NR 546 Week 5
one or more episodes of mania or hypo-
mania with a history of one or more major Bipolar Diseased is diagnosed when
depressive episodes
may precipitate a manic episode or in-
duce rapid-cycling, used cautiously and
never as monotherapy. should be com- Use of antidepressants in the treatment
bined with a mood stabilizer to pre- of bipolar disease
vent the onset of a hypomanic or manic
episode.
Bipolar I vs Bipolar II vs Cyclothymia
Mood-related symptoms in BP may be
characterized as having either too little
positive affect or too much negative af-
fect
Prefrontal Cortex (PFC)
Concentration
MDD can be mapped to specific malfunc-
Mental fatigue
tioning brain circuits:
Mood
Prefrontal Cortex (PFC)
PFC & Amygdala
PFC & Amygdala
Guilt, suicidality, worthlessness
Striatum
Striatum
Nucleus Accumbens
Physical fatigue
Hypothalamus
Nucleus Accumbens
Pleasure interests
1/6
, NR 546 Week 5
Hypothalamus
Sleep, appetite
Selective Serotonin Reuptake Inhibitors
(SSRIs) inhibit 5-HT reuptake
Serotonin Norepinephrine Reuptake In-
hibitors (SNRIs)
inhibit 5-HT reuptake
inhibit NE reuptake (increase energy, fo-
cus)
MOA: SSRI, SNRI, NDRI
increase DA in prefrontal cortex (in-
crease cognition)
Norepinephrine Dopamine Reuptake In-
hibitors (NDRI)
inhibit DA reuptake (increase alertness,
motivation)
inhibit NE reuptake (increase energy)
Selective Serotonin Reuptake Inhibitors
(SSRIs): diarrhea, headache, weight
gain, sexual side effects
Serotonin Norepinephrine Reuptake In-
hibitors (SNRIs): elevated blood pres-
Adverse Effects: SSRI, SNRI, NDRI
sure, anxiety, insomnia,
constipation
Norepinephrine Dopamine Reuptake In-
hibitors (NDRI): agitation headache dry
mouth constipation weight loss
citalopram (Celexa) mild antihistamine
effects
escitalopram (Lexapro) no known drug
interactions
fluoxetine (Prozac) longest half-life
Prescribing Pearls: citalopram, escitalo-
paroxetine (Paxil) also treats social anx-
pram, fluoxetine, paroxetine, fluvoxam-
iety and insomnia
ine, sertraline
fluvoxamine (Luvox) treats anxious de-
pression smokers require an increased
dose
sertraline (Zoloft) also treats social anxi-
ety and hypersomnolence
2/6
one or more episodes of mania or hypo-
mania with a history of one or more major Bipolar Diseased is diagnosed when
depressive episodes
may precipitate a manic episode or in-
duce rapid-cycling, used cautiously and
never as monotherapy. should be com- Use of antidepressants in the treatment
bined with a mood stabilizer to pre- of bipolar disease
vent the onset of a hypomanic or manic
episode.
Bipolar I vs Bipolar II vs Cyclothymia
Mood-related symptoms in BP may be
characterized as having either too little
positive affect or too much negative af-
fect
Prefrontal Cortex (PFC)
Concentration
MDD can be mapped to specific malfunc-
Mental fatigue
tioning brain circuits:
Mood
Prefrontal Cortex (PFC)
PFC & Amygdala
PFC & Amygdala
Guilt, suicidality, worthlessness
Striatum
Striatum
Nucleus Accumbens
Physical fatigue
Hypothalamus
Nucleus Accumbens
Pleasure interests
1/6
, NR 546 Week 5
Hypothalamus
Sleep, appetite
Selective Serotonin Reuptake Inhibitors
(SSRIs) inhibit 5-HT reuptake
Serotonin Norepinephrine Reuptake In-
hibitors (SNRIs)
inhibit 5-HT reuptake
inhibit NE reuptake (increase energy, fo-
cus)
MOA: SSRI, SNRI, NDRI
increase DA in prefrontal cortex (in-
crease cognition)
Norepinephrine Dopamine Reuptake In-
hibitors (NDRI)
inhibit DA reuptake (increase alertness,
motivation)
inhibit NE reuptake (increase energy)
Selective Serotonin Reuptake Inhibitors
(SSRIs): diarrhea, headache, weight
gain, sexual side effects
Serotonin Norepinephrine Reuptake In-
hibitors (SNRIs): elevated blood pres-
Adverse Effects: SSRI, SNRI, NDRI
sure, anxiety, insomnia,
constipation
Norepinephrine Dopamine Reuptake In-
hibitors (NDRI): agitation headache dry
mouth constipation weight loss
citalopram (Celexa) mild antihistamine
effects
escitalopram (Lexapro) no known drug
interactions
fluoxetine (Prozac) longest half-life
Prescribing Pearls: citalopram, escitalo-
paroxetine (Paxil) also treats social anx-
pram, fluoxetine, paroxetine, fluvoxam-
iety and insomnia
ine, sertraline
fluvoxamine (Luvox) treats anxious de-
pression smokers require an increased
dose
sertraline (Zoloft) also treats social anxi-
ety and hypersomnolence
2/6
