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Medication (Tips for preventing non-adherence
Wright et al, 2006 (Create…
Medication
Tips for preventing non-adherence
Wright et al, 2006
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Common medications
SSRI's (3rd gen)
Citalopram, Fluoxetine, Sertraline
SNRI's (3rd gen)
Venlafaxine, Duloxetine
Tricyclics (1st gen)
Amitriptyline, clomopramine, dosulepin
MAOI's (2nd gen)
Phenelzine, tranylcypromine
Benzodiazepines
Diazepam, clonazpam, lorazepam
Beta-blockers
Propranolol, oxprenolol
NICE Guidelines
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PTSD
Not recommended, use Trauma Focused Psychological Therapy
Depressive symptoms of mild depression
Do not use ADM routinely to treat because the risk-benefit ratio is poor, but consider them for:
- a past history of moderate/severe depression
- initial presentation of sub threshold depressive symptoms that have been present for a long period (typically 2 or more years)
- sub threshold depressive symptoms or mild depression that persists after other interventions
Moderate or severe depression
Provide a combination of ADM and HI psychological intervention, choice of intervention should be influenced by:
- Duration of episode of depression and trajectory of symptoms
- Previous course of depression and response to treatment
- Likelihood of adherence to treatment and potential side effects
- Persons treatment preference and priorities
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Evidence base
:check:NICE (2009)
States that telephone support improves outcomes and satisfaction - the provision of tel support. informed by clear treatment protocols should be considered for all patients in particular for managing ADM regime
:check:Hunkeler, 2000
strong evidence that tel support improves outcomes and satisfaction in patients taking ADM
ESPCECIALLY WHEN care is organised collaboratively Gilbody, 2004
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:check:Lecompte, 1995
CBT can improve people taking ADM
SSRI's
Selective Serotonin Reuptake Inhibitors
- NICE (2009) guidelines as 1st line of choice for depression
- Most commonly prescribed antidepressant
- Developed in late 1980s
- Act by inhibiting the reuptake of the neurotransmitter Serotonin therefore increasing availability in synapse
Pro's
- Once daily dosage therefore improves compliance
- Safe in overdose
- Relatively side effect free
- Non-sedating
- Additional benefits for co-morbid conditions (OCD, GAD)
Con's
- Side effects can include: sedation, agitation, weight/appetite changes, sleep disturbances, headaches etc
- Can cause serotonin syndrome (when serotonin in your brain become too high causing confusion, twitching, sweating or even temperature, seizures, arrhythmia, unconsciousness)
- Is it over prescribed?
SNRI's
Serotonin and Norepinephrine Reuptake Inhibitors
- 2nd line of treatment when one or two SSRI's have failed for depression
- Developed in the 1990's
- Acts on both serotonin and noradrenergic pathways to block re-uptake and increase synaptic availability
Pros
- Useful in treatment resistant depression
- Can have sedative effects for clients with insomnia
Cons
- Costly
- Less safe in overdose
- Side effects
Benzodiazepines
Benzodiazepines
- Historically over prescribed
- Act by building GABA (gamma animobutyric acid) neurotransmitters therefore modulating the functioning of the GABA system
- Divided into long and short acting depending on half life
- Reduces pathological anxiety, agitation, tension and anxiety
Pros
- Effective and well tolerated
- Few side effects
- Aids sleep
- Reduces muscular tension in anxiety
Cons
- Risk of addiction/habituation especially with short acting
- Inhibition of psychological adjustment e.g bereavement
- Impairment of functioning e.g driving/operating machinery
- Other side effects such as sedation and paradoxical effects (increased anxiety, aggression, withdrawal)
PWP's role
Richards & Whyte, 2008
To assist patients in making the best decision on medication use by:
- gathering information on patients attitudes, use, outcomes, and side effects
- giving information regarding appropriate use of medication
- negotiating shared decisions on patients medication usage
They do not make independant decisions about prescribing (e.g stopping meds, changing dosage)
If there are dangerous side effects then:
- advise to temporarily discontinue
- inform GP of side effects
- strongly advise patient to make GP appointment
- discuss with supervisor as soon as possible
Exposure
Papworth et al, 2013
Anxiety medication can be helpful initially in allowing clients to be able to gather additional information but generally not recommended (Salkovskis, 2007)
During exposure/behavioural experiments, anxiety medication may prevent clients from fully experiencing their anxiety and so may reduce the effects of treatment (safety seeking behavior)