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Biological Therapies
SSRIs
Fluoxetine
Fluvoxamine
Paroxetine
Citalopram
Sertraline
escitalopram
SSRIs
Share no molecular features
Half life:20 hours&3days
Hepatic metabolism
Specific activity in the inhibition of serotonin
reuptake
No activity on other receptors
Occurring 90% of clinical response at the
starting dose
SSRIs
Therapeutic Indications
Depression
Anxiety dis.
Eating dis.
PMS
Premature
ejaculation
Paraphilias
ADHD
Autistic dis.
chronic pain
syndromes.
Psychosomatic
conditions
SSRIs
Adverse Effects
Sexual dysfunction
GI effects
Headache
CNS effects
Antichoinergic effects
Hematologic effects
Electrolyte and glucose disturbances
Endocrine and allergic reactions
Serotonin syndrome
Hyperthermia
shivering
Diarrhea
Agitation
Hyperreflexia
Myoclonus
Seizures
Rigidity
Delirium
coma
SSRI withdrawal
Dizziness
Weakness
Nausea
Headache
Rebound depression
Anxiety
Insomnia
Poor concentration
SSRIs
Drug-drug interactions
Dosage and administration
TCAs
 Tertiary amines:
Imipramine
Amitriptyline
Trimipramine
Doxepine
Clomipramine
 Secondary amines:
Desipramine
Nortriptyline
Protriptyline
 Tetracyclic drugs:
Maprotiline
Amoxapine
TCAs:
Half life :10-70h(longer HL in
Nortriptyline,Maprotiline)
Hepatic metabolism
Blocking of reuptake of serotonin and NE
Antagonism of muscarinic,H1,alfa1,2
Type A antiarrhytmic effects
40-fold difference in plasma concentrations in
different persons
TCAs
Therapeutic Indications
MDD
Panic disorder with Agoraphobia
GAD
OCD
Eating dis.
Pain dis.
Sleep dis.
TCAs
Adverse Effects
Psychiatric effects
Anticholinergic effects
Sedation
Autonomic effects
Cardiac effects
Neurological effects
Allergic and hematological effects
Weight gain
TCAs
Drug – Drug Interactions
 Antihypertensives
 Antipsychotics
 CNS depressants
 Sympathomimetics
 OCPs
 SSRIs
 Lithium
 Primidon
 Ascorbic Acid
MAOIs
Phenelzine
Isocarboxazid
Tranylcypromine
Selegiline
MAOIs
Therapeutic Indications
Panic disorder with agoraphobia
Social phobia
PTSD
Atypical depression
Eating dis.
Pain dis.
MAOIs
Adverse Reactions
Or HTN
Insomnia
Weight gain
Edema
Sexual dysfunction
Hypertensive crisis
paresthesia.,myoclonus,muscle pain
Tyramine-Rich Foods
Cheese
Fish
Sausage
Pates
Mortadella
banana
drugs to be avoided
Antiasthmatics
Antihypertensives
Buspirone
Levodopa
Opioids
Sympathomimetics
SSRIs
Clomipramine
Mood Stabilizers
Lithium
Sodium Valproate
Carbamazepine
Lamotrigine
Topiramate
Gabapentin
Calcium Channel Inhibitors
lithium
No binding to plasma proteins
No metabolism
Slow crossing BBB
Half- life : 20 hours
Decreasing of renal clearance in renal
insufficiency and puerperium / increasing
during pregnancy
Lithium
therapeutic indications
 Bipolar mood disorder
 Schizophrenia/schizoaffective disorders
 MDD
 Aggression
 PMS
 Bulimia
 Binge drinking
 BPD
 OCD
 PTSD
 Trichotilomania
Lithium
maintenance treatment


1.
2.
3.
4.
5.
6.
7.
After the second episode of BMD1
After the first episode in :
Adolescents
High suicide risk
Poor support systems
No percipitating factors
Sudden onset
First episode of mania
FH of BMD1
LITHIUM
Adverse effects
Gastrointestinal effects
Neurological effects
Renal effects
Cardiac effects
Thyroid effects
Dermatological effects
Lithium toxicity
 Coarse tremor
 Dysarthria
 Ataxia
 GI symptoms
 Cardiovascular changes
 Renal dysfunction
 Fasciculations
 Myoclonus
 Seizures
 coma
LITHIUM
Drug interactions
 DAs
 Anticonvulsants
 Thiazids
 Potassium sparing
diuretics
 NSAIDs
 ACEIs
 Calcium channel
inhibitors
 Osmotic diuretics
 Loop diuretics
 Xantins
 Carbonic anhydrase
inhibitors
Lithium
Clinical Guidelines
Initial medical work up
Dosage
Serum concentrations
Discontinuation
Patient education
Sodium valproate
Effects on GABA neurotransmitter system.
Therapeutically effective at serum
concentrations above 50 -100 microgr/ml
Half-life : 8-17 hours
Maintaining effective plasma concentrations
with dosing 1 to 4 times a day
Sodium Valproate
Therapeutic Indications
Bipolar 1Disorder (acute – prophylaxis )
Schizoaffective Disorder
Behavioral dyscontrol syndromes
Dementia
Organic brain diseases
TBI
Other mental disorders
Sodium Valproate
Adverse Reactions
 GI effects
 Sedation
 Ataxia
 Dysarthria
 Tremor
 Weight gain
 Hair loss
 Elevation of liver
transaminases
 Thrombocytopenia
 Platelet dysfunction
 Hyponatremia
 Hepatotoxicity
 Pancratitis
 PCO
Sodium Valproate
Drug interactions
Lithium
Carbamazepin
Antidepressants
SDAs
DAs
Phenytoin
Phenobarbital
BZDs
Sodium Valproate
Administration
R/O liver and pancreatic disease
Dose on the first day : 250 mg
plasma concentrations : 50-100 mg/ml
Daily dose : 1200-1500mg
Mood-stabilizing effects appear between 5-15
days after initiation
Carbamazepine
Steady-state levels in 2-4 days on a steady
dosage
Half-life : 12-17 h after 1 month of
administration
Metabolized in liver
decreasing synoptic transmission
Reduction of currents through NMDA
channels
Antagonism of adenosine A1 receptors
Carbamazepine
Therapeutic Indications
Bipolar disorder (manic-depressive episodes)
Schizophrenia and schizoaffective disorder
Impulse-control dis.
PTSD
Alcohol and BZD withdrawal
Carbamazepine
Adverse Reactions
Blood Dyscrasias
Hepatitis
Exfoliative dermatitis
GI Effects
CNS Effects
Cardiac Effects
Hyponatremia
Carbamazepine
Drug Interactions
 SSRIs
 Anti psychotics
 Cimetidine
 Erythromycin
 Isoniazide
 Ketoconazole
 Verapamil
 allopurinol
 OCP
 TCAs
 Na-valproate
 Bupropion
 MAOIs
 Clomipramine
 Primidone
 Phenytoin
Carbamazepine
Treatment
CBC,LFT,ECG,Serum Electrolytes
Initiate with 200mg to 600-1200mg
Anticonvulsant Blood Concentration :
12microgr/ml
Laboratory Monitoring :CBC
,Billirubin,LFT,CBZ Level
4-
Carbamazepine
Treatment Discontinuation
WBC<3000/mm3
Erythrocyte Count < 4000000/mm3
PMN<1500/mm3
HCT <32%
HB<11gr/100ml
Reticulocyte Count<0.3 %
Serum Iron Concentration,150mg/100ml