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NS 48 - Anxiolytics, antidepressants, antipsychotics 1 (i) (ICD10…
NS 48 - Anxiolytics, antidepressants, antipsychotics 1 (i)
ICD10 depression criteria
symptoms for @ least 2 wks
core symptoms
depressed mood
anhedonia
decreased energy
other symptoms: disturbance in sleep/weight/appetite, psychomotor retardation/agitation, decreased self-esteem, poor concentration, guilt/self-reproach, suicidal
mild: 4 symptoms (incl 2 core)
moderate: 6 symptoms (incl 2 core)
severe: 7 symptoms (incl all 3 core)
Monoamine hypothesis for depression
caused by decreased 5HT + NA
animal + human studies show that increasing 5HT + NA boosts mood
reserpine = antihypertensive
reduces 5HT + NA
SE = depressive symptoms
however not entire picture...
antidepressants have a lag phase (no clinical effect) of 2-3 wks
MOA relies on more that just increasing 5HT (e.g. maybe 5HTR density increases over wks?)
no antidepressant works immediately
individual drugs have same clinical efficacy yet different pharmacological efficacies
e.g. 1 drug may block 5HT reuptake more efficiently, but an increased clinical benefit won't be observed
Treating depression
Non-pharmacological
CBT
interpersonal therapy
combined therapy
Pharmacological
for moderate to severe cases
choice depends on anticipated adverse effects, drug interactions, comorbidities, patient's perception, previous success with a drug (represcribing common)
1st line normally SSRIs
2+ wks before antidepressant effect
ECT
for severe/resistant cases
TCAs
e.g. amitriptyline, imipramine
inhibit NA + 5HT reuptake @ mucarinic/cholingeric, alpha-adreno + histamine Rs (lots of Rs -> more SEs -> poor tolerability)
today more commonly prescribed for neuropathic pain
SEs: sedation (histamine Rs blocked, can help with insomnia), postural hypotension (alpha Rs blocked, and for old people, falls + fractures), antichol effects (xerostomia, constipation, blurred vision)
toxic overdose: cardio toxicity (can occur @ normal doses too) -> prolonged QT interval -> dysthmias
SNRI
e.g. Venlafaxine
inhibits presynaptic uptake of 5HT + NA
lacks sedative + anti-chol SEs
high dose must be given
SEs = dose related hypertension + nausea
Mirtazapine
presynaptic alpha 2 adrenoR antagonist
increases central 5HT + NA
SEs = sedation + weight gain
Agomelatine
selective 5Ht R antagonist
not many SEs
melatonin R agonist
St John's Wort
evidence-based herbal treatment
induces hepatic enzymes
! drug interactions
in health shops: no regulation of active ingredient dose