Question

The balance of excitation and inhibition in the brain is essential for homeostasis. In many disorders such as epilepsy, schizophrenia and ADHD this balance is disrupted. Discuss how medications can help to improve the balance of disorders with increased excitation or inhibition.

Answer 1

Medication can play major role in treating mental illness.Treatment may also include psychotherapy and brain stimulation therapy were recommended in some cases.

Medication can help to improve balance of mental disorders with increased excitation or inhibition.

ANTIDEPRESSANTS:

Antidepressants are the medication commonly used in the treatment of depression.These can also be used in other health condition such as anxiety,pain and insomnia.Sometimes antidepressants are used to treat ADHD in adults.

Selective serotonin reuptake inhibitors (SSRIs):

• Fluoxetine
• Citalopram
• Sertraline
• Paroxetine
• Escitalopram

Selective Norepinephrine reuptake Inhibitors(SNRIs):

• Venlafaxine
• Duloxetine

Mechanism of action:These class of drugs that reduce symptoms of depressive disorders by correcting chemical imbalance of neurotransmitters in the brain.Imbalance of chemical in the brain that leads to change in mood and behavior.It works by inhibiting the reuptake of neurotransmitter,hence increasing their level around the nerve with in the brain.Serotonin is a chemical messengers that carry signal between brain nerve cells.Neurotransmitter are play crucial role in communication link between nerve cells in the brain.Neurotransmitters reside with in vesicles found in nerve cells,which are released from one nerve and taken up by other nerve endings.

Side effects:

• Nausea and vomiting
• Weight gain
• Diarrhea
• Sleepiness
• Sexual problems
• Drymouth
• Hypoglycemia
• Blurred vision

ANTI ANXIETY MEDICATION: Anxiolytics are used to treat anxiety.These medications are help to reduce the symptoms of anxiety such as panic attack, fear and worry.

• Benzodiazepines: Clonazepam, Alprazolam, Lorazepam
• Buspirone
• Pregabalin
• Hydroxyzine
• Antihistamine

Mechanism of action:

• Benzodiazepines used to reduce symptoms of anxiety by increasing the action of a brain chemical called gamma aminobutyric acid (GABA).Gamma aminobutyric acid is a chemical used ro communicate between the nerves and it reduce brain activity.It is believed that excessive activity in the brain that may lead to anxiety.
• Buspirone may reduce anxiety by exhibiting high affinity for serotonin and moderate affinity for brain (D2)dopamine receptors on nerves,there by altering the chemical message between nerves.
• Pregabalin is anticonvulsant drug that reduces the calcium dependent release of pro-nociceptive neurotransmitter possibly by modulation of calcium channel function and it may interact with descending noradnergic and serotonergic pathway in the brain stem that modulate pain transmission in the spinal cord.

Side effects:

• Sedation
• Drowsiness
• Confusion
• Nausea
• Hypertension
• Drymouth
• Suicidal thoughts
• Fatigue
• Difficulty breathing

STIMULANTS:

Stimulants are used ti increase alertness,attention,energy and also elevate blood pressure,heart rate,respiration according to National institute on Drug Abuse 2014). These medication are often prescribed to treat children,adolescents or adults diagnosed with Attention deficit hyperactivity disorder.

• Methylphenidate
• Amphetamine
• Dextroamphetamine
• Lisdexamfetamine Dimesylate
• Clonidine
• Guanfacine

Mechanism:Stimulants are CNS medication that affect dopamine level by blocking reputake i.e., Reabsorption of dopamine by neurons,central nervous system and cells in the brain.These medication also block the metabolic enzymes that absorb loose dopamine. Clinical effect begins within 20minutes of dosing and lasts up to 3 to 4hrs.

Side effects:

• Difficulty to fall asleep
• Loss of appetite
• Stomach pain
• Headache
• Personality Changes
• Motor or verbal tics(Sudden,repetitive movements)

ANTI PSYCHOTIC DRUGS:

These medications can be used in combination to treat delirium,dementia,and other mental health conditions:

• Attention Deficit Hyperactivity Disorder
• Depression
• Eating disorders
• Post traumatic stress disorder
• Obsessive compulsive disorder
• Generalized anxiety disorder

Antipsychotics:

• Chlopromazine
• Haloperidol
• Perphenazine
• Fluphenazine
• Risperidone
• Olanzapine
• Ziprasidone
• Quetiapine

Mechanism: It tend to block dopamine D2 receptors in the dopaminergic pathway of the brain and it also antagonise 5HT2A receptors. Certain symptosm such as feeling agitation and hallucinations usually go away within days of starting of medication,later on delusion go away and full effect of the medication may not be seen for up to 6weeks.

Side effects:

• Drowsiness
• Increased appetite
• Weight gain
• Weakness
• Dry mouth
• Constipation
• Seizures

MOOD STABILIZERS:

These drugs are primarily to treat bipolar disorder,mood swings associated with other mental disorders.Lithium is approved for the treatment for mania and maintenance treatment of bipolar disorder.

Mood stabilizers work by decreasing abnormal activity in the brain and used to treat:

• Depressionn
• Schizoaffective Disorder
• Disorders of impulse control

Mechanism: Gamma aminobutyric acid and glycine are inhibitory neurotransmitters;glutamate and aspartate are excitatory neurotransmitters.Monoamine neurotransmitter such as dopamine,norepinephrine are the most important neurotransmitters in the pathophysiology of mood disorders and in the mechanism of action of antidepressants.

Side effects:

• Frequent urination
• Tremors
• Nausea and vomiting
• Slurred speech
• Excessive thrist
• Seizures
• Hallucinations