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Drugs used in the treatment of affective disorders

Drugs used in the treatment of affective disorders. Dr. Vidumini De Silva. Disorders of the mood. Depression Mania Manic depressive psychosis. Depression and anti depressanats. monoamine hypothesis

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Drugs used in the treatment of affective disorders

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  1. Drugs used in the treatment of affective disorders Dr. Vidumini De Silva

  2. Disorders of the mood • Depression • Mania • Manic depressive psychosis

  3. Depression and anti depressanats • monoamine hypothesis • endogenous depression is due to deficiency of CNS noradrenergic or serotonergic activity or transmission • drugs used in depression elevates the level of these

  4. Antidepressanats • Tricyclic antidepressants • Monoamine oxidase inhibitors(MAO) • Selective serotonin reuptake inhibitors(SSRI) • SSNRI

  5. Tricyclic antidepressanats • Inhibit the reuptake of noradrenaline and 5 hydroxytryptamine in brain. • Take a week or more to show there antidepressant effect • Have anticholinergic and anti histaminic effects. • Best given one daily oral dose at night • treatment is usually started with a small dose at night and increased at 2 weekly intervals.

  6. Indications for use • Depression • Neuralgias • Nocturnal enuresis in children • Irritable bowel syndrome • Some forms of headache

  7. Adverse effects • Dry mouth,blurring of vision,constipation and difficulty in micturition • CVS effects tachycardia. Arhythmias • May precipitate epilepsy • confusion in the elderly

  8. Monoamine oxidase inhibitors • MAO is one of the two main enzymes involved in the metabolism of 5HT and catecholamines • in depression not responding to other medication

  9. SSRI’s • Less side effects compared to Tricyclics and MAO inhibitors specially anticholinergic effects • Doesn’t offer greater efficacy than TCA in depression • eg Fluoxetine, Fluvoxamine, Paroxetine, Citalopram, Sertraline

  10. SSRI • Used in Depression, Panic disorders, Bulimia nervosa, Obsessive compulsive disorder and social phobias. • Venlafaxine is a SSNRI used in depression and anxiety disorder

  11. Side Effects • Gastrointestinal side effects are common Nausea Vomiting Diarrhoea Constipation Abdominal pain

  12. Venlafaxine • SSNRI • Less sedating • Less anticholinergic effects • Should be used with caution in IHD and hypertension

  13. Drugs used in manic depressive psychoses • Lithium • Carbamazepine • Sodium valproate

  14. Lithium • Effective in the prophylaxis of manic depressive psychoses,unipolar depression and treatment of acute mania • Well absorbed from the gut and eliminated unchanged in urine • Has a narrow therapeutic index. • Needs the monitoring of plasma concentrations. Toxicity is common if levels >1.5mmol/l • CNS side effects like tremor ,giddiness and ataxia may be the early features of toxicity.

  15. Carbamazepine • Used in the prophylaxis of manic depressive psychoses • Used In patients who cannot tolerate lithium or who do not respond to lithium

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