Escitalopram training

TRAINING PROGRAM
By
Muhammad Nauman Khalid
Product Manager
PSY Standpharm

 Nervous System
 Brain
 Neurons
 Synapse
 Neurotransmission
 Depression
 Anxiety
 Escitalopram
What We Will Get From This Session

WHY
ARE WE
HERE??

DR. FARRUKH and a bus driver BABU are both
in love with the same woman named SAIRA.
The bus driver need to go for a long trip of 10 days.
Before he left he gave Saira 10 apples. Why?
QUESTION

NERVOUS SYSTEM?
WHAT IS

The nervous system is an organ system in
charge of sending messages to and from the
brain and spinal cord to and from all parts of
the body.
• Coordinates, controls and integrates (unite) the
different actions.
• Transmits signals between different parts of the
body.
The Nervous System

Nervous System consists of two main parts:
1. Central Nervous System (CNS)
2. Peripheral Nervous System (PNS)
Nervous System

• Made up of brain and spinal cord
• Acts as body’s control center,
coordinates body’s activities
• Impulses travel through the
neurons in your body to reach the
brain
• Central Nervous System is yellow
in this diagram.
Central Nervous System

• Made up of all the nerves that carry
messages to and from the central nervous
system.
• Similar to telephone wires that connect all of
our houses in the community
• Central Nervous System and Peripheral
Nervous System work together to make
rapid changes in your body in response to
stimuli.
• Peripheral Nervous System is green in this
diagram.
Peripheral Nervous System

SOMATIC NERVOUS SYSTEM
• The part of the peripheral nervous system associated with the voluntary control
of body movements via skeletal muscles
AUTONOMIC NERVOUS SYSTEM
• Relay information from central nervous system to organs
• Helps maintain a balance in involuntary functions of the body
• Involuntary: You do not consciously control these

Parasympathetic Nervous
System
Decreases heart rate
Decreases respiratory rate
Decreases blood pressure
Sympathetic Nervous
System
Increases heart rate
Increases respiratory rate
Increases blood pressure
• Sympathetic Nervous System: controls in times of stress and emergencies,
such as the flight or fight response
• Parasympathetic Nervous System: counteracts the Sympathetic nervous
system and controls body in times of rest
Autonomic Nervous System

IF YOU CAN?
ANSWER

Central Nervous System
• Brain
• Spinal cord

• The brain is one of
the largest and most
complex organs in
the human body
• It is made up of
more than 100
billion of Neurons
which communicate
in trillions of
connections
• Protected by
membranes and
skull bones
Brain

• Integrates and regulates body activities.
• Center for learning, memory, thought, reasoning and
controlled behavior.
• Produces and controls neurotransmitters.
Brain Functions

Three main sections
• Cerebrum
• Cerebellum
• Brainstem
Brain Structure

• Controls conscious activities, intelligence, memory,
language, muscles.
• Wrinkled with countless folds and grooves and covered
with an outer layer of gray matter called the cerebral
cortex.
• Divided into 4 lobes
The Cerebrum

Four Lobes Cerebrum

• Muscle coordination is developed here as well as the
memory of physical skills.
• If the cerebellum is injured, your movements become
jerky.
• When you see an amazing athlete perform, you are
watching a well-trained cerebellum at work.
The Cerebellum

• Made up of the medulla oblongata, pons and midbrain.
• Medulla oblongata controls involuntary activities such
as heart rate and breathing
• Pons and midbrain act as pathways connecting various
part of the brain with each other.
The Brainstem

OXEPIN
 The Limbic System is a set of brain structures located on
both sides of the thalamus, immediately beneath
the cerebrum.
 Emotional life is largely housed in the limbic system
 It has a great deal to do with the formation of
memories.
Limbic System

OXEPIN
Structure of Limbic System

OXEPIN
Structure of Limbic System
1. Pituitary Gland: It is known as “Master Gland” of the body, it
produces many hormones that travel throughout the body
2. Hippocampus: It is involved with various processes relating to
cognition. It is associated mainly with memory, in particular
long-term memory
3. Hypothalamus: It links the nervous system to the endocrine
system via the pituitary gland
4. Amygdala: It is responsible for emotions, survival instincts, and
memory.

OXEPIN
Cognition
.

The limbic system supports a variety of functions including
Emotions
Behavior
MotivationOlfaction
Long Term
Memory
Functions of Limbic System

•The basic building block or basic
unit of structure and function of
the nervous system
•Cells that conduct impulses.
•Made up of dendrites, cell body
and an axon
Neurons

Structure of Neuron

• Dendrites: branch-like extensions that receive
impulses and carry them toward cell body.
• Axon: single extension of the neuron that carries
impulses away from the cell body.
• The axon branches out at ending to send impulses to
many different neurons. Dendrites receive impulses
from many other axons.
Neurons

Types of Neurons
Sensory Motor Interneurons
Neurons

• Sensory Neurons: carry impulses from inside and
outside the body to brain and spinal cord.
• Interneurons: found within brain and spinal cord,
process incoming impulses and pass them on to
motor neurons.
• Motor Neurons: carry impulses away from the brain
and spinal cord.
Types of Neurons

So how do these neurons work if someone taps
you on the shoulder . . .
1. Receptors in the skin sense touch or other stimuli.
2. Sensory neurons transmit the touch message.
3. Information is sorted and interpreted in the brain. A
response in determined by interneurons.
4. Motor neurons transmit a response message to the
shoulder muscles.
5. The shoulder muscles are activated, causing the head to
turn.

• Synapses are functional
connections between
neurons which permit a
neuron (or nerve cell) to
pass an electrical or
chemical signal to another
cell.
Synapse

• The area where the terminal is in contact with
other cells is called the synapse.
• The side of the terminal from where the signal
comes is called the pre synapse
• whereas the receiving side is called the post
synapse.
Synapse

Synapse

Neurotransmission
• Neurotransmission is transfer of nerve impulses from
one neuron to other neuron through a synapse.
• This transfer of impulses occurs by the help of two
processes.
1. Electrical Neurotransmission
2. Chemical Neurotransmission

Chemical Neurotransmission
• When a neuron receives a message from one or more
adjacent neurons.
• Neurotransmission is started in which chemicals
called neurotransmitters are released by the axon
terminal of a neuron (the presynaptic neuron)
• Neurotransmitter binds and activates the receptors on
the dendrites of another neuron (the postsynaptic
neuron).

• Within the cells, small neurotransmitter molecules are packaged in
the vesicles.
• When signals travels to the synapse,
• Vesicles moves to the synaptic membrane: the vesicle and cell
membrane diffuse leading to the release of the packaged
neurotransmitter from presynaptic neuron, by a mechanism called
EXOCYTOSIS.
• The neurotransmitters then enters the Synaptic Cleft or Gap and
bind to the receptors of postsynaptic neuron.
Neurotransmission - Process

Neurotransmission - Process

 Neurotransmitters are chemical messengers
of the brain.
 Their primary task is to help transfer signals
from cell to cell, in order for the neuronal
signal transmission to carry on properly.
Neurotransmitters

Adrenalin: Fight or flight Neurotransmitters
Noradrenalin: Concentration Neurotransmitter
Dopamine: Pleasure Neurotransmitter
GABA: Calming neurotransmitter
Acetylcholine: Learning neurotransmitter
Glutamate: Memory neurotransmitter
SEROTONIN
Mood Neurotransmitter
Neurotransmitters

•Serotonin
• Serotonin is a neurotransmitter which affects
emotion, mood and anxiety.
• It is also involved in regulating sleep,
wakefulness and eating.
Neurotransmitters

Depression
Depression is a state of low mood and mental
illnesses
Characterized by:
• a profound and persistent
• feeling of sadness or despair
• and/or
• loss of interest in things that once were pleasurable.

• Depression is believed to occur when there are
imbalances in the brain of mood-regulating
neurotransmitters.
• Neurotransmitters involved in mood regulation:
•Serotonin
•Norepinephrine
•Dopamine
Chemistry of Depression

OTHER
PSYCHIATRIC
DISORDERS
DRUG ABUSE
CHRONIC,
PAINFUL OR
SERIOUS
MEDICAL ILLNESS
MEDICATIONS
Schizophrenia Alcoholism Cancer Antihypertensives
Anxiety disorders Parkinson's disease
Antirheumatics
NSAIDs (e.g.
aspirin)
Eating disorders Stroke
Heart disease
Causes of Depression

PREDISPOSING PRECIPITATING MAINTAINING
Life events Social factors
Family tendency to
depression
Bereavement Poor housing
Insecurity Losing one's job An unhappy marriage
Dependency Long-term illness Financial worries
Drug-induced Drug-induced
Factors of Depression

•Psychological (Emotional)
•Somatic (Physical)
•Cognitive (Intellectual)
Symptoms of Depressive Disorder

• Sadness, despair
• Loss of interest or pleasure (anhedonia)
• Unexplained anxiety
• Inappropriate feeling of guilt
• Loss of self esteem, shame
• Worthlessness
• Hopelessness
• Suicidal thoughts
Psychological (Emotional) Symptoms

• Sleep disturbances
• Headache and pains
• Changes in appetite or weight
• Loss of energy, fatigue
• Loss of libido
Somatic (Physical) Symptoms

• Slowed thinking
• Indecisiveness
• Poor concentration
• Impaired memory
Cognitive (Intellectual) Symptoms

• Major Depression / Major Depressive
Disorder
• Persistent Depressive Disorder
• Bipolar Disorder
• Seasonal Affective Disorder (SAD)
• Psychotic Depression
• Peripartum (Postpartum) Depression.
• Premenstrual Dysphoric Disorder (PMDD)
• 'Situational' Depression.
Types of Depression

• Persistent Depressive Disorder
Persistent depressive disorder, also called dysthymia is a continuous long-term (chronic) form of
depression.
• Bipolar Disorder
Bipolar disorder, formerly called manic depression, is a mental health condition that causes
extreme mood swings that include emotional highs (mania or hypomania) and lows (depression)
• Seasonal Affective Disorder (SAD)
Seasonal affective disorder (SAD) is a type of depression that's related to changes in
seasons — SAD begins and ends at about the same times every year.
• Psychotic Depression
Psychotic depression, also known as depressive psychosis, is a
major depressive episode that is accompanied by psychotic symptoms.
• Peripartum (Postpartum) Depression.
Peripartum depression refers to depression occurring during pregnancy or after
childbirth.`
Types of Depression

MDD is a mental disorder characterized
by:
• One or more episodes of depression lasting at
least 2 weeks
and
• Loss of interest or pleasure in normally
enjoyable activities.
Major Depressive Disorder

• Changes in appetite or weight
• Changes in sleep
• Decreased energy
• Feelings of worthlessness or guilt
• Difficulty in thinking, concentrating, or making
decisions
• Recurrent thoughts of death or suicidal ideas,
plans or attempts.
Symptoms of Major Depressive Disorder

What is Anxiety?

• Anxiety is an abnormal fear that is out of proportion to
any external stimulus.
• It is feeling of:
• Intense worry
• Uneasiness
• Fear
• Increased Apprehension
in the absence of any obvious danger.
Anxiety Disorders

This persistent nervousness or attack of nervousness
will lead to Symptoms include:
• Tension – Mental or emotional stress
• Agitation – Emotional disturbance
• Insomnia - Sleeplessness
• Apprehension – Fear of unknown / future
• Irritability – Annoying excessive response to stimuli
• Autonomic Hyperactivity
• Hyperventilation – Breathing faster and deeper
Anxiety Symptoms

• Anxiety is also believed to occur when there are
imbalances in the brain of mood-regulating
chemicals called neurotransmitters.
• Neurotransmitters role in mood regulation:
• Serotonin
• GABA – Gamma Aminobutyric Acid
• Norepinephrine
• Dopamine
Chemistry of Anxiety

• Generalized Anxiety Disorders (GAD)
• Social Anxiety Disorder (SAD)
• Panic Disorder
• Obsessive Compulsive Disorder (OCD)
• Phobias
• Post Traumatic Stress Disorder (PTSD)
Types of Anxiety Disorders

• Social Anxiety Disorder (SAD
everyday interactions cause significant anxiety, fear, self-consciousness and
embarrassment because you fear being scrutinized or judged by others.
• Panic Disorder
A panic attack is a sudden episode of intense fear that triggers severe physical reactions
when there is no real danger or apparent cause.
• Obsessive Compulsive Disorder (OCD)
• (OCD) features a pattern of unreasonable thoughts and fears (obsessions) that lead
you to do repetitive behaviors (compulsions).
• Phobias
phobias are an overwhelming and unreasonable fear of objects or situations that pose
little real danger but provoke anxiety and avoidance
Types of Anxiety Disorders

Generalized anxiety disorder is characterized
by:
• Chronic feelings of excessive and unrealistic
worry and anxiety
• without a specific cause.
Generalized Anxiety Disorder (GAD)

• A family history of anxiety
• Recent or prolonged exposure to stressful
situations, including personal or family
illnesses
• Excessive use of caffeine or tobacco, which
can make anxiety worse
• Childhood abuse
Causes of Generalized Anxiety Disorder

• Excessive, ongoing worry and tension.
• An unrealistic view of problems.
• Restlessness or a feeling of being "edgy"
• Irritability.
• Muscle tension.
• Headaches.
• Sweating.
• Difficulty concentrating
Symptoms of Generalized Anxiety Disorder

• Selective serotonin reuptake inhibitors (SSRIs) are
a widely used type of antidepressant medication.
• They're mainly prescribed to treat depression,
particularly persistent or severe cases.
• SSRIs are usually the first choice medication for
depression because they generally have fewer
side effects than most other types of
antidepressant.
Selective Serotonin Reuptake Inhibitors

SSRIs Approved To Treat Depression:
The Food and Drug Administration (FDA) has approved these SSRIs to treat depression:
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Selective Serotonin Reuptake Inhibitors

• Serotonin is a neurotransmitter found in CNS
• Also known as 5- Hydroxytryptamine
• Found in gastrointestinal tract and blood
stream
• Plays an important part in the biochemistry of
• depression, bipolar disorder, and anxiety
Serotonin

• Sleep
• Sensory perception
• Mood (depression)
• Appetite
• Behavior (sexual and hallucinogenic)
• Memory and Learning
Serotonin
Serotonin Controls:

Increased Levels:
• More restful sleep
• Elevated moods
Decreased Levels:
• Anxiety
• Depression
• Troubled sleep patterns
Psychological Effects:
Serotonin

Mechanism of Action:
The mechanism of antidepressant action of
Escilam, is presumed to be linked to
potentiation of serotonergic activity in the
central nervous system CNS resulting from its
inhibition of CNS Neuronal reuptake of
serotonin (5-HT).
Escilam
(Escitalopram)

Escilam increases intra-
synaptic levels of the
neurotransmitter
serotonin
by blocking the reuptake
of the neurotransmitter
into the presynaptic
neuron.
Mechanism of Action

Absorption
Absorption is good & does not affect
by food.
Peak Plasma Concentration / Tmax 3 to 4 hrs
Half Life 27-32 hrs
Absolute Bioavailability 80%
Metabolism Mainly in liver
PHARMACOKINETICS SUMMARY

Indications for Escilam
Major Depressive Disorder
Generalized Anxiety Disorder
Off Label Uses
Obsessive-Compulsive Disorder
Insomnia
Vasomotor Symptoms Associated with
Menopause

Initial Dose 10 mg orally once a day
Maintenance
Dose
10 to 20mg mg orally once a day
Dosage

Administration advice:
-Doses may be administered in the morning or evening, without
regard to food.
-10 and 20 mg oral tablets are scored and can be divided into equal
doses.
Monitoring:
-Hepatic: Hepatic function
-Metabolic: Hyponatremia (when the concentration of sodium in your blood is abnormally
low)
-Nervous system: Serotonin syndrome
-Psychiatric: Emergence or worsening of depression, suicidal thoughts
or behavior, and/or any unusual changes in mood or behavior
-Renal: Renal function
Dosage

Switching between MAOI (Monoamine oxidase
inhibitors) and this drug:
At least 14 days should elapse between ceasing
one of these medicines and starting the other.

Males
Ejaculation Disorder
(Primarily ejaculation Delay)
Decreased Libido
Impotence
Females
Decreased Libido
Anorgasmia
Side Effects

HYPONATREMIA
occurs when the concentration of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps
regulate the amount of water that's in and around your cells.
ACTIVATION OF MANIA/HYPOMANIA
an excessive enthusiasm or desire; an obsession.
SEIZURES
A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior,
movements or feelings, and in levels of consciousness
SUICIDE
Precautions

OXEPIN
Pregnancy Warnings
This drug should be used only if the potential benefit justifies the risk to the fetus,
taking into account the risks of untreated Bipolar I depression or treatment-
resistant depression.
Pregnancy Categories
A: Generally acceptable.
B: May be acceptable.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human
studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer
alternatives exist.
Pregnancy: CATEGORY C

•TP Rs. 140/-
•MRP Rs. 164.7/-
Escilam
10mg
•TP Rs. 327/-
•MRP Rs. 384.7/-
Escilam
20mg

For any further clarification don’t hesitate to
contact me
mani.khalid@yahoo.com
00923008875154

Escitalopram training

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