Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs used to treat conditions like depression, which is often associated with low serotonin levels. Unlike agonists or antagonists that bind to receptors, SSRIs work by blocking the reuptake process. This action prevents unused serotonin from being reabsorbed by the presynaptic neuron, allowing it to remain in the synaptic cleft for a longer period. The extended presence of serotonin enhances its interaction with postsynaptic receptors, thereby strengthening its overall effect. Common examples of SSRIs include Prozac, Paxil, and Zoloft.

SSRIs and SNRIs

Tricyclic (or heterocyclic) antidepressants inhibit the reuptake of serotonin and/or norepinephrine, and are thus called due to their three (or more)-ring chemical structure. Some examples include:

- Amitriptyline (Elavil) 
- Nortriptyline (Aventyl)
- Maprotiline hydrochloride (Ludiomil)
- Desipramine hydrochloride (Norpramin)
- Clomipramine (Anafranil)

A similar drug is Bupropion (Wellbutrin), which is an aminoketone that weakly blocks norepinephrine, serotonin, and dopamine reuptake.

Tricyclic Antidepressants

MAOIs inhibit the breakdown of the enzyme that breaks down monoamine neurotransmitters. Some MAOIs have antidepressant effects, including:

- Phenelzine (Nardil)
- Isocarboxazid (Marplan)
- Tranylcypromine (Parnate)

Monoamine Oxidase Inhibitors (MAOIs)

Reference for Side Effects of Antidepressants

Side effects of SSRIs: 
* Headache
* Nausea
* Weight gain
* Drowsiness
* Reduced sex drive

Side effects of Tricyclics:
* Dry mouth
* Constipation
* Blurred vision
* Drowsiness
* Reduced sex drive
* Increased risk of suicide

Side Effects of Antidepressants

A clinician is considering two different types of medication for a patient. Medication A primarily works by increasing the amount of serotonin available between nerve cells. Medication B works by increasing the availability of both serotonin and norepinephrine. Which of the following statements accurately distinguishes between the mechanisms of these two medications?

References for Long-Term Use of Antidepressants

In past years, the overall use of antidepressants has increased. This could be from a mixture of increased "new" users or longer durations of use. Long-term is defined as 12 months or more of consistent medication use. Prevalence and incidence have increased SSRI use specifically. Treatments typically are as follows:

treatment of acute phase: 4-6 weeks
treatment for prevention of relapses: 4 to 12 months
treatment for prevention of recurrence: maintenance treatment (2-5 years)

Long-Term Use of Antidepressants

Antidepressants are psychotropic medications prescribed to alleviate symptoms of mood disorders like depression and anxiety. They work by addressing chemical imbalances of neurotransmitters in the brain. Different types of antidepressants target different neurotransmitters; for example, selective serotonin reuptake inhibitors (SSRIs) increase the availability of serotonin, while serotonin-norepinephrine reuptake inhibitors (SNRIs) elevate the levels of both serotonin and norepinephrine. Common SSRIs include Prozac and Zoloft, while tricyclics include Tofranil and Elavil.

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- Antidepressants 
- Mood stabilizing medication 
- Psychotherapy 
- Alternative treatments (electroconvulsive therapy, transcranial stimulation)

Mood Disorder Treatments

- Currently, experts believe antidepressants and anticonvulsants may offer the most benefit for patients with OCPD
- Patients should find a prescriber with experience treating the condition and the treatment process may involve a lot of trial and error. 

Medications and OCPD

- Antidepressants
- Anxiolytics
- Stimulants
- Antipsychotics
- Mood Stabilizers

Types of Pyschopharmaceuticals

* Antipsychotics
* Atypical Antipsychotics
* Anti-depressants
* Anti-anxiety agents
* Mood Stabilizers
* Stimulants

Commonly Prescribed Psychotropic Medications

Psychopharmacology is the study of medications as a treatment for mental disorders. This includes understanding:

1. Protein binding

2. Half-life

3. Polymorphic genes

4. Drug - to - drug Interactions

Psychopharmacology

Nolen-Hoeksema, S. (2020). Abnormal Psychology (8th ed.). McGraw Hill.

Abnormal Psychology

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

A type of psychotropic medication prescribed for anxiety and agitation that occur in OCD, PTSD, panic disorder, and social phobia. Common brand names include benzodiazepines such as alprazolam (Xanax) and lorazepam (Ativan), and diazepam (Valium).  They work as GABA agonists. GABA is a neurotransmitter responsible for the suppression of brain activity which assuages anxiety. Other medications such as buspirone (Buspar), antihistamines, and beta-blockers can also be used as anxiolytics to treat the physiological symptoms of anxiety such as racing heart.

Anxiolytics/Anti-Anxiety Agents

Antipsychotics are a drug class used to treat psychosis and other related disorders, such as schizophrenia. There are two types of antipsychotics: first-generation or typical antipsychotics include drugs like haloperidol, and second-generation or atypical antipsychotics include drugs like risperidone. Common brand names include Haldol, Mellaril, Prolixin, and Thorazine.

Antipsychotics

Antidepressants

Treatments that are either no longer used or are used in a different way based on research. (ECT, TMS, rTMS, VNS)

Alternative Treatments for Mood Disorders

A patient has been diagnosed with severe, treatment-resistant depression, having shown no improvement after trials with multiple antidepressant medications and various forms of psychotherapy. A clinician suggests electroconvulsive therapy (ECT) as the next step. Evaluate this recommendation. In your response, you should weigh the potential benefits of ECT for this type of patient against its associated risks and societal stigma. Conclude with a justified argument for or against proceeding with this treatment.

Evaluating a Treatment Recommendation for Severe Depression

Based on the following case study, evaluate the initial treatment plan and propose a more appropriate therapeutic strategy, explaining your reasoning.

Evaluating a Treatment Plan for a Mood Disorder

- They are typically used to treat epilepsy and seizures but can also be used for mood disorders. 

- They treat epilepsy and seizures by reducing brain activity because they act on various channels in the brain. 

- They can also treat bipolar disorder by reducing symptoms of mania and depression that cause bipolar disorder. This is done by affecting sodium and calcium channels which ultimately helps neurotransmitters and the production of less severe symptoms. 

Anticonvulsants

Stimulants are drugs that send more messages throughout the body. You feel more awake, energetic, and alert. Simulants are also a type of psychotropic medication that can be prescribed for ADHD. Common brand names are Adderall and Ritalin. They work by improving the individual's ability to focus on tasks and maintain attention. Some of the side effects include lack of appetite, sleeping probelms, stomachache, and headache.

Stimulants

These are a class of antipsychotic drugs that have a high affinity for other types of receptors and not dopamine receptors. They are also known as 2nd Generation Antipsychotics. They can be prescribed for Schizophrenia and other types of severe thought disorders. They can target dopamine and serotonin receptors to treat schizophrenia's negative symptoms, such as withdrawal and apathy; newer drugs may treat both positive and negative symptoms.

Atypical Antipsychotics include: 
- Aripiprazole (Abilify)

- Clozapine (Clozaril)

- Olanzapine (Zyprexa)

- Quetiapine (Seroquel)

- Risperidone (Risperdal)

- Ziprasidone (Geodon)

Atypical Antipsychotics

A type of psychotropic medication often prescribed for bipolar disorder to treat episodes of mania as well as depression. Common brand names include Lithium, Depakote, Lamictal, and Tegretol. Some side effects involve excessive thirst, irregular heartbeat, itching/rash, swelling (face, mouth, and extremities), nausea,  and loss of appetite.

Mood Stabilizers

Based on the patient's reported symptoms in the case study, which class of psychotropic medication would be the most appropriate first-line treatment to address the cyclical nature of their condition? Justify your answer.

Selecting Appropriate Psychotropic Medication

Drug-Drug interactions are when two different/similar types of drugs interact with one another. This can cause unpredictable side effects. 

Drug to drug interactions

- Psychotherapeutics

- Opioids

- Depressants

- Marijuana

- Hallucinogens

- Stimulants

- Nicotine


Psychoactive Drugs

A Microdose is a medication given at less than 1/100th of a dose to yield an effect. Studies on this are safe because they are in such limited amounts.

Microdosing

Antidepressants are a kind of drug that works to alleviate symptoms of depression. They come in multiple different classes, such as SSRIs, SNRIs, MAOIs, TCAs, and NaSSAs, most of which work on increasing the efficacy of serotonin or norepinephrine. Most antidepressants take a few weeks in order to reach full effect.  

What are Antidepressants

The classic definition: A compound that has clinical antipsychotic efficacy while producing minimal catalepsy. 
Now: An atypical agent is now seen as an agent that 

1. decreased propensity to produce catalepsy or other movement disorders, 

2. does not elevate prolactin concentrations, 

3. significantly reduced positive and negative symptoms of schizophrenia.

Atypical Antipsychotics - What is an atypical Antipsychotic?

Low threshold responders are individuals who experience a type of drug hypersensitivity that causes amplified or abnormal effects from medications and psychoactive substances which are caused by biological and genetic sensitivities. These individuals have abnormal responses to antidepressants, antipsychotics, stimulants, sedatives, and recreational substances like caffeine, alcohol, cannabis, and psychedelics. Unlike general adverse drug reactions which can be sudden and unexpected, low threshold responders have a predictable pattern of intolerance to multiple substances due to neurotransmitter imbalances, slowed metabolism, or receptor sensitivity. 

The biggest cause of this is due to mutations in specific genes that regulate dopamine, serotonin, or other neurotransmitter responses, especially when given anything that changes the levels of neurotransmitters in the brain. These individuals are often mislabeled as treatment resistant as they may develop an intolerance to substances that impact neurotransmission or may have a heightened response to these substances.

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