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Depression

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Depression At least 5 of the following symptoms for 2 weeks (criteria 1 or 2 essential): 1. Depressed mood. 2. Loss of interest or pleasure. 3. Significant weight ... – PowerPoint PPT presentation

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Title: Depression


1
Depression
  • At least 5 of the following symptoms for 2 weeks
    (criteria 1 or 2 essential)
  • 1. Depressed mood.
  • 2. Loss of interest or pleasure.
  • 3. Significant weight loss or gain.
  • 4. Insomnia or hypersomnia.
  • 5. Psychomotor agitation or retardation.
  • 6. Fatigue or loss of energy.
  • 7. Feelings of worthlessness or excessive guilt.
  • 8. Impaired thinking or concentration
    indecisiveness.
  • 9. Suicidal thoughts/thoughts of death.

2
Depression
  • Likely cause inadequate monoamine levels
  • Treatment
  • Blocking NT reuptake by presynaptic end

3
Antidepressants
  • Used to relieve symptoms of depression as well as
    help patients with anxiety disorders
  • Major groups
  • Tricyclic antidepressants
  • Heterocyclic antidepressant
  • Selective serotonin reuptake inhibitors
  • Monoamine oxidase inhibitors
  • Atypical antidepressants

4
Antidepressants
  • They now have recognised roles in the treatment
    of
  • generalized anxiety disorder,
  • panic disorder,
  • obsessive compulsive disorder,
  • social phobia,
  • bulimia nervosa,
  • chronic pain and
  • Nocturnal enuresis (Imipramine)

5
Antidepressants
  • On balance, the selective serotonin reuptake
    inhibitors (SSRIs) and other newer
    antidepressants may be better tolerated and have
    a wider safety margin than the tricyclic
    antidepressants (TCAs) and irreversible
    nonselective monoamine oxidase inhibitors
    (MAOIs).

6
Antidepressants
  • A delay in onset of antidepressant response of at
    least 1 to 2 weeks occurs with all
    antidepressants.

7
Antidepressants
  • Tricyclic Antidepressants (TCAs)
  • Prototype Imipramine
  • Mechanism of Action
  • Block neuronal reuptake of norepinephrine and
    serotonin which intensifies their effects
  • Uses Depression, bipolar disorder,
  • Considerations Initial responses develop in 1-3
    weeks maximal responses over 1 to 2 months.

8
Antidepressant Mechanism
TCAs SSRIs Block Here
9
TCA Side Effects
  • Sedation
  • Anticholinergic effects
  • Orthostatic hypotension
  • Cardiac toxicity
  • Ventricular dysrythmias

10
Heterocyclic antidepressant
  • Second generation antidepressant
  • (e.g., Amoxapine, bupropion, maprotiline,
    trazodone) and newer, third generation drugs
  • (duloxetine, mirtazapine, nefazodone,
    venlafaxine).
  • It has less cardiovascular and anticholinergic
    adverse effects than the TCAs and has a wider
    margin of safety in overdose.

11
Antidepressants
  • Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Most commonly prescribed group of antidepressants
  • As effective as TCAs but do not cause
    hypotension, sedation, or anticholinergic effects
    (dry mouth, blurred vision, photophobia,
    constipation, urinary hesitancy, tachycardia).
  • Use major depression/
  • Prototype Fluoxetine (Prozac)
  • Mechanism of action
  • Produces selective inhibition of serotonin
    reuptake
  • Blockade of transmitter uptake occurs quickly,
    therapeutic effects are the result of adaptive
    cellular changes that take place in response to
    prolonged uptake blockade
  • Other SSRIs citalopram, fluvoxamine, paroxetine
    and sertraline.

12
Selective Serotonin Reuptake Inhibitors (SSRIs)
  • Block only serotonin (not NE) reuptake
  • Elevate serotonin levels
  • Fewer side effects than TCS
  • No hypotension
  • No anticholinergic effects
  • No cardiotoxicity
  • Most common side effect
  • Nausea, diarrhoea, insomnia, sexual dysfunction

13
Antidepressants
  • Monoamine Oxidase Inhibitors (MAOIs)
  • Most dangerous risk of triggering hypertensive
    crisis by eating foods rich in tyramine.
  • MAO is an enzyme found in the liver, the
    intestinal wall, and terminals of
    monoamine-containing neurons. Their function is
    to convert NE, serotonin, and dopamine into
    inactive products.
  • MAO inhibitors block this process.
  • Uses depression, bulimia, obsessive-compulsive
    disorder, reduce panic attacks
  • Caution many drug interactions

14
Monoamine Oxidase Inhibitors (MAOIs)
  • Monoamine oxidase
  • Present in liver, intestines MonoAmin releasing
    neurons
  • Inactivates monoamines
  • Inactivates dietary tyramine in liver
  • Foods rich in tyramine cheese red wine

15
MAOI Side Effects
  • CNS Stimulation
  • Anxiety, agitation
  • Orthostatic hypotension
  • Hypertensive Crisis
  • From increased tyramine consumption
  • Excessive arteriole constriction, stimulation of
    heart

16
MAOI Dietary Tyramine
17
Antidepressant Mechanism
TCAs SSRIs Block Here
18
Antidepressants
  • Atypical Antidepressants
  • Bupropion (Wellbutrin)
  • Bupropion is an antidepressant which inhibits
    neuronal reuptake of dopamine and is a
    noncompetitive nicotine antagonist at nicotinic
    cholinergic receptors.
  • Adverse effects include nausea, rashes, facial
    swelling, insomnia and dry mouth.
  • Contraindicated in patients with a seizure
    disorder bulimia or anorexia nervosa monoamine
    oxidase inhibitor treatment in the previous 14
    days

19
Antidepressants Agents
  • TCAs
  • imiprimine (Tofranil)
  • amitriptyline (Elavil)
  • nortriptyline (Pamelor )
  • SSRIs
  • fluoxetine (Prozac)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • Fluvoxamine
  • MAOIs
  • phenelzine (Nardil)
  • Moclobemide
  • Second generation antidepressant
  • (eg, Amoxapine, bupropion, maprotiline, trazodine
    and newer, third generation drugs (duloxetine,
    mirtazapine, nefazodone, venlafaxine).

20
Drugs for Bipolar Disorder
  • Bipolar Disorder
  • Severe biologic illness characterized by
    recurrent fluctuations in mood either the mood
    is abnormally elevated or depressed.
  • Drug therapy
  • Mood stabilizers
  • Antidepressants (used w/mood stabilizer)
  • Antipsychotics (used w/mood stabilizer)

21
Drugs for Bipolar Disorder
  • Mood Stabilizing Drugs
  • Provide relief from an acute manic or depressive
    episode, preventing symptoms from recurring.
  • Prototype Lithium
  • Low therapeutic index so levels MUST be monitored
    (toxicity can occur at blood levels that are only
    slightly greater than therapeutic).

22
Drugs for Bipolar Disorder
  • Prototype Lithium
  • Action Specific mechanism unknown alters sodium
    transport in nerve and muscle cells

23
Drugs for Bipolar Disorder
  • Prototype Lithium
  • CV Arrhythmias hypotension peripheral
    circulatory collapse.
  • CNS Tremor ataxia dizziness confusion
    hallucinations seizures drowsiness muscular
    weakness slurred speech.

24
Drugs for Bipolar Disorder
  • Prototype Lithium
  • EENT Blurred vision tinnitus.
  • GI Anorexia nausea vomiting diarrhea
    sialorrhea dry mouth parotitis.
  • GU Urinary urgency polyuria albuminuria
    sexual dysfunction symptoms of nephrogenic
    diabetes decreased creatinine clearance.

25
Drugs for Bipolar DisorderLithium Interactions
  • Acetazolamide, osmotic diuretics, theophyllines,
    urinary alkalinizers Increased renal excretion
    of lithium.
  • ACE inhibitors, thiazide diuretics, loop
    diuretics, NSAIDs, fluoxetine Increased lithium
    serum levels.

26
Drugs for Bipolar Disorder
  • Mood Stabilizing Anticonvulsants
  • Prototype Valproic acid (Depakene, Depakote)
  • It is the only antiseizure agent that has been
    approved by the FDA for treatment of BPD.
  • It is as effective as lithium, works faster, and
    has a higher therapeutic index and more desirable
    side effect profile.
  • First line treatment for BPD

27
Drugs for Bipolar Disorder
  • Valproic acid (Depakene, Depakote)
  •  Action
  • Believed to work by increasing brain levels of
    GABA.
  • It may also inhibit catabolism of GABA,
    potentiate postsynaptic GABA responses, and
    affect potassium channels or directly stabilize
    membranes.

28
Drugs for Bipolar Disorder
  • Valproic acid (Depakene, Depakote)
  • Contraindications Hepatic disease dysfunction.

29
Drugs for Bipolar Disorder
  • Valproic acid (Depakene, Depakote)
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