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Anti Depressant Agents
What is depression? <ul><li>Depressed mood </li></ul><ul><li>Feelings guilt </li></ul><ul><li>Impaired concentration </li>...
Types of Depression <ul><li>Reactive </li></ul><ul><ul><li>Adverse life event </li></ul></ul><ul><ul><li>Physical illness ...
DSM-IV-TR Criteria for Major Depressive Episode <ul><li>5 or more present during same 2 week period & represents a change ...
How do the drugs work?  <ul><li>Manipulation of neurotransmitter metabolism </li></ul><ul><li>Prevention of neurotransmitt...
 
Indications <ul><li>Depression </li></ul><ul><li>Obsessive-Compulsive Disorder </li></ul><ul><li>Panic Disorders </li></ul...
Therapeutic Classes <ul><li>Tricyclic Anti-depressants </li></ul><ul><li>Imipramine(Tofranil)  Amitriptyline(Elavil </li><...
2 nd  & 3 rd  Generation <ul><li>Amoxapine </li></ul><ul><li>Maprotiline </li></ul><ul><li>Trazadone </li></ul><ul><li>Bup...
SSRI’s  MAO’s <ul><li>Selective Serotonin Reuptake Inhibitors </li></ul><ul><ul><li>MOA </li></ul></ul><ul><ul><li>Toxicit...
Treatment Schedules <ul><li>Find the right drug for the right patient </li></ul><ul><li>Empirical Determination </li></ul>...
Drug Interactions <ul><li>CNS depressants & Etoh-  enhance depressant effect </li></ul><ul><li>AntiThyroid drugs & TCA-  i...
Drug Interactions  cont. <ul><li>SSRI’s & MAOI’s –  HTN crises, serotonin syndrome, death </li></ul><ul><li>SSRI’s & St Jo...
<ul><li>Bad Wrap?! </li></ul>
Second Opinion <ul><li>Studies show that U.S. suicides have dropped 15% since SSRI’s were introduced </li></ul><ul><li>Big...
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Anti depressants

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Transcript of "Anti depressants"

  1. 1. Anti Depressant Agents
  2. 2. What is depression? <ul><li>Depressed mood </li></ul><ul><li>Feelings guilt </li></ul><ul><li>Impaired concentration </li></ul><ul><li>Loss of interest </li></ul><ul><li>Fatigue </li></ul><ul><li>Sleep & weight changes </li></ul><ul><li>Suicidal thoughts </li></ul>
  3. 3. Types of Depression <ul><li>Reactive </li></ul><ul><ul><li>Adverse life event </li></ul></ul><ul><ul><li>Physical illness </li></ul></ul><ul><ul><li>Drugs </li></ul></ul><ul><ul><li>senility </li></ul></ul><ul><li>Major Depressive </li></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>May occur at any age </li></ul></ul><ul><ul><li>Unresponsive to changes in life </li></ul></ul><ul><li>(endogenous) </li></ul>
  4. 4. DSM-IV-TR Criteria for Major Depressive Episode <ul><li>5 or more present during same 2 week period & represents a change from previous functioning. </li></ul><ul><li>Depressed qd – fatigue – death thoughts- agitation - retardation </li></ul><ul><li>Diminished interest- feelings guilt </li></ul><ul><li>Weight loss - insomnia -worthless </li></ul>
  5. 5. How do the drugs work? <ul><li>Manipulation of neurotransmitter metabolism </li></ul><ul><li>Prevention of neurotransmitter re-uptake </li></ul><ul><li>Selective receptor antagonism </li></ul>NE (norepi), 5-HT (serotonin) DA (dopamine), MAO (monoamine oxidase)
  6. 7. Indications <ul><li>Depression </li></ul><ul><li>Obsessive-Compulsive Disorder </li></ul><ul><li>Panic Disorders </li></ul><ul><li>Enuresis </li></ul><ul><li>Chronic Pain </li></ul>
  7. 8. Therapeutic Classes <ul><li>Tricyclic Anti-depressants </li></ul><ul><li>Imipramine(Tofranil) Amitriptyline(Elavil </li></ul><ul><ul><li>MOA </li></ul></ul><ul><ul><li>System Effect (sedation, weight gain, orthostatic hypotension) </li></ul></ul><ul><ul><li>Overdose </li></ul></ul>
  8. 9. 2 nd & 3 rd Generation <ul><li>Amoxapine </li></ul><ul><li>Maprotiline </li></ul><ul><li>Trazadone </li></ul><ul><li>Bupropion </li></ul><ul><li>Venlafaxne </li></ul><ul><li>Mirtazapine </li></ul><ul><li>Nefazodone </li></ul><ul><li>MOA </li></ul><ul><li>System Effect </li></ul><ul><li>Overdose </li></ul>
  9. 10. SSRI’s MAO’s <ul><li>Selective Serotonin Reuptake Inhibitors </li></ul><ul><ul><li>MOA </li></ul></ul><ul><ul><li>Toxicity </li></ul></ul><ul><ul><ul><li>No sedation </li></ul></ul></ul><ul><ul><ul><li>Serotonin Syndrome </li></ul></ul></ul><ul><ul><li>Fluoxetine, Fluvoxamine Paroxetine Sertraline Venlafaxine </li></ul></ul><ul><li>Monoamine Oxidase Inhibitors </li></ul><ul><ul><li>MOA </li></ul></ul><ul><ul><li>Toxicity </li></ul></ul><ul><ul><ul><li>Hypertensive crisis </li></ul></ul></ul><ul><ul><li>Drug Interactions Plentiful! </li></ul></ul><ul><ul><li>No outpatient use </li></ul></ul><ul><ul><li>Phenelzine (Nardil) </li></ul></ul>
  10. 11. Treatment Schedules <ul><li>Find the right drug for the right patient </li></ul><ul><li>Empirical Determination </li></ul><ul><ul><li>Patient acceptance </li></ul></ul><ul><ul><li>Adverse effects </li></ul></ul><ul><ul><li>Tolerance </li></ul></ul><ul><li>Labs do not rule over clinical judgment </li></ul><ul><li>LOOK AT PATIENT! </li></ul>
  11. 12. Drug Interactions <ul><li>CNS depressants & Etoh- enhance depressant effect </li></ul><ul><li>AntiThyroid drugs & TCA- increased risk of granulocytosis </li></ul><ul><li>MAOI’s & TCA –contraindicated in outpt setting  HTN crisis </li></ul><ul><li>Sympathomimetics & TCA- increase CV toxicities (HTN, tachycardia, dysrhythmias) </li></ul>
  12. 13. Drug Interactions cont. <ul><li>SSRI’s & MAOI’s – HTN crises, serotonin syndrome, death </li></ul><ul><li>SSRI’s & St Johns Wart – serotonin syndrome </li></ul>
  13. 14. <ul><li>Bad Wrap?! </li></ul>
  14. 15. Second Opinion <ul><li>Studies show that U.S. suicides have dropped 15% since SSRI’s were introduced </li></ul><ul><li>Biggest cause of Suicide? </li></ul>Untreated Depression
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