Antidepressants in Psychiatric Disorders
Antidepressants+in+Psychiatric+Disorder
May 13, 2015
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Antidepressants in Psychiatric Disorders
Antidepressants? Are drugs that relieve the symptoms of depression
Were first developed in the 1950s
There are approx. 30 different kinds of antidepressants available today and are of 5 main types:
− MAOIs (Monoamine oxidase inhibitors)
− Tricyclics
− SSRIs (Selective Serotonin Reuptake Inhibitors)
− SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)
− NASSAs (Noradrenaline and Specific Serotoninergic Antidepressants)
Classes of Antidepressants SNRIs: newer form of antidepressant that work on both
norepinephrine and 5-HT. They typically have similar side effects to the SSRIs.− Desvenlafaxine, Duloxetine, Milnacipram, Venlafaxine
SSRIs: work by preventing the reuptake of serotonin by the presynaptic neuron, thus maintaining higher levels of 5-HT in the synapse − Citalopram, Escitalopram, Fluoxetine, Fluvoxamine,
Paroxetine, Sertraline,
Tricyclics: block the reuptake of certain neurotransmitters such as norepinephrine (noradrenaline) and serotonin − Amitriptyline, Clomipramine, Imipramine, Nortriptyline
MAOIs: work by blocking the enzyme monoamine oxidase which breaks down the neurotransmitters dopamine, serotonin, and norepinephrine (noradrenaline).
− MAOIs can be as effective as tricyclic antidepressants, although they can have a higher incidence of dangerous side effects (as a result of inhibition of cytochrome P450 in the liver
− Isocarboxazid, Phenelzine
map of TCAs and SNRI pharmacological properties
Advantages Disadvantages / Side Effects
• Often effective in reducing panic attacks and elevating depressed mood. • Well researched. • Usually a single daily dose
Anticholinergic : dry mouth, blurred vision constipation, urinary retensionAntihistaminergic : SedationAlpha blockade : Postural hypotension
Uses of Antidepressants Moderate to severe depressive illness (Not
mild depression)
Schizophrenia
Severe anxiety and panic attacks
Obsessive compulsive disorders
Post-traumatic stress disorder
Chronic pain
Eating disorders
Depression A common mental disorder that presents with
− Depressed mood − Loss of interest or pleasure − Feelings of guilt or low self-worth − Disturbed sleep or appetite− Low energy and − Poor concentration.
Major Types:− Major depressive disorder,
− Dysthymic disorder
− Bipolar disorder
− Cyclothymic
Prevalence− 20 – 25% of women (35 – 45 years)− 7-12 % of men (after 55 years)− 50 – 75 % remain undiagnosed & untreated.
Aaron M. Koenig; First line pharmacotherapies for depression – what is the best choice?;‑ POLSKIE ARCHIWUM MEDYCYNY WEWNĘTRZNEJ 2009; 119 (7-8)
Frequently prescribed antidepressants for Depression
Schizophrenia Is a psychiatric diagnosis that describes a
mental disorder characterized by abnormalities in the perception or expression of reality
Characterized by psychosis, hallucinations, delusions, cognitive defects, occupational and social dysfunction
Onset in late teens or early 20s in males; sometime later in females
Incidence : 1 - 3 %
Gender : Affects males and females equally
• Males in the early 20’s• Females in early 30’s
SchizophreniaEtiology and Pathophysiology
− Etiology Genetic predisposition Intrauterine, birth or postnatal
complications Viral CNS infections Environmental stressors (biochemical or
social)
− Pathophysiology Increased dopamine in mesolimbic
pathways causes delusions and hallucinations
Dopamine deficiency in mesocortical and nigrostriatal pathways causes negative symptoms (apathy, withdrawal)
Hallocinogens produce effect through action on 5-HT2 receptors
Schizophrenia
Positive symptoms−Hallucinations−Delusions−Disordered thinking−Disorganized
speech−Combativeness−Agitation−Paranoia
Negative symptoms−Social withdrawal−Emotional
withdrawal−Lack of motivation−Poverty of speech−Blunted affect−Poor insight−Poor judgement−Poor self-care
Antidepressants in Schizophrenia Studies show that depressive symptoms are common in
all phases of Schizophrenia
In one study, improvement in treatment scores was significantly greater in 58 schizophrenics given the neuroleptic Perphenazine after a two-week washout than in the 29 patients given placebo. Half the Perphenazine-treated group also had Amitriptyline; these showed a significantly greater improvement than the placebo group as regards flatness of effect and in other sub-scores on the Wing scale, but they did not improve significantly more than patients given perphenazine alone
Reference: Use of antidepressants in schizophrenia; BRITISH MEDICAL JOURNAL; [email protected]
Study of 35 outpatient schizophrenics who had developed true depressive symptoms showed that depressive symptoms responded better in the group given Amitriptyline together with perphenazine, but three-quarters of those receiving combined treatment had an increase in blood pressure and body weight. In another study of schizodepressives chlorpromazine alone appeared to be as good as chlorpromazine combined with amitriptyline. Thus the value of antidepressants even for schizophrenics with definite depression has yet to be firmly substantiated.
Reference: Use of antidepressants in schizophrenia; BRITISH MEDICAL JOURNAL; 1037
Antidepressants in Schizophrenia
Anxiety Anxiety disorders are extremes of normal
anxiety.
Occur when normal anxiety system becomes dysregulated - excessive, inappropriate or deficient
Causes− Genetic linkage− Structural abnormalities in the brain
− Neurochemical dysfunction
Generalized Anxiety Disorder (GAD)
Is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it
Worries are accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes
Usually begins at an earlier age and symptoms may manifest themselves more slowly than in most other anxiety disorders
Reference: NPS News; ISSN 1441-7421 October [email protected]
Antidepressant as a Generalized Anxiolytics
Recently, Venlafaxine XR became the first agent approved to treat both mood in depression and anxiety in GAD
Antidepressants are more effective than benzodiazepines for treating the uncontrollable worry associated with GAD
They do not produce tolerance or dependence
Panic Attacks Sudden, unexpected attacks –
overwhelming anxiety
Physical symptoms− Palpitations, chest pain, choking
sensation, dizziness, breathlessness, tingling in the hands and feet, sweating, faintness, nausea or abdominal distress
Emotional and behavioral symptoms− Fear of dying, losing control, going
mad, feeling of unreality
Panic attacks -Management SSRIs - Paroxetine, Citalopram
Benzodiazepines - good short term relief but high risk of dependency - Alprazolam
TCAs - Imipramine, Clomipramine
MAOIs - especially in mixed panic depressive states
Obsessive Compulsive Disorders
Repetitive unwanted obsessions or compulsive acts
Obsession is recurrent and intrusive thought, feeling, idea, image or impulses−Usually distressing−Extreme need for
orderliness−Persistent doubts
Obsessive Compulsive Disorders
Pharmacotherapy•SSRIs, Clomipramine•Augmentation with Quetiapine or Risperidone•Clonazepam
Post-Traumatic Stress Disorder
Typically occur after a traumatic event (especially crimes, war)− Symptoms : re-experiencing trauma
(dreams, flashbacks), avoidance of anything associated with trauma, and constant state of hypervigilance
Causes: Major Negative events in life− War− Childhood abuse− Accidents− Earthquakes− Floods
PTSD - management
SSRIs
Serotinergic TCAs
Zoloft (sertraline) has FDA approval for this indication
Phobias Intense, irrational fear of
a specific object or situation
Types of phobia:− Agoraphobia− Social phobia− Specific phobias
Antideperssants for Anxiety
Psychological therapies should be the first choice for most anxiety disorders to control symptoms and improve functioning.
If these do not provide sufficient benefit and drug therapy is needed, an antidepressant may be added− Serotonin Selective Reuptake Inhibitors (SSRIs) -
E.g. : Fluoxetine− Serotonin-Norepinephrine Reuptake Inhibitors
(SNRIs) - E.g. : venlafaxine− Atypical Antidepressants− Tricyclic Antidepressants (TCAs)− Monoamine Oxidase Inhibitors (MAOIs)
Why Antidepressants for Anxiety??
Reference: Stephen M. Stahl; Mergers and Acquisitions among PsychotropicsClinical Neuroscience Update; J Clin Psychiatry 60:5, May 1999 [email protected]
Antidepressants for Anxiety??
Reference: Stephen M. Stahl; Mergers and Acquisitions among PsychotropicsClinical Neuroscience Update; J Clin Psychiatry 60:5, May 1999
Eating disorders
An eating disorder is a condition which affects an individuals eating habits, either as a result of their own doing (self-inflicted), or as a bodily reaction to the consumption of food
Types:− Anorexia Nervosa (It is an obsessive fear of
gaining weight )− Bulimia Nervosa (A person with bulimia eats
a lot of food in a short amount of time)− Binge Eating (A binge eating disorder is
characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full)
Epidemiology Primarily affect women and girls, boys and men are
also vulnerable
Lifetime prevalence− Anorexia nervosa: 1%− Bulimia nervosa: 1-2%− Binge-eating disorder: 2.6%
5-10% of the obese population
Women vs. men− Anorexia and bulimia nervosa
10x more common in women
− Binge eating disorder 33% of those diagnosed are men
Median age onset: − Anorexia & bulimia: 18-21 years old
Role of Antidepressant ineating disorders
Trials have shown that binge eating and purging in people with bulimia nervosa can be reduced with antidepressant medicines
They can also improve a person’s perception about their body and weight
National Prescribing Service Limited; Australian Prescriber; 2 august 2005
Related Documents
