M.Bojar Neurol.lecture - 2.LF UK1 Serotonin & 5-HT agonists role in the NS impairment -migraine, depression Role of 5-HT, its agonists, antagonists, reuptake inhibitors and other 5-HT associated agents. Serotonergic and noradrenergic systems and their role in pathophysiology and in treatment of the NS disorders. N.V.& brain-stem structures, peripheral & central pain processing system.

M.Bojar Neurol.lecture - 2.LF UK2 Serotonin & 5-HT agonists role in the NS impairment -migraine, depression Modified hypothesis of spreading depression. ACh and vasoactive intestinal peptide (VIP) - integrated hypothesis. Inherited channelopathies - paroxysmal diseases- neuromuscular & paroxysmal disorders {migraine,stroke-like,Epi}. SSRI in therapy of depressive, obsessive- compulsive disorders, bulimia nervosa.

M.Bojar Neurol.lecture - 2.LF UK3 Serotonin & 5-HT agonists role in the NS impairment -migraine, depression „Happiness “ pills - SSRI& sumatriptan, {affects selectively 5-HT 1B/D receptors}. Aricept, Viagra and Imigran - what about the costs and the Health Care budget? How serious is serious? What about the side-effects? Who takes care How do neurotic/ headache patients „understand“ of S.E.of SSRI/sumatriptan?.

M.Bojar Neurol.lecture - 2.LF UK4 Serotonin & 5-HT agonists role in the NS impairment -migraine, depression The psychiatrists&other specialists&G.P.s to be aware of the unequal level of knowledge of S.E., incidence and real danger. How to balance it ? Defensive-medicine information - patients overloaded by too many nonnstructured& unclear information -CAVE!! new psychogenic S.E. complaints.

M.Bojar Neurol.lecture - 2.LF UK5 Serotonin & 5-HT agonists role... Fluoxetine side-effects: Gastrointestinal symptoms incl. nausea, vomiting and diarrhea(which may be severe). Abdominal pain, acid stomach, constipation, anorexia with weight loss, dry mouth, anxiety or drowsiness, tremor, palpitations, rash, convulsion, fever, headache, tremor, insomnia, confusion, sweating, weakness, hypothermia, sexual dysfunction. Occasionally-blood disorders, including lowered sodium and liver dysfunction. A hypersensitivity syndrome has been described involving symptoms in the skin and inflammation of inner organs. A number of other disorders have been reported, including vaginal bleeding on withdrawal, several different blood disorders, violent behaviour and hair loss.

M.Bojar Neurol.lecture - 2.LF UK6 Serotonin & 5-HT agonists role... Sumatriptan side-effects : Chest pain and tightness in the chest (sometimes AP-like pain), tingling, heat, heaviness, pressure, flushing, dizziness, feeling of weakness, loss of sensation in the extremities, drowsiness and fatigue, changes in liver function, nausea and vomitting, transient pain at the injection site. What about anxiety&irritation etc?

M.Bojar Neurol.lecture - 2.LF UK7 Serotonin & 5-HT agonists role in the NS impairment -migraine, depression A well-balanced approach, respecting the autonomy of patients&their family members & their rights to be informed is a must. However, this is conditio sine qua non, if these new fascinating medicaments should make not too much or very little harm to our patients. Nisi caste, saltem caute.