Antidepressant

Management of psychological disorders Medical treatment Psychotherapy Support groups

Depression Point prevalence –5-6 % Life time prevalence –10 % Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

Amine hypothesis of mood Major depressive disorders results from functional deficiencies of norepinephrine or serotonin Most antidepressant drugs enhance the action of NE and serotonin (5-HT)

Drawbacks of amine hypothesis Postmortem studies do not reveal any decrease in NE or 5-HT Actions within hours effects within weeks Bupropion has minimal effects on NE or 5- HT

Antidepressants Little difference in efficacy Choice depends on –Presence of concomitant disease –Existent therapy –Suicidal risk –Response to previous therapy

Depression Major depressive episodes (endogenous) Tricyclic and SSRIs Popularity due to well tolerance For severe inpatient –Tricyclic antidepressant Electroconvulsion therapy (ECT)

Side effects Tachycardia Postural hypotension Sedation Sexual dysfunction Very narrow therapeutic window

Hyponatraemia and antidepressant therapy Hyponatraemia (usually in the elderly and possibly due to inappropriate secretion of antidiuretic hormone) has been associated with all types of antidepressants However, it has been reported more frequently with SSRIs than with other antidepressants. The CSM has advised that hyponatraemia should be considered in all patients who develop – drowsiness, confusion, or convulsions while taking an antidepressant.

Suicidal behaviour and antidepressant therapy The use of antidepressants has been linked with suicidal thoughts and behaviour children, young adults, and patients with a history of suicidal behaviour are particularly at risk. Where necessary patients should be monitored for suicidal behaviour, self-harm, or hostility, Particularly at the beginning of treatment or if the dose is changed.

MAO inhibitors Drug interactions MAO and tyramine Cheese, chicken liver, beer and red wine –Headache –Tachycardia –Nausea –Arrythmia

St John's wort Hypericum perforatum Unlicensed indication Mild depression Active ingredient Drug interaction

Depression Major depressive episodes (endogenous) Tricyclic and SSRIs Popularity due to well tolerance For severe inpatient –Tricyclic antidepressant Electroconvulsion therapy (ECT)

Depression MAO inhibitors and atypical depression –Labile mood, rejection sensetivity, appetite disorders 4-6 weeks before change treatment Drug washout

Panic disorders and phobias Antidepressant are generally used Imipramine and MAOIs SSRIs Benzodiazepines

Obsessive-compulsive disorders SSRIs are especially effective –Fluoxetine –Fluvaxamine Clomipramine –SNRIs

Enuresis Tricyclic antidepressant Imipramine Not preferred approach

Chronic pain Tricyclic is clinically useful SNRIs –Venalafaxine –Duloxetine SSRIs are not effective

Unresponsive patients 5 Ds

Diagnosis Drug Dose Duration of treatment Different treatment