressants • Bupropion (Wellbutrin) – decreases the craving for Nicotine used in smoking cesation

  10. Psychomotor Stimulants • Generally referred to as the amphetamines • Produce CNS stimulation more than an antidepressant effect, little used for depression • Act by increasing NE and DA activity • Clinical use for narcolepsy and treatment of hyperkinetic children • Amphetamines have a high abuse potential • Adverse effects due to excessive CNS and autonomic stimulation

  11. Lithium • Lithium is an elemental ion similar to sodium competes with Na+ - slows nerve conduction • Acts to depress nerve excitability that helps prevent mood swings and manic behavior • Common adverse effects include nausea, diarrhea, tremors, increased thirst, ringing in the ears (tinnitis), and more seriously kidney and heart damage • Periodic blood levels to prevent over dosage

  12. Drugs to Know • Mao inhibitor • Phenylzine Nardil) • Tricyclics • Amitriptylin (Elavil) • Doxepin (Sinequan) • SSRI • Fluoxetine (Prozac) • Paroxetine (Paxil)

  13. Drugs to Know • Psychomotor stimulants • Amphetamine • Dextroamphetamine (Dexedrine) • Methylphenidate (Ritalin) • Atypical antidepressants • Bupropion (Wellbutrin)

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