Antidepressants mood_stabilizers
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Transcript of Antidepressants mood_stabilizers
ANTIDEPRESSANTS & ANTIDEPRESSANTS & Mood StabilizersMood Stabilizers
Antidepressants
Actions:
Block the reuptake of serotonin and norepinephrine (neurotransmitters) so that more are available in the brain to transmit messages.
Antidepressants
Indications: Recurrent depressive disorders Psychomotor retardation Depression with no clear precipitating event Family history of depression Chronic pain Eneuresis
Antidepressants
Have a long half life and can often be given once a day.
Therapeutic effects of some may not be seen until 3-4 weeks.
Selective Serotonin reuptake Inhibitors (SSRIs)
Fluoxetine HCL (Prozac)
Non-tricyclic, less sedation, fewer side effects
Sertraline HCI (Zoloft)
Lower risk of toxicity in overdose, fewer side effects, shorter half-life than prozac
SSRI Antidepressants (cont’d.)
Paroxetine HCI (Paxil):
Effectiveness comparable to Imipramine (Tofranil), shortest half-life, safer for
elderly.
Fluvoxamine (Luvox)
Citalopram (Celexa)
Escitalopram oxalate (Lexapro)
SSRIs Block transport mechanism that
returns unbound serotonin left in synaptic cleft into the presynaptic neuron
Terminates transmission of the message carried by that receptor
When blocked, more serotonin is available to the postsynaptic receptor
SNRI (serotonin and norepinephrine reuptake inhibitor)
Effexor (Venlafaxine) inhibits serotonin & norepinephrine re-
uptake side effects include:
dizziness, migraine, weight gain
Serzone (Nefazadone) Trazodone HCL (Desyrel)
Serotonin Agonist reuptake inhibitor
Remeron inhibits serotonin & norepinephrine re-
uptake side effects include:
somnolence, dizziness, weight gain adverse effects: agranulocytosis,
neutropenia
Norepinephrine-Dopamine antagonist
Bupropion Hycrochloride (Wellbutrin) increases norepinephrine and dopamine Provides mild dopamine reuptake Blocks reuptake of norepinephrine does not affect serotonin reuptake does not inhibit monoamine oxidase
Nonselective norepinephrine-serotonin
reuptake inhibitors (Tricyclics)
Imipramine……………….Tofranil
Desipramine……………...Norpramine, Pertofrane
Amitriptyline……………..Elavil, Endep
Nortriptyline………………Pamelor, Aventyl
Protriptyline……………….Vivactil
Doxepin……………………Sinequan
Nonselective norepinephrine-serotonin reuptake inhibitors
Affect norepinephrine, serotonin acetylcholine and histamine receptors
Increase availability of norepinephrine, serotonin
Inhibit transport back into the presynaptic neuron
Side Effects: Antidepressants
Anticholinergic effects: Common and troublesome in tricyclics: interfere with patient compliance.
dry mouth constipation urinary hesitancy/retention
sweating drowsiness blurred vision
Cardiovascular: Postural hypotension, tachycardia, heart conduction defects.
Antidepressants – Side Effects
Anticholinergic effects: Closed angle glaucoma worsened Toxic: confusion, psychosis
Other:Weight gain, lowered seizure threshold, EPS
Overdose: 1000 – 4000 mg is fatal
Side Effects of Antidepressants(cont’d.)
Managing Side Effects of Tricyclic Antidepressants (Cont’d.)If these dangerous side effects occur, advise the patient either to call provider stop the medication, or reduce the dosage.
Orthostatic hypotension Marked, persistent sedation Atropine-like psychosis Cardiovascular conduction defect Seizures Severe anticholinergic effect: urinary retention, etc.
Antidepressant DrugsMAO Inhibitors:
phenelzine….…………Nardil
isocarboxazide ……….Marplan
tranylcypromine………Parnate
MAO Inhibitors
Actions: Monamine oxidase is an enzyme responsible for destroying epinephrine, norepinephrine and serotonin. MAO inhibitors block this enzyme. The effect is CNS stimulation and increased psychomotor activity.
symptoms relieved in 2-4 weeks
Potential hypertensive crisis it certain foods or medicines ingested
MAO Inhibitors(cont’d.)
Dietary restrictions necessary: foods high in
tyramine must be avoided: aged cheese, chicken
liver, beer, Chianti wine, cold or sinus medicines,
diet pills, blood pressure regulating meds. Severe
atypical headache is usually the first sign
Side effects: autonomic: orthostatic hypotention,
dizziness, increased appetite anticholinergic effects are
rare.
Antidepressant Drugs(cont’d.)
Psychostimulants
Methylphenidate Hydrochloride (Ritalin)
Dextroamphetamine Sulfate (Dexedrine)
Pemoline (Cylert)
Source: Gomez (1993)
Mood Stabilizers
Lithium Effective in manic excitement and preventative for
manic and depressive recurrences in bipolar patients. Also used in other psychiatric disorders that do not
respond to other drug therapies. Can lead to toxic reactions which may be fatal.
Blood level monitoring is necessary to maintain intherapeutic range.
Therapeutic levels range from .7 to 1.5. Higher levels are used to treat manic or psychotic excitement.
Lithium
Common Indications:Acute ManiaBipolar Prophylaxis
Probably Effective:Unipolar Prophylaxis
Possibly Effective:BulimiaAlcohol AbuseAggressive BehaviorSchizoaffective disorder
Lithium
Mechanism of ActionUnclear
DosingNarrow therapeutic
indexMonitor blood levels q 2-3 days initially then q 1-3 months levels must be
below 1.5mEq/L
Adverse Effects
Excessive drug
levels
Therapeutic drug
levels
Drug Interactions
Diuretics
Anticholinergic
drugs
Mood Stabilizers
Lithium(cont’d.)Side effects:Neuromuscular and CNS: tremor (fingers) cog wheeling and mild parkinsonism possible. sluggishness and forgetfulness treated by decreased dose. GI: Chronic nausea, diarrhea, take with food.Weight gain and endocrine effects: Increased appetite and
excessive thirst may cause weight gain - transitory Decreased thyroid levels: Thyroid medication may be necessary.
Renal: polyuria and polydypsia may occur. Dose of drug should be lowered.
Mood Stabilizers
Lithium(cont’d.)Allergic rashes – may be due to some ingredient in the
capsule. Drug form can be changed to liquid citrate. Cause birth defects
Lithium
Common Causes for Increased Lithium Level:Decreased sodium intakeDiuretic therapyDecreased renal functioningFluid-electrolyte loss (sweating, diarrhea,
dehydration)Medical illnessOverdose
Mood Stabilizers
Anticonvulsants – used to promote mood stabilizationCarbamazepine (Tegretol): Used in patients who do not respond to lithium. More effective for rapid-cycling bipolar patients (4 or more affective episodes per year).Blood levels should be monitored weekly for the first eight weeks. Dose should be adjusted to maintain a serum levels of 6-8 mg/L.
Mood Stabilizers(cont’d.)
Side effects: sedation, mal coordination (common) agranulocytosis, aplastic anemia (rare) regular blood counts unnecessary . Watch for fever and sore throat.
Can cause increased liver enzymes but serious hepatic problems rare.
Associated with birth defects.
Mood Stabilizers(cont’d.)
Valproate (Valproic acid) – Depakene, Depakote used in manic and schizoaffective patients (treatment resistant) Improvement occurs in 1-2 weeks. Blood levels should be obtained every few days until 50 mg/l is reached.
Side effects – Major concern – severe hepatotoxicity (may be fatal). Liver function tests should be done every month. Decreased platelet levels can occur.Associated with neural tube birth defects. Very toxic when taken in suicide attempt.
Lamitrogine- lamictal Anit-convulsant used for type 2 BPD
Side effect- rash, nausea, vomitting and diarrhea.
Mood Stabilizers(cont’d.)
Clonazepam (Klonopin) – Benzodiazepine which is useful in treating acute mania
Side effects: sedation, atoxia, disinhibition effect.