Transcript Selective Serotonin Reuptake Inhibitors

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‫مكانيسم‌هايي‌كه‌داروها‌موجب‌درمان‌اختالالت‌روان‌پزشكي‌‬
‫مي‌شوند‬
‫•‬
‫•‬
‫•‬
‫•‬
‫•‬
‫حاضر)‪:‬‬
‫تاثير‬
‫بر‬
‫(حال‬
‫اصلي‬
‫مكانيسم‬
‫‪ Neurotransmission‬است‪.‬‬
‫‪ :Neurotransmission‬آزاد سازي يك واسطه‬
‫نروني(نروترانسميتر) و اتصال آن به نرون گيرنده در‬
‫نرون بعدي و ايجاد تغييرات در آن‪.‬‬
‫كليه ارتباطات در مغز ناشي از تعامل ميان نرون‌ها است‪.‬‬
‫اين ارتباط به صورت انتقال پيام‌هاي الكتريكي است‪.‬‬
‫انتقال پيام الكتريكي از يك نرون به نرون ديگر توسط در‬
‫اتصال دهنده‌هاي شيميايي انجام مي‌شود‪.‬‬
Psychopharmacology : history
“if we understand what is broken, it should be
possible to fix it.”
Despite that the chemical pathology of psychiatric
and psychosomatic diseases near the end of the
20th century is still rudimentary, many excellent
medications are now available.
How were these drugs found and developed?
psycho tropics
Medications used to treat psychiatric disorders
are referred to as psychotropic.
 other names: (Neuroleptics, tranqualizers)
In us every 6 women and 14 men use a
psychoropics.
Understanding of how the brain works led to :
more effective, less toxic, better tolerated,
specifically targeted agents.
psycho tropics 2: classification
According to:
Clinical application: antidepressants, antipsychotics,
mood stabilizers, anxiolytics, hypnotics, cognitive
enhancer, stimulants
Structure: tricyclics
Mechanism: monoamine oxidase inhibitors
History: traditional, first generation
Uniqueness: atypical
Depression: biological Hypotheses
Serotonin: functional or absolute deficiency in
serotonin (Sr)
Catecholamine: functional or absolute
deficiency in Norepinephrine (NEP), dopamine,
Permissive hypothesis: diminished Sr gives
permission for a superimposed NEP deficiency
Beta adrenergic hypothesis: increased
beta-adrenergic receptor sensitivity
Antidepressant:Classification
 Tricyclic antidepressants (TCA)
 MAO inhibitors
 Second/third generation or atypical ADs
 Selective serotonin reuptake inhibitors
(SSRIs)
 others
Tricyclic Antidepressants
 Amitriptyline HCl
 Coated tablet 10mg, 25mg; scored F.C. tablet 50mg,100 mg
 Clomipramine HCl
 Coated tablet 10mg, 25mg, 50mg, 75mg
 Desipramine HCl
 Coated tablet 25 mg
 Nortriptylline
 Tablet 10mg, 25mg
 Imipramine
 Coated tablet 10mg, 25 mg, 50mg; injection 25mg/2ml
 Doxepin
 Capsule 10mg, 25mg; F.C. tablet 10mg, 25 mg
Selective Serotonin Reuptake Inhibitors (SSRIs)
 Fluoxetine
Capsule 1mg, 20mg
 Fluvoxamine
 Tablet 50mg, 100mg
 Citalopram
 Tablet 20mg, 40 mg
 Sertralin: 50, 100

 Paroxerin:
Other Antidepressants
 Trazodone
Tablet 50mg
 Maprotiline
Tablet 25mg, 75mg
 Bupropion
Tablet 75mg
 Venlafaxine
Tablet 37.5mg, 75mg, 150mg
Benzodiazepines (BZDs)
• Alprazolam
• Clonazepam
• Lorazepam
Tablet 0.5 mg, 1 mg
• Oxazepam
• Flurazepam
• Diazepam
Tablet 10mg
• Clordiazepoxide
• Midazolam
Tablet 5mg, 10mg
Tablet 1mg, 2mg
Tablet 1mg, 2mg
injection 2mg/ml, 4mg/ml
Capsule 15mg
Tablet 2mg, 5mg
10mg;injection 5mg/ml
Syrup 2mg/ml, injection 5mg/ml
Anti- Psychotic Medication
• Anti- psychotic medication is used to control psychosis
• Psychological treatments are more effective when medication
is taken as well
• Medication is only ONE PART of a comprehensive package of
care that aims to help keep a person stable and to live as
normal a life as possible
• Anti- psychotic medications are MOST EFFECTIVE at
controlling POSITIVE SYMPTOMS (hallucinations, delusions) less effective at treating negative ones (apathy, withdrawal
etc)
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Therapeutic guideline
• Antipsychotics have revolutionized
treatment of schizophrenia
• Two major group:
Dopamin antagonista (Das): (haloperidol,
perphenazine, trifluoperazine, fluphenazine,
thioridazine, chlorpromazine,…)
Serotonin Dopamine Antagonists:
( risperidone, olanzapine, clozapine,quetiapine,…)
Mood stabilizers
Indications: Bipolar, cyclothymia,
schizoaffective, impulse control and
intermittent explosive disorders.
•Classes: Lithium and anticonvulsants
• Which you select depends on what you
are treating and again the side effect
profile.
I. Lithium
• 1st medication for manic-depressive disorder
• Discovered by Cade in Australia
• Neurotoxic if overdose – thus serum level
monitoring needed
• Common side-effects: polyuria & polydipsia, hand
tremor
• Toxic side-effects: neuroleptic malignant
syndrome (+ haloperidol)
• ?controversy as 1st line treatment (especially in
primary care)
Lithium- how to use it
1st medication for manic-depressive disorder
Before starting :Get baseline creatinine, TSH
and CBC. In women check a pregnancy test
•During the first trimester is associated with
Ebstein’s anomaly 1/1000 (20X greater risk than
the general population)
􀂾 Monitoring: Steady state achieved after 5 days
Check 12 hours after last dose.
Once stable check q 3 months and TSH and creatinine q 6
months.
􀂾 Goal: blood level between 0.6-1.2
Lithium toxicity
• Mild- levels 1.5-2.0 see vomiting, diarrhea,
ataxia, dizziness, slurred speech,
nystagmus.
• Moderate: 2.0-2.5 nausea, vomiting,
anorexia, blurred vision, clonic limb
movements, convulsions, delirium,
Syncope
• Severe: >2.5 generalized convulsions,
• oliguria and renal failure
Various anti-epileptics
• valproate (divalproex) - esp. mania/mixed
• carbamazepine /oxcarbazepine - esp.
mania/mixed
• lamotrigine - esp. BP-D/rapid cycling
• topiramte - mania/mixed, esp. rapid cycling
• Gabapentine/pregabalin - analgesic
& ?anxiolytic effect