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Antidepressants  mood_stabilizers
 

Antidepressants mood_stabilizers

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    Antidepressants  mood_stabilizers Antidepressants mood_stabilizers Presentation Transcript

    • ANTIDEPRESSANTS & Mood Stabilizers
    • AntidepressantsActions:Block the reuptake of serotonin and norepinephrine(neurotransmitters) so that more are available in thebrain to transmit messages.
    • AntidepressantsIndications:  Recurrent depressive disorders  Psychomotor retardation  Depression with no clear precipitating event  Family history of depression  Chronic pain  Eneuresis
    • Antidepressants Have a long half life and can often be given once a day. Therapeutic effects of some may not be seen until 3-4 weeks.
    • Selective Serotonin reuptake Inhibitors (SSRIs)Fluoxetine HCL (Prozac)  Non-tricyclic, less sedation, fewer side effectsSertraline HCI (Zoloft)  Lower risk of toxicity in overdose, fewer side effects, shorter half-life than prozac
    • SSRI Antidepressants (cont’d.)Paroxetine HCI (Paxil): Effectiveness comparable to Imipramine (Tofranil), shortest half-life, safer for elderly.Fluvoxamine (Luvox)Citalopram (Celexa)Escitalopram oxalate (Lexapro)
    • SSRIs Block transport mechanism that returns unbound serotonin left in synaptic cleft into the presynaptic neuron Terminates transmission of the message carried by that receptor When blocked, more serotonin is available to the postsynaptic receptor
    • SNRI (serotonin and norepinephrinereuptake inhibitor) Effexor (Venlafaxine)  inhibits serotonin & norepinephrine re-uptake  side effects include:  dizziness, migraine, weight gain Serzone (Nefazadone) Trazodone HCL (Desyrel)
    • Serotonin Agonist reuptakeinhibitor Remeron  inhibits serotonin & norepinephrine re-uptake  side effects include:  somnolence, dizziness, weight gain  adverse effects: agranulocytosis, neutropenia
    • Norepinephrine-Dopamine antagonistBupropion Hycrochloride (Wellbutrin) increases norepinephrine and dopamine Provides mild dopamine reuptake Blocks reuptake of norepinephrine does not affect serotonin reuptake does not inhibit monoamine oxidase
    • Nonselective norepinephrine- serotonin reuptake inhibitors (Tricyclics)Imipramine……………….TofranilDesipramine……………...Norpramine, PertofraneAmitriptyline……………..Elavil, EndepNortriptyline………………Pamelor, AventylProtriptyline……………….VivactilDoxepin……………………Sinequan
    • Nonselective norepinephrine-serotonin reuptake inhibitors Affect norepinephrine, serotonin acetylcholine and histamine receptors Increase availability of norepinephrine, serotonin Inhibit transport back into the presynaptic neuron
    • Side Effects: AntidepressantsAnticholinergic effects: Common and troublesomein tricyclics: interfere with patient compliance.  dry mouth  sweating  constipation  drowsiness  urinary hesitancy/retention  blurred vision Cardiovascular: Postural hypotension, tachycardia, heart conduction defects.
    • Antidepressants – Side EffectsAnticholinergic effects:  Closed angle glaucoma worsened  Toxic: confusion, psychosisOther: Weight gain, lowered seizure threshold, EPSOverdose: 1000 – 4000 mg is fatal
    • Side Effects of Antidepressants(cont’d.) Managing Side Effects of Tricyclic Antidepressants(Cont’d.)If these dangerous side effects occur, advise the patienteither to call provider stop the medication, or reduce thedosage.  Orthostatic hypotension  Marked, persistent sedation  Atropine-like psychosis  Cardiovascular conduction defect  Seizures  Severe anticholinergic effect: urinary retention, etc.
    • Antidepressant DrugsMAO Inhibitors: phenelzine….…………Nardil isocarboxazide ……….Marplan tranylcypromine………Parnate
    • MAO InhibitorsActions: Monamine oxidase is an enzyme responsiblefor destroying epinephrine, norepinephrine andserotonin. MAO inhibitors block this enzyme. Theeffect is CNS stimulation and increased psychomotoractivity.  symptoms relieved in 2-4 weeks  Potential hypertensive crisis it certain foods or medicines ingested
    • MAO Inhibitors(cont’d.)  Dietary restrictions necessary: foods high in tyramine must be avoided: aged cheese, chicken liver, beer, Chianti wine, cold or sinus medicines, diet pills, blood pressure regulating meds. Severe atypical headache is usually the first signSide effects: autonomic: orthostatic hypotention,dizziness, increased appetite anticholinergic effects arerare.
    • Antidepressant Drugs(cont’d.)Psychostimulants Methylphenidate Hydrochloride (Ritalin) Dextroamphetamine Sulfate (Dexedrine) Pemoline (Cylert)Source: Gomez (1993)
    • Mood StabilizersLithium  Effective in manic excitement and preventative for manic and depressive recurrences in bipolar patients.  Also used in other psychiatric disorders that do not respond to other drug therapies. Can lead to toxic reactions which may be fatal.  Blood level monitoring is necessary to maintain in therapeutic range.  Therapeutic levels range from .7 to 1.5. Higher levels are used to treat manic or psychotic excitement.
    • LithiumCommon Indications: Acute Mania Bipolar ProphylaxisProbably Effective: Unipolar ProphylaxisPossibly Effective: Bulimia Alcohol Abuse Aggressive Behavior Schizoaffective disorder
    • LithiumMechanism of Action Adverse Effects Unclear  Excessive drug levelsDosing Narrow therapeutic  Therapeutic drug levels index Drug Interactions Monitor blood levels  q 2-3 days initially  Diuretics then  q 1-3 months  Anticholinergic drugs  levels must be below 1.5mEq/L
    • Mood StabilizersLithium(cont’d.) Side effects: Neuromuscular and CNS: tremor (fingers) cog wheeling and mild parkinsonism possible. sluggishness and forgetfulness treated by decreased dose. GI: Chronic nausea, diarrhea, take with food. Weight gain and endocrine effects: Increased appetite andexcessive thirst may cause weight gain - transitoryDecreased thyroid levels: Thyroid medication may be necessary. Renal: polyuria and polydypsia may occur. Dose of drug should be lowered.
    • Mood StabilizersLithium(cont’d.)Allergic rashes – may be due to some ingredient in the capsule. Drug form can be changed to liquid citrate. Cause birth defects
    • LithiumCommon Causes for Increased Lithium Level: Decreased sodium intake Diuretic therapy Decreased renal functioning Fluid-electrolyte loss (sweating, diarrhea, dehydration) Medical illness Overdose
    • Mood StabilizersAnticonvulsants – used to promote mood stabilization Carbamazepine (Tegretol): Used in patients who do not respond to lithium. More effective for rapid-cycling bipolar patients (4 or more affective episodes per year). Blood levels should be monitored weekly for the first eight weeks. Dose should be adjusted to maintain a serum levels of 6-8 mg/L.
    • Mood Stabilizers(cont’d.)Side effects: sedation, mal coordination (common)agranulocytosis, aplastic anemia (rare) regularblood counts unnecessary . Watch for fever andsore throat.Can cause increased liver enzymes but serioushepatic problems rare.Associated with birth defects.
    • Mood Stabilizers(cont’d.)Valproate (Valproic acid) – Depakene, Depakote used inmanic and schizoaffective patients (treatment resistant)Improvement occurs in 1-2 weeks. Blood levels should beobtained every few days until 50 mg/l is reached.Side effects – Major concern – severe hepatotoxicity (maybe fatal).Liver function tests should be done every month.Decreased platelet levels can occur.Associated with neural tube birth defects.Very toxic when taken in suicide attempt.
    •  Lamitrogine- lamictal  Anit-convulsant used for type 2 BPD  Side effect- rash, nausea, vomitting and diarrhea.
    • Mood Stabilizers(cont’d.)Clonazepam (Klonopin) – Benzodiazepine which isuseful in treating acute maniaSide effects: sedation, atoxia, disinhibition effect.