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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

31. DOPAMINE RECEPTORS presynaptic autorecptor D1 D2D3 D4 D5 dopamine transporter 5--33 Stahl S M, Essential Psychopharmacology (2000)

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

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

34. SEROTONIN RECEPTORS alpha 2 hetero receptor 5HT1D autoreceptor 5HT1A serotonin transporter 5HT2A 5HT2C 5HT35HT4 5HTX 5HTY 5HTZ 5--36 Stahl S M, Essential Psychopharmacology (2000)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

51. 5--56 Stahl S M, Essential Psychopharmacology (2000) Sleep CentersInsomnia

52. 5--57 Stahl S M, Essential Psychopharmacology (2000) Spinal CordSexual Dysfunction

53. 5--58 Stahl S M, Essential Psychopharmacology (2000) Brainstem Vomiting Center Nausea and vomiting

54. 5--59 Stahl S M, Essential Psychopharmacology (2000) GutGI cramps/Diarrhea

55. Monoamine Receptor Hypothesis of Depression Normal functioning Decrease in NT Receptors up- regulate due to lack of NT 5--60 5-61 6-62 Stahl S M, Essential Psychopharmacology (2000)

56. 5--63 Stahl S M, Essential Psychopharmacology (2000) BDNF gene Stress BDNF

57. 5--64 Stahl S M, Essential Psychopharmacology (2000) Apoptosis

58. substance P release pain and swelling substance P release 5--65 Stahl S M, Essential Psychopharmacology (2000)

59. = substance P hypothalamus amydala and limbic areas dopamine centers norepinephrine centers Neurokinin Hypothesis of Emotional Malfunctioning Corollary: Blockng the Appropriate Neurokinin Receptor will Reduce Emotional Distress 5--66 Stahl S M, Essential Psychopharmacology (2000)

60. substance P Neurokinin A (NK-A) Neurokinin B (NK-B) ArgProLysGln Phe GlyLeuMetNH2 GlyLeuMetNH2 GlyLeuMetNH2 Val SerAspThrLysHis AspPheHisMetAsp 5--67 Stahl S M, Essential Psychopharmacology (2000)

61. PPT-A gene PPT-A mRNA signal peptidase endoplasmic reticulum converting enzyme substance P NK-1 receptor 5--68 Stahl S M, Essential Psychopharmacology (2000) PPT-A spliced mRNA PPT-A protein PT-A

62. PPT-A gene PPT-A mRNA signal peptidase endoplasmic reticulum converting enzyme substance P NK-1 receptor 5--69 Stahl S M, Essential Psychopharmacology (2000) PPT-A spliced mRNA PPT-A protein PT-A

63. PPT-A gene PPT-A mRNA signal peptidase endoplasmic reticulum converting enzyme substance P NK-1 receptor PPT-A spliced mRNA 5--70 Stahl S M, Essential Psychopharmacology (2000) PPT-A protein PT-A

64. PPT-A gene PPT-A mRNA signal peptidase endoplasmic reticulum converting enzyme NK-A NK-2 receptor 5--71 Stahl S M, Essential Psychopharmacology (2000) PPT-A spliced mRNA PPT-A protein PT-A

65. PPT-A gene PPT-A mRNA signal peptidase endoplasmic reticulum converting enzyme NK-A NK-2 receptor PPT-A spliced mRNA 5--72 Stahl S M, Essential Psychopharmacology (2000) PPT-A protein PT-A

66. PPT-B gene PPT-B mRNA PPT-B protein signal peptidase endoplasmic reticulum PT-B converting enzyme NK-B NK-3 receptor PPT-B spliced mRNA 5--73 Stahl S M, Essential Psychopharmacology (2000)