Source / episode info

• **Episode:**67
• **Title:**Divine Intervention Episode 67 – Psych Pharmacology (Part 1 of 2)
• **Published:**2018-12-31
• Source:Episode page

One-liner

This episode provides a comprehensive review of psychopharmacology, detailing the mechanisms, side effects, and clinical applications of antidepressants (SSRIs, SNRIs, TCAs, MAOIs), anxiolytics (Benzodiazepines/Barbiturates), hypnotics (Z-drugs), and agents for sleep disorders (orexin antagonists).

High-yield summary

• TCAs: Block {H}_1, _1, and muscarinic receptors (anticholinergic effects); overdose causes wide-complex QRS complexes due to sodium channel blockade.
• SSRIs/SNRIs: First-line for most psychiatric disorders (MDD, GAD, OCD, PTSD); require 4–6 weeks to reach therapeutic effect; risk of Serotonin Syndrome when combined with other serotonergic agents.
• MAOIs: Non-selective inhibitors ({Phenelzine}, {Tranylcypromine}); contraindicated with high-tyramine diet due to risk of hypertensive crisis, treated by {Phentolamine}.
• Sleep Disorders: Narcolepsy is characterized by low CSF Orexin and excessive daytime sleepiness; insomnia can be managed with orexin receptor antagonists ({Suvorexant}).
• Anxiolysis/Hypnosis: Benzodiazepines increase GABA-A frequency of opening, while Barbiturates increase the duration of GABA-A opening.

Learning objectives

• Differentiate the mechanisms of action and toxicities of TCAs, SSRIs, SNRIs, and MAOIs.
• Recognize the clinical presentation and diagnostic workup of primary sleep disorders (Narcolepsy vs. Insomnia).
• Understand critical drug interactions in psychopharmacology, particularly those involving monoamine oxidase inhibitors and dietary tyramine.
• Apply knowledge of anxiolytic agents (Benzodiazepines vs. Barbiturates) regarding receptor binding kinetics and overdose management.
• Identify the appropriate first-line treatment for common psychiatric conditions like Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), and OCD.

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