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DEPRESSION

RECOVERY OR REMISSION. NORMAL MOOD. DEPRESSION. Stahl S M, Essential Psychopharmacology (2000). 5-1. EPISODE OF DEPRESSION. TIME. 6 - 24 months. NORMAL MOOD. RESPONSE. RESPONSE. DEPRESSION. Stahl S M, Essential Psychopharmacology (2000). 5-2. NORMAL MOOD. REMISSION. 100%.

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DEPRESSION

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  1. RECOVERY OR REMISSION NORMAL MOOD DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-1 EPISODE OF DEPRESSION TIME 6 - 24 months

  2. NORMAL MOOD RESPONSE RESPONSE DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-2

  3. NORMAL MOOD REMISSION 100% RECOVERY DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-3 acute 6 - 12 weeks continuation 4-9 months maintenance 1 or more years TIME

  4. NORMAL MOOD RECURRENCE RELAPSE DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-4 acute 6 - 12 weeks continuation 4-9 months maintenance 1 or more years TIME

  5. MANIA MIXED EPISODE HYPOMANIA NORMAL MOOD DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-5

  6. RAPID CYCLING NORMAL MOOD DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-6 12 months

  7. NORMAL MOOD DYSTHYMIA DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-7 2+ years

  8. DOUBLE DEPRESSION NORMAL MOOD PARTIAL RECOVERY DYSTHYMIA DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-8 6 - 24 months 2+ years

  9. MEDICATION NORMAL MOOD 67% RESPONDERS medication started 33% NON-RESPONDERS DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-9 8 weeks

  10. PLACEBO NORMAL MOOD 33% RESPONDERS placebo started 67% NON-RESPONDERS DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-10 8 weeks

  11. PLACEBO SUBSTITUTION placebo 50% continue response NORMAL MOOD antidepressant treatment 50% relapse DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-11

  12. DRUG CONTINUATION 90% continue response NORMAL MOOD antidepressant treatment 10% relapse DEPRESSION Stahl S M, Essential Psychopharmacology (2000) 5-12

  13. MAO enzyme destroying neurotransmitter monoamine neurotransmitter NORMAL STATE -- no depression DEPRESSION -- caused by neurotransmitter deficiency Stahl S M, Essential Psychopharmacology (2000) 5-13 5-14 MONOAMINE HYPOTHESIS

  14. MAO inhibitor blocks the enzyme from destroying monoamine neurotransmitter reuptake pump blocked by antidepressant Stahl S M, Essential Psychopharmacology (2000) 5-15 5-16 Increase in neurotransmitters causes return to normal state

  15. Stahl S M, Essential Psychopharmacology (2000) 5-17 NOREPINEPHRINE IS PRODUCED tyrosine transporter DDC DA TYR DOPA TOH DBH NE (norepinephrine)

  16. Stahl S M, Essential Psychopharmacology (2000) 5-18 NOREPINEPHRINE IS DESTROYED MAO COMT destroys NE norepinephrine transporter

  17. Stahl S M, Essential Psychopharmacology (2000) 5-19 NOREPINEPHRINE RECEPTORS presynaptic alpha 2 autoreceptor postsynaptic alpha 2 receptor alpha 1 receptor postsynaptic beta 1 receptor

  18. Stahl S M, Essential Psychopharmacology (2000) 5-20 somatodendritic alpha 2 autoreceptor terminal alpha 2 autoreceptor

  19. Stahl S M, Essential Psychopharmacology (2000) 5-21 NE occupying somatodendritic autoreceptor causes a decrease in firing and a decrease of NE release NE

  20. Stahl S M, Essential Psychopharmacology (2000) 5-22 NE occupying terminal alpha 2 receptor halts release of NE NE

  21. Stahl S M, Essential Psychopharmacology (2000) 5-23 Norepinephrine Pathways Locus Coeruleus

  22. Frontal 1 Depression beta 1 receptor Stahl S M, Essential Psychopharmacology (2000) 5-24

  23. Frontal 2 Attention alpha 2 receptor Stahl S M, Essential Psychopharmacology (2000) 5-25

  24. Limbic Energy Level Agitation Emotions Stahl S M, Essential Psychopharmacology (2000) 5-26

  25. Cerebellum Tremor Stahl S M, Essential Psychopharmacology (2000) 5-27

  26. Spinal Cord Blood Pressure Stahl S M, Essential Psychopharmacology (2000) 5-28

  27. Heart Tachycardia Stahl S M, Essential Psychopharmacology (2000) 5-29

  28. Bladder Urinary Retention Stahl S M, Essential Psychopharmacology (2000) 5--30

  29. Stahl S M, Essential Psychopharmacology (2000) 5--31 DOPAMINE IS PRODUCED tyrosine transporter DDC TYR DOPA TOH DA (Dopamine)

  30. DOPAMINE IS DESTROYED Stahl S M, Essential Psychopharmacology (2000) 5--32 MAO dopamine transporter COMT destroys NE

  31. DOPAMINE RECEPTORS Stahl S M, Essential Psychopharmacology (2000) 5--33 presynaptic autorecptor dopamine transporter D2 D3 D4 D1 D5

  32. Stahl S M, Essential Psychopharmacology (2000) 5--34 SEROTONIN IS PRODUCED tryptophan transporter AAADC 5HTP Tryptophan TRY-OH 5HT (Serotonin)

  33. Stahl S M, Essential Psychopharmacology (2000) 5--35 SEROTONIN IS DESTROYED serotonin transporter MAO

  34. SEROTONIN RECEPTORS Stahl S M, Essential Psychopharmacology (2000) 5--36 5HT1D autoreceptor alpha 2 hetero receptor serotonin transporter 5HT3 5HT4 5HT2C 5HTX 5HT2A 5HTY 5HTZ 5HT1A

  35. Stahl S M, Essential Psychopharmacology (2000) 5--37 5-38

  36. Stahl S M, Essential Psychopharmacology (2000) 5--39 5-40 5HT1D

  37. Stahl S M, Essential Psychopharmacology (2000) 5--41

  38. Stahl S M, Essential Psychopharmacology (2000) 5--42

  39. Stahl S M, Essential Psychopharmacology (2000) 5--43 serotonin neuron serotonin alpha 2 hetero receptor norepinephrine

  40. Stahl S M, Essential Psychopharmacology (2000) 5--44 serotonin neuron alpha 2 hetero receptor

  41. Stahl S M, Essential Psychopharmacology (2000) 5--45 norepinephrine serotonin alpha 1 receptor

  42. Stahl S M, Essential Psychopharmacology (2000) 5--46 norepinephrine serotonin alpha 1 receptor

  43. Stahl S M, Essential Psychopharmacology (2000) 5--47 NE-5HT Interactions brake accelerator Locus Coeruleus

  44. 5HT brake 5HT accelerator Stahl S M, Essential Psychopharmacology (2000) 5--48 serotonin neuron postsynaptic alpha 2 hetero receptor presynaptic alpha 2 autoreceptor alpha 1 receptor presynaptic alpha 2 autoreceptor norepinephrine neuron

  45. Stahl S M, Essential Psychopharmacology (2000) 5--49 5-50 5HT2A

  46. Stahl S M, Essential Psychopharmacology (2000) 5--51 Serotonin Pathways Raphe Nucleus

  47. Frontal Cortex Mood Stahl S M, Essential Psychopharmacology (2000) 5--52

  48. Akathisia/ Agitation Basal Ganglia OCD Stahl S M, Essential Psychopharmacology (2000) 5--53

  49. Limbic Anxiety Stahl S M, Essential Psychopharmacology (2000) 5--54

  50. Hypothalamus Appetite/bulimia Stahl S M, Essential Psychopharmacology (2000) 5--55

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