Biological Basis for Understanding Psychotropic drugs

Functions of the BrainMonitorRegulateInitiate and Maintain basic drives MediateStore/RetrieveThink LanguageProcess

Brain 101 Review

•Neurons▫Neurotransmitters:

Dopamine: fine muscle movement, integration of emotion & thoughts, decision making

Norepinephrine: affects mood, fight/ flight response

Serotonin: sleep regulation, pain perception, sexual behavior & agression

Gamma-aminobutyric acid (GABA): plays role in inhibition, muscle relaxing properties

Acetylcholine: role in learning, memory, regulates mood, sexual drive

Anatomy of the brain

•Major areas▫Brainstem▫Cerebellum▫Cerebrum▫Limbic System: This is the area that is

located right above the brainstem which is responsible for controlling emotions

Cheat sheet

•Serotonin: Depression or anxiety related•Norepinephrine: Bipolar (deals with flight

or fight response), mania, anxiety•Dopamine: Schizophrenic disorders and

ADHD•Acetylcholine: Alzheimers related•GABA: Anxiety disorders, Schizophrenia

Psychotropic Drugs

• Basic Side Effects for Consideration:▫Changes in basic drives▫Sleep patterns▫Body movement▫Autonomic functions

The ideal drug would relieve mental disturbance without inducing untoward mental or physical side effects!

On your own:

•You may want to review the Brain Imaging Techniques (PET/ MRI/ CT) that are normally used for diagnostics.

•Similarly your book describes the visual images that you can expect from the disorders we will be discussing.

Anti-AnxietyBenzodiazepine: binds GABAGABA: Primary inhibitory neurotransmitter in the brain that

suppresses the ability of the neurons to fire. This results in CNS depression and reduction in anxiety, skeletal muscle spasms, alcohol withdrawal symptoms and seizures.-KLONOPIN-TRANXENE-VALIUM (diazepam)-ATIVAN (lorazepam)-XANAX (alprazolam)

* NOT TO BE TAKEN WITH ALCOHOL & OTHER CNS DEPRESSANTS

Side effects: sedation, drowsiness, dizziness, coordination problems BUSPAR (not a CNS depressant) ; has less sedative properties, much better tolerated than most benzos, no addictive potential

Bipolar DisorderManic Phase Drugs: Lithium-action is not fully understood but alters

multiple neurotransmitters to normalize transmission of norepinephrine, dopamine, serotonin, acetylcholine

*Lithium monitor for toxicity >2.5 can lead to death.

ANTIEPILEPTIC DRUGS:Depakote (Divalproex)-alters GABA

mediated neurotransmissionTegretol-anticonvulsant

Bipolar (con’t)Other Agents

Valproate (Depakene)-antiepilepticLamictal- antiepilepticNeurontin -antiepilepticTopamax- antiepileptic

Klonopin (Clonazepam): a benzodiazepine used for anxiety, strong sedating properties; calms rapidly, used w/ Lithium ..however, clients can develop a tolerance and dependence

Typical Antipsychotic Drugs

•Blocks attachment of Dopamine (typical)•Typical: phenothiazines becoming obsolete

because of side effects and they only target Positive symptoms of Schizophrenia

•Thorazine (most sedative)/ Haldol (least sedative)

• Two Main Concerns: • The blockage of Dopamine can lead to extrapyramidal

side effects such as; parkinsonism, dyskinesia, akathisia, muscle stiffness.

• These agents cause severe anticholinergic effects

Atypical Antipsychotics

•Binds to Dopamine receptors in the limbic system

•Decrease motor side effects•Target positive and negative symptoms of

Schizophrenia•Less side effects!!!- Clozapine (can cause agranulocytosis)- Risperidone- Olanzapine and Geodon

Antidepressant Drugs

•Typical antidepressants:-Tricyclic (TCA’s)- Elavil- NortriptylineWork by blocking reuptake of

norepinephrine and serotoninSide Effects: Anticholinergic in nature, this

really affects compliance

Antidepressant Drugs

• Selective Serotonin Reuptake Inhibitors (SSRIs)

• -Prozac• -Zoloft• -Paxil* Effective yet:*Less anticholinergic

effects than TCA’s * Less sedative than

TCA’s

• Monoamine Oxidase Inhibitors (MAOIs)

• -Marplan• -Nardil• -Parnate

How this works: Monoamine neurotransmitters are destroyed by the enzyme Monoamine oxidase; MAOI drugs inhibit the enzyme, so that the transmitters can get where they need to be.

Heterocyclic (Novel) Antidepressants

•These differ structurally from the TCA’s, SSRI’s, and MAOI’s▫Wellbutrin (also used for smoking cessation by

inhibiting the nicotinic acetylcholine receptors which cause the addiction)

▫Effexor▫CymbaltaThe novel antidepressants act differently because each

acts on a different neurotransmitter or group of

neurotransmitters