Top Banner

Click here to load reader

Bipolar Disorder Depressive Disorders ... (F32.2) Severe depressive episode without psychotic symptoms (F32.3) Severe depressive episode with psychotic symptoms (F32.8) Other depressive

May 12, 2020

ReportDownload

Documents

others

  • Bipolar Disorder

    (F30) Manic episode

    (F30.0) Hypomania

    (F30.1) Mania without psychotic symptoms

    (F30.2) Mania with psychotic symptoms

    (F30.8) Other manic episodes

    (F30.9) Manic episode, unspecified

    (F31) Bipolar affective disorder

    (F31.0) Bipolar affective disorder, current

    episode hypomanic

    (F31.1) Bipolar affective disorder, current

    episode manic without psychotic symptoms

    (F31.2) Bipolar affective disorder, current

    episode manic with psychotic symptoms

    (F31.3) Bipolar affective disorder, current

    episode mild or moderate depression

    (F31.4) Bipolar affective disorder, current

    episode severe depression without psychotic

    symptoms

    (F31.5) Bipolar affective disorder, current

    episode severe depression with psychotic

    symptoms

    (F31.6) Bipolar affective disorder, current

    episode mixed

    (F31.7) Bipolar affective disorder, currently in

    remission

    (F31.8) Other bipolar affective disorders

    • Bipolar II disorder

    • Recurrent manic episodes NOS

    (F31.9) Bipolar affective disorder, unspecified

    Depressive Disorders

    (F32) Depressive episode

    (F32.0) Mild depressive episode

    (F32.1) Moderate depressive episode

    (F32.2) Severe depressive episode without

    psychotic symptoms

    (F32.3) Severe depressive episode with

    psychotic symptoms

    (F32.8) Other depressive episodes

    • Atypical depression

    • Single episodes of "masked"

    depression NOS

    (F32.9) Depressive episode, unspecified

    (F33) Recurrent depressive disorder

    (F33.0) Recurrent depressive disorder, current

    episode mild

    (F33.1) Recurrent depressive disorder, current

    episode moderate

    (F33.2) Recurrent depressive disorder, current

    episode severe without psychotic symptoms

    (F33.3) Recurrent depressive disorder, current

    episode severe with psychotic symptoms

    (F33.4) Recurrent depressive disorder, currently

    in remission

    (F33.8) Other recurrent depressive disorders

    (F33.9) Recurrent depressive disorder,

    unspecified

  • Other Mood Disorders

    (F38) Other mood (affective) disorders

    (F38.0) Other single mood (affective)

    disorders

    • Mixed affective episode

    (F38.1) Other recurrent mood (affective)

    disorders

    • Recurrent brief depressive

    episodes

    (F38.8) Other specified mood (affective)

    disorders

    (F39) Unspecified mood (affective) disorder

    Adjustment Disorders

    (F43.20) Adjustment disorder, Unspecified

    (F43.22) Adjustment disorder, With anxiety

    (F43.21) Adjustment disorder, With depressed

    mood

    (F43.24) Adjustment disorder, With disturbance

    of conduct

    (F43.25) Adjustment disorder, With mixed

    anxiety and depressed mood

    (F43.25) Adjustment disorder, With mixed

    disturbance of emotions and conduct

  • Antidepressants

    Drug Dosage FDA

    indication

    Benefits Risk/side effects PEARLS Special Considerations

    SSRIs

    Fluoxetine

    (Prozac)

    10-80mg/day

    (start 20mg)

    Depression,

    Bulimia,

    OCD, Panic

    disorder

    Activating, non-

    selective,

    inexpensive, long ½

    life, little to no

    discontinuation

    syndrome

    Headache,

    Nausea, Tremor,

    Sweats, Sexual

    Side Effects,

    Dulling of affect;

    long ½ life with

    active

    metabolite; most

    likely to induce

    mania

    Great for those with

    substance abuse disorder or

    long term depression

    and/or treatment resistance

    depression.

    Dose in the morning

    Not very serotonin

    selective, also works on

    norepi. Get big “bang for

    your buck”

    Potent 2D6 inhibitor

    Citalopram

    (Celexa)

    10-40mg/day

    (over 40mg

    black box

    warning). Start

    20mg

    Depression Mildly sedating,

    Well tolerated, does

    not interact with

    most meds, easy

    dosing range,

    intermediate ½ life

    Headache,

    Nausea, sexual

    side effects,

    sedating; may

    not be as

    effective since it

    is very selective;

    QT prolongation

    Great for those with mild

    depression, or first episode

    depression. Extremely

    serotonin selective, no

    norepi effects.

    Can dose morning or

    bedtime

    Impairs Platelet Aggregation;

    Risk of SIADH

    Escitalopram

    (Lexapro)

    10-20mg/day;

    10mg Lexapro=

    20mg celexa

    Depression,

    Generalized

    Anxiety

    Disorder

    Mildly sedating,

    Very selective,

    minimal side effects,

    well tolerated, least

    sexual side effects of

    SSRIs

    Headache,

    Nausea

    Will use when need a very

    selective serotonin agent

    but moderate-severe

    depression.

    Sertraline

    (Zoloft)

    50-200mg Day

    (usually start

    100mg/day)

    Depression,

    Panic, OCD,

    PMDD,

    PTSD, Social

    Anxiety

    Activating, only

    SSRI safe in

    cardiac disease,

    short ½ life

    Most GI side

    effects; Sexual

    Side Effects,

    Large dose

    range, BID

    dosing for

    tolerance at

    200mg/day; max

    absorption

    requires full

    stomach

    Caution: May cause

    agitation in the first week-2

    weeks of treatment

    especially in SSRI naïve

    patients. Start low, go slow,

    warn patients. Only take in

    the morning to start.

  • Antidepressants

    Paroxetine

    (Paxil)

    10-60mg/day Depression,

    GAD, OCD,

    Panic,

    PMDD,

    PTSD, Social

    Anxiety

    Mildly sedating;

    short ½ life; no

    active metabolite

    Headache,

    Nausea, sexual

    side effects,

    anticholinergic

    side effects;

    weight gain;

    discontinuation

    syndrome

    I usually do not use as a

    first line agent because of

    side effects and drug

    interactions.

    Potent 2D6 inhibitor

    Can potentiate bradycardia with

    metoprolol; can decrease

    analgesic effects with tramadol

    SNRIs

    Venlafaxine

    (Effexor)

    XR: 37.5-

    225mg Daily

    (don’t

    recommend IR)

    Depression,

    GAD, Social

    Anxiety,

    Panic

    Works well with

    anxiety, depression,

    ADD; Best 5HT to

    NE ratio; usually

    will know quickly if

    effective; weight

    neutral; short ½ life;

    renal clearance

    Severe

    discontinuation

    syndrome; Can

    raise BP; Risk

    with seizures;

    Many people

    cannot tolerate;

    some QT

    prolongation

    Start low, go slow. Warn

    about first week side

    effects: sweating, agitation,

    jaw clenching, dizziness,

    problems with sleep.

    About 10% of my patients

    can’t tolerate for various

    reasons

    Can take several weeks to wean

    off;

    Desvenlafaxine

    (Pristiq)

    50mg/day (can

    increase to

    100mg/day but

    limited benefit)

    Depression,

    Generalized

    Anxiety

    Disorder

    Better tolerated than

    Effexor; easy

    dosing; quick

    efficacy; works well;

    weight neutral

    Same as Effexor Will use when Effexor is

    clinically effective, but side

    effects are unbearable

    Same as effexor

    Duloxetine

    (Cymbalta)

    30-120mg/day Depression,

    Generalized

    Anxiety

    Disorder;

    Fibromyalgia;

    Chronic Pain

    Calming; quick

    efficacy

    Can increase

    blood pressure;

    can be overly

    sedating; poorly

    tolerated in some

    Great to use with chronic

    pain, fibromyalgia. Usually

    my first line for these

    people.

    Moderate 2D6 inhibitor

    Avoid in Renal and Hepatic

    Dysfunction

    TCAs

    Amitriptyline 25-300mg/day

    (QD or BID)

    Depression Sedating; very

    effective; can use to

    augment SSRI

    Sedating; cardiac

    effects;

    anticholinergic

    effects;

    orthostatic

    hypotension

    Works very well for sleep

    or pm anxiety. Can use in

    junction with SSRI

    (monitor for serotonin

    syndrome). Has serotonin,

    norepi and dopamine

    effects. Good for problems

    with concentration

    Major substrate of 2D6; avoid

    with Alpha-1 antagonists or

    Alpha-2 agonists; C/I in h/o MI

  • Antidepressants

    Nortriptyline 25-150mg/day Depression Sedating; very

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.