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antideprasants
- 1. Therapeutic modalities in psychiatry I. Somatic therapy • Psychopharmacology • ECT • Psychosurgery II. Psychological therapies III. Activity therapy IV. Milieu therapy
- 3. Classification of psychotropic drugs • Antidepressants • Mood stabilizers • Antipsychotics • Anti epileptic • Antiparkinsonian • others
- 4. ANTIDEPRASSENTS • SSRI(Selective Serotonin Reuptake Inhibiters) • MAOI(Mono-Amino oxidise Inhibiters) • TCA( Tricycle Antidepressants)
- 5. MAOI’s • Isocarboxazide • Phenelzine • Selgiline • tranylcypromine – Use very carefully – Insomnia (HS)
- 7. MAOI’s • Drug-food inter-action-Hypertensive crisis(Thyramine) – Aged cheese – Beer – Red wine – Pickle – Smoked food – Beef – Liver – Avocado – Figs • Drud-drug Reaction (TCA and SSRI)
- 8. Management • Pentolamine (Regitine) • Medical alert bracelets
- 9. SSRI’s • Citalapram • Escitalopram(deparen fort) • Fluoxitine(flunil) • Fluoxitamine • Paroxetine • Sertraline(daxid)
- 10. SSRI’s • Indication – Depression – OCD – Panic anxiety disorder – Eating disorder Usually given in morning for three weeks Insomnia
- 11. SSRI’s • Contra indications – With in 14 days of MAOI – Disorders of kidney, liver, heart – Mania – Pregnancy (Teratogenicity) – Warfarine
- 12. SSRI’s • Side effects –CNS stimulation –Nausea and vomiting –Skin rashes and sexual dysfunctions
- 13. TCA’s(MARI’s) • Amitriptiline(amitose) • Amoxapine • Clomipramine • Despramine • Doxepin • Imiprimine • Nortriptiline • Protriptiline • Trimipramine • Trazadone HS
- 14. TCA’s(MARI’s) • Indications – Depression – Enuresis – OCD – Chronic pain
- 15. Side effect • Hypotension • Anticolinergics • Tachycardia • Sedation
- 16. TCA’s(MARI’s) • Contraindications – Diseases of Brain, Heart, liver, kidney – Pregnancy – Glaucoma – Urine retention – Antithyroid agent – With in 14 days of MAOI’s – Oral contrasts – Discontinue before any surgery
- 17. Common side effects • Dry mouth • Constipation • Cycloplegia • Mydriasis • Urine retention • Tremors • EPS • Weight gain
- 18. Nurses responsibility • Restrict thyramine rich food • Report occipital headache, vomiting, nausea, chest pain Etc • Instruct the patient to change position slowly. • Strict monitoring of vitals.
- 19. General guidelines • Do not hesitate to consult doctor if any doubt. • Chart on the patients record. • Always make sure patients identification. • Do not leave the patient until the drug is swallowed. • Do not allow the patient to go bath room for taking medication. • Do not leave the medicine tray with patient.
- 20. • Do not force the patient to take medicine. • Check the drugs daily. • Do not over stoke the medicines. • Make sure no patient has the access to medicine cupboard.
- 21. Thank You
- 22. Mood stabilizers • Lithium • Carbomazapine • Sodium valporate
- 23. Lithium • Element with atomic number 3 and weight 7. • FJ Cade in 1949
- 24. Indications • Acute mania • BPAD prophylaxis • Schizoaffective • Cyclothymia • Impulsivity aggression • Premenestrual dysphoric disorder • Bulimia nervosa • Borderline personality disorder • Tricotilomania • Cluster headacheS
- 25. Dosage • Lithium Carbonate – 350 mg Tablets(licab) – 400 mg sustained release tablet. Lithium citrate 300 mg/5ml liquid 900-2100 mg/ day in 2-3 divided dose
- 26. Mechanism of action • Increase reuptake of serotonin and nor epinephrine. • Inhibits the secretion of catecholamine's. • Decrease post synaptic serotonin receptor sensitivity.
- 27. Blood lithium levels • Therapeutic level-0.8-1.2 mEq/L • Prophylatic level- 0.6-1.2 mEq/L • Toxic lithium level >2 mEq/Ls
- 29. Side effects • Tremors • Motor hyperactivity