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How do ‘Psych’ drugs work: Antidepressants

How do ‘Psych’ drugs work: Antidepressants. C. Matthews MSN, RN, CNE. Before discussing drugs you need to know about:. Neurotransmitters :

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How do ‘Psych’ drugs work: Antidepressants

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  1. How do ‘Psych’ drugs work:Antidepressants C. Matthews MSN, RN, CNE

  2. Before discussing drugs you need to know about: • Neurotransmitters: • Neurons communicate at synapses through the use of neurotransmitters. Neurotransmitters are chemicals sent between neurons as well as the muscles and organs they work with. They attach to receptors on receiving cells, translating into messages. • Retrieved 10/16/2013 from http://cargocollective.com/synapses#how-do-neurons-synapses-and-glia-work-together

  3. http://cargocollective.com/synapses#what-is-a-synapse

  4. Neurotransmitters Neurotransmitters can be classified by function Inhibitory Excitatory Excitatory neurotransmitters: These types of neurotransmitters have excitatory effects on the neuron; they increase the likelihood that the neuron will fire an action potential. Some of the major excitatory neurotransmitters include epinephrine and norepinephrine. • Inhibitory neurotransmitters: These types of neurotransmitters have inhibitory effects on the neuron; they decrease the likelihood that the neuron will fire an action potential. Some of the major inhibitory neurotransmitters include serotonin and GABA http://psychology.about.com/od/nindex/g/neurotransmitter.htm

  5. Antidepressants

  6. Tricyclic Antidepressants • Used for depression • Also used for anxiety and insomnia & chronic pain • Examples of Tricyclic antidepressants: • Amitriptyline (Elavil); doxepin (Sinequan); imipramine (Tofranil) • Name “tricyclic”: • Has to do with the chemical makeup of the drug – how it looks, not how it works • Not used as much now as in past; • Many dangerous adverse effects • Newer drugs give us safer alternatives

  7. How do tricyclics work • Reuptake inhibition of norepinephrine, serotonin or both • See slide with illustrations of SSRI’s • Tricyclics aren’t “selective” about inhibiting just serotonin but the reuptake inhibition works the same as those illustrations

  8. Other stuff to know about tricyclics • Extremely fat soluble = slow excretion, long half-lives • May be 2 weeks of administration before you see effects

  9. MAO Inhibitors • Examples of MAOI’s: phenelzine(Nardil); tranylcyrpomine (Parnate) • In the second youtube illustration [on next slide] the lecturer includes what MAO – Monoamine oxidase does. It helps destroy extra neurotransmitters that are left floating around in the neural synapse. • These drugs inhibit this enzyme from destroying the neurotransmitters – thus leaving them available for future use.

  10. MAOI’s • Have been out of favor in recent past because • Lots of new drugs on market that are easier to take • Many side effects • Black box warning: Increase in suicidal ideation • Severe hypertensive episode can occur if taken when eating foods containing tyramine. There is a long list of foods that are incompatable. Some are listed below. • Some fruits, fava beans, dairy products, alcohol, meats, • Soy sauce, all yeast and yeast extracts, chocolate • However, in the last couple of years health care providers have pulled them back out and you will see them in use now. • The client has to be someone you can trust to be strictly compliant with food & drug intake.

  11. Selective Serotonin Reuptake Inhibitors (SSRI’s) • Examples of SSRI’s: citalopram (Celexa); escitalopram oxalate (Lexapro); fluoxetine (Prozac) • Common Indications for use: depression, anxiety, OCD, and panic • Long half-life -- Onset may be 2 – 4 weeks after beginning therapy. • See illustrations on next slide to see how these drugs work.

  12. See these illustrations for SSRI’s: • http://cargocollective.com/synapses#what-is-a-synapse • http://www.youtube.com/watch?v=m4PXHeHqnmE&list=TLJct0xE-Iy_JsbotYrVylURQCldqRjob1 • http://www.youtube.com/watch?v=jn6S0KbzLSw

  13. Atypical Antidepressants • SNRI’s (serotonin-norepinephrine reuptake inhibitors) • Examples: duloxetine (Cymbalta) and venlafaxine (Effexor) • They elevate mood by increasing the levels of available serotonin and norepinephrine

  14. Atypical Antidepressants • Bupropion (Wellbutrin) • Not only inhibits reuptake of serotonin but may also affect the activity of norepinephrine and dopamine • Caution: lowers seizure threshold • Also marketed as Zyban for cessation of smoking

  15. Atypical Antidepressants • Mirtazapine (Remeron) – • Blocks presynaptic serotonin and norepinephrine receptors, thereby enhancing the release of these neurotransmitters. • http://www.rise.duke.edu/phr150/Antidepressants/howitworks.html

  16. References: • Adams, M., Holland, N. & Urban, C. (2014) Pharmacology for nurses, a pathophysiological approach. (4th ed.) Pearson, Boston.

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