Neurobiology and Neurotransmitters: Psychopharmacology for ...€¦ · 14/01/2021 · Essential psychopharmacology: Neuroscientific basis and practical applications (2nd ed., p

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Neurobiology and Neurotransmitters: Psychopharmacology for Counselors

Franc Hudspeth, PhD, NCC, LPC-S, ACS, RPT-S, RPh, CPCAssociate Professor & Program Director of CMHC

Sacred Heart University, Fairfield, CTEditor, Journal of Counselor Preparation & Supervision

Editor, International Journal of Play Therapy

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Neurobiology and Neurotransmitters: Psychopharmacology for Counselors

Franc Hudspeth, PhD, NCC, LPC-S, ACS, RPT-S, RPh, CPCAssociate Professor & Program Director of CMHC

Sacred Heart University, Fairfield, CTEditor, Journal of Counselor Preparation & Supervision

Editor, International Journal of Play Therapy

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Poll Question #1

Have you ever taken a graduate level psychopharmacology course?

Yes/No

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Learning Objectives(1) Understand basic neurobiology, neurotransmitters, and brain functioning.

(2) Identify common mental health medications and their mechanisms of action.

(3) Conceptualize the interaction of the neurobiology of mental illnesses and medications.

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Mood, emotion,cognitive function

Motivation

SexAppetite

Aggression

AnxietyIrritability

Energy Interest Impulsivity

Drive

Norepinephrine Serotonin

Dopamine

Several Neurotransmitters Are Involved in Regulating Mood

Stahl, S. M. (2000). Essential psychopharmacology: Neuroscientific basis and practical applications (2nd ed., p. 152) Cambridge University Press.

Neurotransmitters

Categorized into three major groups:

(1) amino acids (glutamate, GABA, & glycine)

(2) peptides (vasopressin, somatostatin, & neurotensin)

(3) monoamines (norepinephrine NA, dopamine DA & serotonin 5-HT) plus acetylcholine (ACh).

Workhorse neurotransmitters of the brain are glutamic acid (glutamate) and GABA.


Neurotransmitters & FunctionAcetylcholine - voluntary movement of the muscles, learning, & memory

Norepinephrine - alertness, wakefulness, & arousal

Dopamine - voluntary movement, emotional arousal, & learning, attention Serotonin - memory, emotions, wakefulness, sleep, huger, & temperature

regulation

GABA (gamma aminobutyric acid) - motor behavior & mood

Glutamate - memory, mood

Glycine - spinal reflexes & motor behavior

Neuromodulators - sensory transmission-especially pain


Poll Question #2

In your opinion, should counselors receive formal training in psychopharmacology?

Yes/No

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Neurotransmitter (Excitation vs. Inhibition)EXCITATORY

Acetylcholine

Dopamine

Norepinephrine

Epinephrine

Glutamate

Serotonin

Aspartate

Histamine

INHIBITORYGABA

Glycine


Nutritional


Poll Question #3

Have you worked with/do you currently work with medicated clients?

Yes/No

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Dopamine (DA)

Dopamine is transmitted via three major pathways. The first extends from the substantia nigra to the caudate nucleus-putamen (neostriatum) and is concerned with sensory stimuli and movement. The second pathway projects from the ventral tegmentum to the mesolimbic forebrain and is thought to be associated with cognitive, reward and emotional behavior. The third pathway, known as the tubero-infundibular system, is concerned with neuronal control of the hypothalmic-pituatory endocrine system.

Serotonin (5-HT)The principal centers for serotonergic neurons are the rostral and caudal raphe nuclei. From the rostral raphe nuclei axons ascend to the cerebral cortex, limbic regions and specifically to the basal ganglia. Serotonergic nuclei in the brain stem give rise to descending axons, some of which terminate in the medulla, while others descend the spinal cord.

Norepinephrine (NE)

Many regions of the brain are supplied by the noradrenergic systems. The principal centers for noradrenergic neurons are the locus coeruleus and the caudal raphe nuclei. The ascending nerves of the locus coeruleus project to the frontal cortex, thalamus, hypothalamus and limbic system. Noradrenaline is also transmitted from the locus coeruleus to the cerebellum. Nerves projecting from the caudal raphe nuclei ascend to the amygdala and descend to the midbrain.

Gamma-aminobutyric acid (GABA)GABA is the main inhibitory neurotransmitter in the central nervous system (CNS). GABAergic inhibition is seen at all levels of the CNS, including the hypothalamus, hippocampus, cerebral cortex and cerebellar cortex. As well as the large well-established GABA pathways, GABA inter-neurons are abundant in the brain, with 50% of the inhibitory synapses in the brain being GABA mediated.

Glutamate

In the normal brain, the prominent glutamatergic pathways are: the cortico-cortical pathways; the pathways between the thalamus and the cortex; and the extrapyramidal pathway (the projections between the cortex and striatum). Other glutamate projections exist between the cortex, substantia nigra, subthalmic nucleus and pallidum. Glutamate-containing neuronal terminals are ubiquitous in the central nervous system and their importance in mental activity and neurotransmission is considerable.

Acetylcholine (Ach)There are three Acetylcholine pathways in the CNS. (a) The Pons to thalamus and cortex, (b) Magnocellular forebrain nucleus to cortex, & (c) septohippocampal. In the central nervous system, ACh has a variety of effects as a neuromodulator upon plasticity, arousal and reward. ACh has an important role in the enhancement of sensory perceptions when we wake up and in sustaining attention.ACh has also been shown to promote REM sleep

Gamma-aminobutyric acid (GABA)GABA is the main inhibitory neurotransmitter in the central nervous system (CNS). GABAergic inhibition is seen at all levels of the CNS, including the hypothalamus, hippocampus, cerebral cortex and cerebellar cortex. As well as the large well-established GABA pathways, GABA inter-neurons are abundant in the brain, with 50% of the inhibitory synapses in the brain being GABA mediated.


Poll Question #4

What is the most common mental health issue your clients seek medication(s) to

treat?A. AnxietyB. DepressionC. ADHDD. General “Mood Stabilization”E. Other Mental Health Issue(s)

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Antianxiety Agents

GABA receptors

Valium (diazepam)Ativan (lorazepam)Klonopin (clonazepam)Xanax (alprazolam)


Antidepressants

TCA (Norepinephrine and/or serotonin reuptake presynaptic)

Elavil (amitriptyline) Asendin (amoxapine)Anafranil (clomipramine)Norpramin (desipramine)Sinequan (doxepin)Tofranil (imipramine)Pamelor/Aventyl (nortriptyline)Vivactil (protriptyline)Surmontil (trimipramine)


Antidepressants SSRI (selective serotonin reuptake inhibitors)

Celexa (citalopram)Lexapro (escitalopram)Prozac/Sarafem (fluoxetine)Paxil (paroxetine)Zoloft (sertraline)Luvox (fluvoxamine)Viibryd (vilazodone)Trintellix (vortioxetine)


Antidepressants (cont)

SNRI/SSNRI (selective serotonin and norepinephrine reuptake inhibitors)

Wellbutrin/Zyban (bupropion)Effexor (venlafaxine)Serzone (nefazodone)Cymbalta (duloxetine)Pristiq (desvenlafaxine)Remeron (mirtazepine)Fetzima (levomilnacipran)Savella (milnacipran)

Oleptro (trazodone hcl)


Antipsychotics(dopamine receptor antagonist)

Throazine (Chlorpromazine)Prolixin (fluphenazine)Serentil (mesoridazine)Trilafon (perphenazine)Compazine (prochlorperazine)Stelazine (trifluoperazine)Mellaril (thioridazine)Haldol (haloperidol)


Poll Question #5

Clients that take multiple psychotropic medications are more likely to experience

significant side effects? True/False

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Antipsychotics (multiple neurotransmitter systems)

Loxitane (loxapine) Zyprexa (olanzapine)Seroquel (quetiapine)Risperdal (risperidone)Geodone (ziprasidone)Moban (molindone)Abilify (aripiprazole)Latuda (lurasidone)Invega (paliperidone)Fanapt (Iloperidone) Saphris (asenapine)


CNS Stimulants

AnalepticProvigil (modafinil)

AmphetaminesDexedrine (dextroamphetamine)Desoxyn (methamphetamine)Adderall (amphetamine mixture) Vyvanse (lisdexamfetamine)


CNS Stimulants (cont)Non-Amphetamines

Ritalin/Concerta/Metadate/Methylin (methylphenidate)Cylert (pemoline)Focalin (dexmethylphenidate)Daytrana (methylphenidate)---Patch


MISC ADHD Medications

Strattera (atomoxetine) potent inhibitor of presynaptic NE transporter


Sedative/Hypnotics

(GABA)Ambien (zolpidem)ProSom (estazolam)Lunesta (eszopiclone)Sonata (zaleplon)Halcion (triazolam)Restoril (temazepam)

MelatoninRozerem(ramelteon)


Anticonvulsants/Psychiatric Uses

Tegretol/Carbatrol (carbamazepine)Trileptal (oxcarbazepine)Neurontin (gabapentin)Topamax (topiramate)Depakote/Depakene (valproic acid)Lamictal (lamotrigine)Gabitril (tiagabine)


Cognitive DisordersAricept (donepezil) an acetylcholinesterase inhibitor)

Exelon (rivastigmate) cholinesterase inhibitor

Razadyne/Reminyl (galantamine) Enhance cholinergic functioning

Namenda (menantine) NMDA receptor antagonist

Namzaric (donepezil/memantine)NMDA receptor antagonist, and donepezil hydrochloride, an acetylcholinesterase inhibitor


Poll Question #6

Counseling and medication can be synergistic in nature.

True/False

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ReferencesAdvokat, C. D., & Comaty, J. E. (2018). Julien’s primer

of drug action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs (14th ed.). Worth Publishers.

Sinacola, R. S., Peter-Strickland, T., & Wyner, J. (2019).Basic psychopharmacology for counselors andpsychotherapists (2nd ed.). Pearson Higher Education, Inc.

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Questions?

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Neurobiology and Neurotransmitters: Psychopharmacology for ...€¦ · 14/01/2021 · Essential psychopharmacology: Neuroscientific basis and practical applications (2nd ed., p