Presentation on theme: "Introduction to Psychopharmacology"— Presentation transcript:
1 Introduction to Psychopharmacology Charles P. Samenow, MD, MPH
2 ObjectivesIdentify major classes of somatic treatments for the major DSM-IV-TR DiagnosesDescribe basic mechanism of action of somatic treatmentsExplain how mechanism of action related to major side effect profiles
4 TricyCLIC ANTIDEPRESSANTS Block the re-uptake of three neurotransmitter systems:SerotoninNorepinephrineDopamineUtilized in:Major Depressive DisorderDysthymiaGeneralized Anxiety DisorderPanic DisorderObsessive-Compulsive Disorder
5 Tricyclic ANTIDEPESSANTS Older “Dirtier” Medication:3-4 weeks for onset (sometimes even 4-6 weeks)Can be lethal in overdose (cardiotoxic)Have side effect profiles:Anticholinergic: dry mouth, constipation, confusion, urinary retentionHistaminic blockade: sedation and weight gainAlpha-adrengergic blockade: orthostatic hypotentionSerotinergic: sexual side effect
6 MAOIBlock Monoamine Oxidase in the wall of the gut, CNS and platelets leading to build up of Dopamine and NorepinephrineUtilized in:Major Depressive DisorderAtypical DepressionAnxiety Disorders
8 MAOIInhibition of MAO in the gut leads to increased Tyramine absorption. Hence, patients must avoid Tyramine containing foods (fava beans, aged meats and cheeses, wines, sauerkraut, etc…)Ingestion of Tyramine can lead to hypertensive crisisRequire 3-4 weeks (sometimes 6-8 weeks)Fatal in overdoseCannot be combined with other serotinergic acting drugs (Tricyclic’s, SSRI’s) due to risk of serotonin syndrome.Overdose can be fatal
9 SSRI Blockade of serotonin reuptake from the synapse Utilized in: Major DepressionDysthymiaOCDPanic DisorderPTSDSocial PhobiaBulimia NervosaDepressed phase of Bipolar (only with a mood stabilizer)
11 SSRI Take 2-4 weeks for onset Fewer side effects than older medications – “Cleaner” and more easily toleratedFirst line agents in pregnancy (although Class C)Major side effects:Gastrointestinal (first few days)Sexual Side EffectsBlack Box Warning: Increased Suicidality in AdolescentsTreatment emergent mania in bipolar disorderDiscontinuation Syndrome
12 SNRI Blocks Re-uptake of Serotonin and Norepinephrine Careful balance between two neurotransmitter systemsUtilized in Depression, Anxiety and Pain Syndromes“Cleaner”/More Easily ToleratedMajor Side Effects:Blood PressureDiscontinuation Syndrome
13 MISCELLANEOUS Wellbutrin (Buproprion) Remeron (Mirtazapine) Inhibition of Norepinephrine Re-uptakeNo sexual side effectsAlso marketed as Zyban for smoking cessationContraindicated in eating disorders due to lowering seizure thresholdMain side effect is anxietyRemeron (Mirtazapine)Alpha-2 Antagonist (net effect -> increased norepinephrine)May cause sedation or increased weight gainOften used in the elderly
15 BENZODIAZAPINES Use is determined by ½ life: Long (Diazepam, Chlorediazepoxide)Medium (Alprazolam)Short (Lorazepam)Utilized for panic and insomniaPotentiation of GABA receptors by binding to special binding siteLong-term use may lead to tolerance, withdrawal and physiologic dependenceSide effects are sedation and amnesia
23 EPSDystonia – acute, involuntary muscle spasms often seen in ocular muscles and neckParkinsonism – tremor, cogwheel rigidity, masked facies, and shuffling gaitAkasthesia – a subjective sense of restlessness.Tardive Dyskinesia – long-term involuntary jerking of face, neck, trunk or extremities. May be permanent.
24 ATYPICAL (SECOND GENERATION) Utilized in:Acute SchizophreniaMaintenance of SchizophreniaAcute ManiaMaintenance of BipolarTreatment of Bipolar DepressionMechanism of Action: Blockade of D2 and 5HT-2A. Serotonin modulate dopamine, particularly in the nigrostriatal pathways. Hence, more Dopamine blockade in the mesolimbic as opposed to nigrostriatal pathways.
26 ATYPICALS Often first line Efficacy on positive and negative symptoms NMS and EPS unlikelySide Effects are based on receptor profileProlongation of QTc (Cardiovascular)Metabolic SyndromeWeight GainGlucose IntoleranceIncreased Lipids and Triglycerides
29 LITHIUM Indicated for acute mania and maintenance bipolar Specific evidence to support use in preventing suicideBlocks inositol-1-phosphataseNarrow therapeutic range: dangerous in overdoseSide Effects:TremorRenal ImpairmentThyroid DysfunctionCardiovascular
30 ANTICONVULSANTSMajor Agents: Carbamazepine, Valproic Acid and LamotrigeneMay prevent kindlingEach agent has side effects that are outside scope of this lecture
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