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Questions and Answers
What is the primary mechanism of action for SSRIs?
What is the primary mechanism of action for SSRIs?
Which of the following is NOT an indication for SSRIs?
Which of the following is NOT an indication for SSRIs?
Which of the following is a common adverse effect of SSRIs?
Which of the following is a common adverse effect of SSRIs?
Which of the following symptoms is associated with serotonin syndrome?
Which of the following symptoms is associated with serotonin syndrome?
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What is a significant advantage of SSRIs compared to tricyclic antidepressants?
What is a significant advantage of SSRIs compared to tricyclic antidepressants?
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What is the required wash-out period when switching from an SSRI to an MAOI?
What is the required wash-out period when switching from an SSRI to an MAOI?
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Which medication primarily blocks the reuptake of dopamine and norepinephrine?
Which medication primarily blocks the reuptake of dopamine and norepinephrine?
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What should clients be informed about the time it may take to see therapeutic effects from depression medication?
What should clients be informed about the time it may take to see therapeutic effects from depression medication?
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Which of the following is a possible physical component of anxiety disorders?
Which of the following is a possible physical component of anxiety disorders?
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Which of the following is NOT considered a dietary restriction when taking MAOIs?
Which of the following is NOT considered a dietary restriction when taking MAOIs?
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What are the three main emotional and mental health disorders?
What are the three main emotional and mental health disorders?
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Which condition is characterized by periodic swings in emotions?
Which condition is characterized by periodic swings in emotions?
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Which of the following best describes psychosis?
Which of the following best describes psychosis?
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What major adverse effect is commonly associated with antipsychotic drugs?
What major adverse effect is commonly associated with antipsychotic drugs?
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How can the effectiveness of drug therapy be established?
How can the effectiveness of drug therapy be established?
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Which statement is true regarding mood disorders?
Which statement is true regarding mood disorders?
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What is characterized as an unpleasant emotional state related to perceived dangers?
What is characterized as an unpleasant emotional state related to perceived dangers?
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What is a characteristic of mood stabilizers?
What is a characteristic of mood stabilizers?
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Which of the following is a common indication for tricyclic antidepressants?
Which of the following is a common indication for tricyclic antidepressants?
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What is a significant adverse effect of tricyclic antidepressants due to α1-adrenoceptor blockade?
What is a significant adverse effect of tricyclic antidepressants due to α1-adrenoceptor blockade?
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What mechanism do MAOIs utilize to treat depression?
What mechanism do MAOIs utilize to treat depression?
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Which of the following is a serious risk associated with MAOIs?
Which of the following is a serious risk associated with MAOIs?
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What type of receptor blockade contributes to sedation as an adverse effect of tricyclic antidepressants?
What type of receptor blockade contributes to sedation as an adverse effect of tricyclic antidepressants?
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Which tricyclic antidepressant is commonly used for childhood enuresis?
Which tricyclic antidepressant is commonly used for childhood enuresis?
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What is the primary concern when a patient overdoses on tricyclic antidepressants?
What is the primary concern when a patient overdoses on tricyclic antidepressants?
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What is a common adverse effect of MAOIs due to its central nervous system stimulation?
What is a common adverse effect of MAOIs due to its central nervous system stimulation?
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What is the primary reason some psychotherapeutic drugs take a long time to show effects?
What is the primary reason some psychotherapeutic drugs take a long time to show effects?
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Which of the following is NOT a symptom of depression as defined by the DSM-5?
Which of the following is NOT a symptom of depression as defined by the DSM-5?
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Which neurotransmitter is categorized as a catecholamine and is relevant to depression?
Which neurotransmitter is categorized as a catecholamine and is relevant to depression?
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What do SSRIs primarily target in their mechanism of action?
What do SSRIs primarily target in their mechanism of action?
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Which of the following antidepressants was launched first in 1988?
Which of the following antidepressants was launched first in 1988?
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What is a common misconception about the biochemical imbalance theory of mental health conditions?
What is a common misconception about the biochemical imbalance theory of mental health conditions?
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Which type of antidepressant is NOT categorized as a newer-generation antidepressant?
Which type of antidepressant is NOT categorized as a newer-generation antidepressant?
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What should patients do when starting SSRIs for depression?
What should patients do when starting SSRIs for depression?
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What is the primary mechanism through which benzodiazepines exert their anxiolytic effects?
What is the primary mechanism through which benzodiazepines exert their anxiolytic effects?
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Which of the following is NOT a common side effect of benzodiazepines?
Which of the following is NOT a common side effect of benzodiazepines?
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Which drug is primarily indicated for the treatment of generalized anxiety disorder (GAD)?
Which drug is primarily indicated for the treatment of generalized anxiety disorder (GAD)?
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What condition necessitates monitoring of serum lithium levels?
What condition necessitates monitoring of serum lithium levels?
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Which of the following benzodiazepines is commonly used as an anxiolytic?
Which of the following benzodiazepines is commonly used as an anxiolytic?
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What is a common risk associated with atypical antipsychotics?
What is a common risk associated with atypical antipsychotics?
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Which medication is most appropriate for acute mania in bipolar disorder?
Which medication is most appropriate for acute mania in bipolar disorder?
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Which of the following is NOT a typical use of benzodiazepines?
Which of the following is NOT a typical use of benzodiazepines?
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What type of psychotherapeutic effect should be monitored in patients receiving anxiolytics?
What type of psychotherapeutic effect should be monitored in patients receiving anxiolytics?
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Which of the following side effects is commonly associated with atypical antipsychotics?
Which of the following side effects is commonly associated with atypical antipsychotics?
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Which of the following statements about SSRIs and SNRIs is correct?
Which of the following statements about SSRIs and SNRIs is correct?
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How do benzodiazepines typically differ from barbiturates in terms of safety?
How do benzodiazepines typically differ from barbiturates in terms of safety?
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What is a characteristic symptom of a panic disorder?
What is a characteristic symptom of a panic disorder?
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Study Notes
Psychotherapeutic Drugs
- Categories of psychotherapeutic drugs:
- Antipsychotic drugs (Ch 34)
- Antidepressants (Ch 35)
- Drugs for Bipolar Disorder (Ch 36)
- Anxiolytics (Ch 38)
Objectives
- Define conditions related to depression, anxiety, and psychoses
- Discuss prototype drugs for each condition
- Discuss mechanism of action, indications, adverse effects, precautions, contraindications, and interactions for drugs
- Describe therapeutic effects of the agents
- Describe patient care for patients receiving these drugs
Psychotherapeutic Drugs: General Information
- Treatment for emotional and mental health disorders
- Ranges from occasional distress to inability to function daily
Naming of Drugs
- Anti-anxiety drugs (anxiolytics)
- Antidepressants and mood stabilizers
- Antipsychotics
Establishing Drug Therapy Effectiveness
- Inherent subjectivity in describing and reporting symptoms
- Methods used to assess effectiveness include verbal reports, observations, and standardized rating scales (e.g., Hamilton Depression Rating Scale)
Main Emotional and Mental Health Disorders
- Anxiety
- Mood (affective) disorders
- Psychoses
Anxiety
- An unpleasant emotional state, often involving perception of real or perceived dangers
Mood (Affective) Disorders
- Mania (abnormally pronounced emotions)
- Depression (abnormally reduced emotions)
- Bipolar disorder (periodic swings between mania and depression)
Psychosis
- Major emotional disorder impairing mental function, leading to loss of contact with reality
- Examples include schizophrenia and drug-induced psychoses
Psychotherapeutic Drugs: Challenges
- Difficulty understanding and treating mental health disorders
- Complex consequences of drug action and long time needed for mood disorders to show full effect
- Adaptive responses can influence the effects of drugs
Psychotherapeutics: Pathophysiology
- Biochemical imbalance theory (oversimplified)
- Coordination of neuronal activity is crucial for mental health
Mood (Affective) Disorders: Antidepressants Ch 35
Mood and Affect
- "Mood": sustained emotional attitude, typically assessed through patient self-report
- "Affect": how a patient's emotional state is conveyed to others, involving perception of responsiveness
Mood (Affective) Disorders
- Depression
- Mania
- Episodes of both (e.g., bipolar disorder)
Depression: Symptoms
- Persistent sad, anxious, or "empty" mood
- Loss of interest in hobbies and activities
- Changes in appetite and weight
- Insomnia or oversleeping
- Restlessness or irritability
- Feelings of worthlessness, guilt, helplessness, or hopelessness
- Difficulty concentrating, remembering, or making decisions
- Thoughts of death or suicide
- Decreased energy or fatigue
- Persistent physical symptoms not responding to treatment
Monoamine NTs and Depression
- Catecholamines (e.g., norepinephrine)
- Indolamines (e.g., serotonin)
Antidepressant Drugs
- Newer-generation antidepressants:
- Selective serotonin reuptake inhibitors (SSRIs)
- Mixed serotonin (5-HT) and NE reuptake inhibitors (SNRIs)
- NE reuptake inhibitors
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
Anti-Depressant Drugs: SSRIs
- Common antidepressants for depression
- Examples:
- Sertraline (Zoloft)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Fluvoxamine
- Citalopram (Celexa)
Drugs for Depression: SSRIs
- SSRIs may take 2-6 weeks to show effects
- Clients should continue taking the medication
- Structural brain changes?
SSRI: Mechanism of Action
- Selectively inhibit 5-HT reuptake, increasing serotonin concentration in the synapse
- Little or no effect on NE or DA reuptake
- Advantage over TCAs and MAOIs: minimal effect on the cardiovascular system
SSRI: Indications
- Major Depressive Disorder
- Bipolar affective disorder (but not alone)
- Eating disorders
- Obsessive-compulsive disorder
- Panic attacks
- Myoclonus
SSRI: Adverse Effects
- CNS: headache, nervousness, insomnia, fatigue
- GI: nausea
- Other: sexual dysfunction, weight gain
Serotonin Syndrome
- Symptoms can occur within 2-72 hours of treatment
- Cognitive: confusion, agitation, restlessness
- Autonomic: tachycardia, hypertension, hyperthermia, sweating
- Neuromuscular: clonus, hypereflexia, tremor
Drugs for Depression - SNRI
- Serotonin and norepinephrine reuptake inhibitor
- Examples:
- Venlafaxine (Effexor)
- Duloxetine
Drugs for Depression – SSRI and SNRI
- Not more effective than older TCAs and MAOIs
- Fewer adverse effects than TCAs (anticholinergic effects) and MAOIs ("cheese reaction")
- Few drug-drug or drug-food interactions
Tricyclic Antidepressants (TCAs)
- Examples:
- Amitriptyline
- Imipramine
- Desipramine
- Clomipramine
- Second-line treatment, often used as adjunct therapy
- Indications include depression, childhood enuresis, obsessive-compulsive disorders, and adjunctive analgesics/trigeminal neuralgia
Tricyclic Antidepressants
- No evidence that SSRIs/SNRIs are more effective than TCAs for major depressive disorder
Tricyclic Antidepressant Drugs
- Largely replaced as first-line by SSRIs/SNRIs
- Considered second-line for clients who fail with SSRIs or other newer antidepressants, often as adjunct therapy
Tricyclic Antidepressant Drugs: Mechanism of Action
- Blockade of NE reuptake
- Blockade of 5-HT reuptake
- Receptor blockade of muscarinic cholinergic receptors, α1-adrenoceptors, and H1 receptors
Tricyclic Antidepressant Drugs: Adverse Effects
- Sedation (CNS H1 receptor blockade, but resolves in 1-2 weeks)
- Anticholinergic effects (blurred vision, dry mouth, constipation, urinary retention, tachycardia)
- Orthostatic hypotension (α1-adrenoceptor blockade)
Tricyclic Antidepressant Drugs: Serious Adverse Effects
- Caution in patients with existing cardiac disorders (dysrhythmias, slows conduction in Bundle of His)
- Increased risk of seizures
- TCAs can be lethal in overdose (70–80% mortality before hospital arrival)
TCAs in Overdose
- No antidote for acute toxicity
- Treatment focuses on decreasing drug absorption (activated charcoal), increasing urine alkalinity to speed elimination, managing seizures/dysrhythmias with medications, and providing basic life support
Monoamine Oxidase Inhibitors (MAOIs)
- First-generation antidepressants
- Treatment for depression not responding to other drugs
MAOIs: Mechanism of Action
- Inhibit the MAO enzyme within the CNS and peripheral tissues
- Reducing the breakdown of monoamine neurotransmitters (DA, 5-HT, NE) in neurons, resulting in increased release from neurons
MAOIs: Adverse Effects
- Orthostatic hypotension (dizziness, lightheadedness, tachycardia)
- CNS stimulation (insomnia, anxiety)
MAOIs: Food and Drug Interactions
- Ingestion of foods/drinks with tyramine may lead to hypertensive crisis
- Severe headache, hypertension, tachycardia, possible cerebral hemorrhage, stroke, and death
- Avoid foods high in tyramine (aged cheeses, smoked/cured meats, some processed foods, red wines, broad beans)
MAOIs
- Require a 2- to 5-week washout period between SSRI and MAOI therapy
- Require a 2-week washout period between MAOI and TCA/SSRI therapy
- Maintain dietary restrictions 2 weeks after MAOI cessation
Other Drugs for Depression
- Bupropion (block of DA and NE reuptake)
- Mirtazapine (increases 5-HT release, antagonism at certain 5-HT receptors)
- Vortioxetine (2014; complex modulation of 5-HT neurotransmission, 5-HT reuptake blockade)
Drugs for Depression: Client Care Implications
- Inform clients that therapeutic effects may take 2–4 weeks to appear
- Monitor clients closely during this time, assess for suicidal tendencies, and provide support
- Sedation may occur with TCAs; notify physician if lasting more than 2 weeks
- Monitor for signs of improved sleep patterns, nutrition, self-esteem, feelings of hope, interest in appearance, daily activities, and reduction in depressive or suicidal thoughts
Anxiety Disorders (Chapter 38)
- Anxiety is an unpleasant state with both psychologic components (fear, apprehension, dread, unease) and physical components (tachycardia, palpitations, trembling, sweating, shortness of breath)
- Treatment is considered when anxiety is persistent and disabling
Anxiety Disorders
- Examples:
- Generalized anxiety disorder (GAD)
- Social anxiety disorder
- Obsessive-compulsive disorder (OCD)
- Posttraumatic stress disorder (PTSD)
- Panic disorder
- Phobias
Anxiolytic Drugs
- Benzodiazepines (BZDs): depress activity in the brainstem and limbic systems, provide rapid relief but should be used cautiously/sparingly as they can be habit-forming/addictive
- Barbiturates (similar action, no longer used)
- Antidepressants (SSRIs, SNRIs) used for many anxiety disorders
- Buspirone: 5-HT1 agonist for GAD (effects appear after weeks)
- Drugs for seizures (e.g., valproate, gabapentin) in GAD
- Antipsychotics (e.g., olanzapine, risperidone) in GAD and PTSD
Benzodiazepines
- CNS depressant (sedative-hypnotic)
- Increasing dosage leads to progressive sedation, hypnosis, and possible stupor
- Indications include anxiety, muscle relaxation, seizure control, depression and alcohol withdrawal
Benzodiazepines: Indications
- Anxiety
- Sedation
- Muscle relaxation
- Seizure control
- Adjuvant therapy for depression
- Alcohol withdrawal
Benzodiazepines
- Examples:
- Lorazepam (Ativan)
- Alprazolam
- Diazepam (Valium)
- Clonazepam
Benzodiazepines: Mechanism of Action
- Enhance the effect of GABA
- Reducing neuronal excitability and depressing CNS activity
Benzodiazepines
- Little respiratory depression with oral administration (contrast to barbiturates)
- Safer in overdose than barbiturates
- Respiratory depression may occur with IV administration, or when combined with opioids, alcohol, or barbiturates
Benzodiazepines: Adverse Effects
- Decreased CNS activity (drowsiness, coordination loss, dizziness, confusion)
- Affects manual skills
- Potentially habit-forming and addictive (but less so than barbiturates)
Psychotherapeutic Drugs: Client Care Implications (anxiolytics)
- Monitor for anxiolytics therapeutic effects: improved mental alertness, cognition, mood, fewer anxiety and panic attacks, improved sleep and appetite, reduced tension and irritability, and increased interest in self and others
Bipolar Disorder (Chapter 36)
- Mania (euphoria/hypomania): characterized by enthusiasm, rapid thought/speech patterns, extreme self-confidence, impaired judgment, and risk-taking behaviors
- Depression: similar symptoms to other depressive conditions
Bipolar Disorder: Treatments
- Mood stabilizers: lithium carbonate (often first-line treatment for acute episodes and maintenance)
Bipolar Disorder: Lithium Therapeutic Range and Monitoring
- Narrow therapeutic range (0.4–1.5 mmol/L)
- Toxicities above 2 mmol/L can be dangerous
- Monitor plasma levels regularly (3–6 months for maintenance)
- Most patients are treated in a 0.6–0.8 mmol/L range
Bipolar Disorder: Lithium Adverse Effects
- Short-term effects (fine finger tremor, polyuria, thirst, gastrointestinal upset, resolved)
- Long-term effects (renal impairment, goiter, hypothyroidism)
Bipolar Disorder: Lithium Toxicity
- Symptoms above 1.5 mmol/L): persistent GI upset (early warning sign), course hand tremor, CNS effects (confusion, sedation, incoordination), seizures, and coma
- Na depletion or volume depletion could trigger toxicity
Bipolar Disorder: Newer Drugs
- Valproate and carbamazepine (used for seizures)
- Olanzapine, quetiapine (atypical antipsychotics)
- Fluoxetine (for depression, controversial)
Psychosis: Antipsychotic Drugs (Chapter 34)
- Mental disorder characterized by abnormal perceptions and emotions, and loss of contact with reality
- Severe disorganization in personality, thought, emotion, and behavior
- Examples include schizophrenia, schizoaffective disorder, and depressive or drug-induced psychoses
Psychotic Disorders
- Psychotic disorders (schizophrenia, schizoaffective disorder, and depressive/drug-induced psychoses)
Schizophrenia
- Positive symptoms (exaggeration): delusions, paranoia, hallucinations, disorganized or catatonic behavior
- Negative symptoms: flat emotions, withdrawal from social contacts, lack of speech, poor self-care, and avolition
- Cognitive symptoms: disorganized thoughts/speech and memory/learning difficulties
Drugs for Psychosis
- Labelled as antipsychotics
- Can be used for other conditions (e.g., anxiety, bipolar)
Antipsychotics = Neuroleptics
Indications for Antipsychotics
- Serious mental illnesses (e.g., schizophrenia, bipolar affective disorder, depressive/drug-induced psychoses)
- Autism
- Movement disorders (e.g., Tourette's syndrome)
- Other conditions (e.g., nausea, vomiting, intractable hiccups)
Schizophrenia Drug Therapy
- Objectives: suppress acute episodes, reduce relapse, and maintain highest possible function
- Adjunctive drugs (e.g., benzodiazepines, antidepressants)
- Treatment timescale: initial effects in 1-2 days, substantial improvement in 2-4 weeks, full effects potentially several months
Antipsychotics: Classification of Drugs
- First-generation (FGAs; typical/conventional): chlorpromazine, haloperidol
- Second-generation (SGAs; atypical): clozapine, risperidone
Typical Antipsychotics: Mechanism of Action
- Dopamine (D2) receptor antagonists
- Block receptors in the CNS (limbic system, basal ganglia) associated with emotion/cognitive function/motor function (nigrostriatial pathway/motor function)
- Also bind to other receptors (histamine, muscarinic cholinergic, α1-adrenoceptors)
Typical Antipsychotics: Adverse Effects
- Extrapyramidal motor disturbances
- Early-onset (acute dystonias, pseudoparkinsonism, akathisia)
- Tardive dyskinesia (after months/years)
- Neuroleptic malignant syndrome (usually 4-14 days after therapy start): lead pipe rigidity, sudden high fever (>41°C), CV problems, seizures, and coma
- Other adverse effects (sedation/delirium, orthostatic hypotension, various body system effects)
Atypical Antipsychotics
- Newer drugs in Canada (lurasidone, asenapine)
- Fewer extrapyramidal side effects than typical antipsychotics
- Examples: clozapine, olanzapine, risperidone, (IM depot injections)
- Mechanism of action: block 5-HT receptors, less effect on DA receptors, equal or better efficacy to typical antipsychotics.
Atypical Antipsychotics: Adverse Effects
- Varies with medication, but frequently includes: • Clozapine: agranulocytosis, anemia (require regular blood counts) • Other potential adverse effects from other receptor blockade in typical antipsychotics
- Weight gain, blood glucose management issues, plasma lipid changes that are typically associated with atypical antipsychotics
All Antipsychotics
- Common side effect is weight gain
- Associated disturbances in metabolism (blood glucose management, plasma lipids), with varying extent across medications
Antipsychotics Agents: Client Care Implications
- Do not take alcohol or other CNS depressants with antipsychotics
- Monitor for extrapyramidal symptoms (EPD), particularly with long-term haloperidol therapy (report symptoms to physician)
- Monitor for therapeutic effects: improved mood/affect, reduction in psychotic symptoms/episodes, reduced hallucinations/paranoia/delusions and ability to cope
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Description
Test your knowledge on SSRIs and their role in treating mental health disorders. This quiz covers mechanisms of action, indications, adverse effects, and specific conditions related to serotonin syndrome and psychosis. Ideal for students of psychology and psychiatry.
