Psychopharmacology

George Hsiao

2008

Contraindication

• Benign prostatic hyperplasia (BPH)

• Glaucoma

• Arrhythmias (quinidine-like effect, class Ia)

• Seizure

SSRI

TCA

Luvox

Prozac

SSRIs plus other 5-HT activity (3rd generation)

SSRI + 5-HT1A Antagonist (Half-life short)

SSRI + 5-HT1A Antagonist

Premature ejaculation (Dopaxetine, 2005)

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.

Bupropion

• PD: some dopaminergic effect (mild psychostimulation)

• dopamine reuptake inhibitor

• Little anticholinergic, cardiac effects and psychosexual inhibition

• First-line treatment of depressive disorders

Symptoms of Borna Disease (bipolar disorder)

Mania Problems

PET Scans of A Bipolar Disorder (D-M-D)

Observations of A 3-week Manic Episode

300 mg tid

Inositol phosphatases within the neurons

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.