522psychdepre08[3]
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Psychopharmacology
George Hsiao
2008
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Contraindication
• Benign prostatic hyperplasia (BPH)
• Glaucoma
• Arrhythmias (quinidine-like effect, class Ia)
• Seizure
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SSRI
TCA
Luvox
Prozac
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SSRIs plus other 5-HT activity (3rd generation)
SSRI + 5-HT1A Antagonist (Half-life short)
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SSRI + 5-HT1A Antagonist
Premature ejaculation (Dopaxetine, 2005)
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SSRI Discontinuation Syndrome
The abrupt discontinuation of an SSRI (especially one with a shorter half-life such as paroxetine, sertraline, or fluvoxamine) has been associated with a syndrome that way include: somatic and psychological symptoms.
(i) Somatic symptoms: dysequilibrium (dizziness, vertigo and ataxia), tremor, fatigue and migraine-like auras.
(ii) Psychological symptoms: anxiety, agitation, lowered mood, confusion, memory problems, and vivid dreams.
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Bupropion
• PD: some dopaminergic effect (mild psychostimulation)
• dopamine reuptake inhibitor
• Little anticholinergic, cardiac effects and psychosexual inhibition
• First-line treatment of depressive disorders
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Symptoms of Borna Disease (bipolar disorder)
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Mania Problems
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PET Scans of A Bipolar Disorder (D-M-D)
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Observations of A 3-week Manic Episode
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300 mg tid
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Inositol phosphatases within the neurons
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Drug interactions a) TCAs-plus-MAOIs==dangerous—hyper sy
mpathetic response. b) MAOIs-plus-L-dopa (for anti-Parkinson’s D
z)==dangerous—acute hypertensive reaction. c) Induction of hepatic microsomal enzymes
(barbiturates). d) Selective serotonin reuptake inhibitor (SSR
I)-plus-MAOIs==lethal“serotonin syndrome”—hyperthermia, shiverin
g (寒戰 ), myoclonus (肌陣縮症 ), agitation (精神激昂 ), hypomania, nausea, tremor and coma.
e) Lithium-plus-thiazide diuretics==dangerous—lithium toxicity.