Gooden Center - Best Treatment Center For Women’s Mental Health

Category: Others/ Misc

Presentation Description

Visit Gooden Center if you are in search of the best treatment center for women’s mental health. Life becomes more challenging when you are suffering from mental disorders like bipolar disorder, depression, anxiety, borderline personality disorder, dissociative disorders and self-harm However, these conditions can be treated with partial hospitalization and intensive outpatient programs. Visit our website for more details.


Presentation Transcript

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Effective approach in treatment of anxiety and depression The road to recovery

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Mechanism of anxiety • Overactivation of brain neurotransmission and neuronal firing glutamate/calcium influx • Underinhibition of brain neurotransmission and neuronal firing GABA • Both

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• Generalized anxiety disorder • Obsessive-compulsive disorder • Panic disorder • Post-traumatic stress disorder • Social phobia or social anxiety disorder Anxiety disorders - Types

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Definition • Depression is a common mental mood disorder characterized by sadness loss of interest or pleasure feelings of guilt or low self- worth disturbed sleep or appetite feelings of tiredness and poor concentration.

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Epidemiology • Chances of developing a depressive illness are estimated to be 1 in 5 for women and 1 in 10 for men • The WHO estimated that within 20 years recurrent depressive disorder will be the second most serious cause of morbidity and burden of disease in the world. • Depression affects approximately 350 million people worldwide constituting a major portion of mental health disorders. • According to the World Mental Health Survey approximately 6 people aged 18 years and above have had an episode of depression in the previous year. • Lifetime prevalence rates of depression range from 8 to 12 in most countries

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Symptoms of depression  Persistently sad anxious or "empty" mood.  Feelings of hopelessness.  Feelings of guilt worthlessness helplessness.  Loss of interest anhedonia or pleasure in hobbies and activities that were once enjoyed.  Insomnia early-morning awakening or oversleeping.

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Symptoms of depression  Decreased appetite and/or weight loss or overeating weight gain.  Fatigue decreased energy being "slowed down."  Thoughts of death or suicide suicide attempts.  Restlessness irritability.  Difficulty concentrating remembering making decisions.  Persistent physical symptoms that do not respond to treatment such as headaches digestive disorders and chronic pain.

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Mechanism of depression The monoamine hypothesis states that depression is caused by a deficiency of monoamines particularly noradrenaline and serotonin. NA 5-HT

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Positive and negatives of anti- anxiety drug options

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SSRI- AS DRUG OF CHOICE • It is considered as first choice for depression anxiety and co-morbid depression associated with anxiety. • Block presynaptic serotinin reuptake5-HT which increases serotinin levels in the synapse • SSRIs have little effect on the NE or dopamine transporters and a low affinity for the histaminic muscarinic/cholinergic and alpha receptors. • Hence adverse effects are less as compared to TCAs.

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SSRI • Fluoxetine • Fluvoxamine • Paroxetine • Sertaline • Citalopram • Escitalopram

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PAROXETINE  Paroxetine is US FDA approved SSRI  No dependence or addiction potential  Lowers intraplatelet serotonin levels  Inhibitsplateletplugformation  Doesnotactivatecoagulation  Paroxetine normalizes heart rate variability Paroxetine Paroxetine blocks the uptake of serotonin thus increasing serotonin concentration at synaptic cleft

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Indication • MajorDepressiveEpisodes • ObsessiveCompulsiveDisorder • PanicDisorderwithandwithoutagoraphobia • SocialAnxietyDisorder/Socialphobia • GeneralisedAnxietyDisorder • Post-traumaticStressDisorder

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Dosage recommendation of normal paroxetine tablet • Administeredoncedailyinthemorningwithfood

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dosage recommendation of paroxetine controlled release tablet

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Adverse effects • Akathisia- restlessness and psychomotor agitation such as an inability to sitorstand • Serotoninsyndrome/Neuroleptmalignantsyndrome characterised by clustersofsymptomssuchashyperthermiarigiditymyoclonusautonomic instability with possible rapid fluctuations of vital signs mental status changes including confusion irritability extreme agitation progressing to deliriumandcoma • Withdrawal symptoms Dizziness sensory disturbances sleep disturbances anxiety nausea tremor confusion sweating headache diarrhoea palpitations. Emotional instability irritability and visual disturbances

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Warning precautions Paroxetine should not be used for the treatment of children and adolescents 7-17 years as controlled clinical trials have found paroxetine to be associated with increasedriskforsuicidalbehaviourandhostility. Increased plasma concentrations of paroxetine occur in patients with severe renal impairment creatinine clearance less than 30 ml/min or in those with hepatic impairment. Therefore dosage should be restricted to thelowerendofthedosagerange.

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Warning precautions At least two week should elapse between discontinuation of paroxetine andinitiationoftherapywithanyMAOI. • As with all antidepressants paroxetine should be used with caution in patients witha history of mania. Paroxetineshould bediscontinued in any patiententeringamanicphase. • Teratogenic Effects: Pregnancy Category D Epidemiological studies have shown that infants exposed to paroxetine in the first trimester of pregnancyhaveanincreasedriskofcongenitalmalformationsparticularly cardiovascularmalformations. • Paroxetine is secreted in human milk and caution should be exercised whenparoxetinehydrochlorideisadministeredtoanursingwoman.

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ESCITALOPRAM • USFDAapprovedsince2002 • S-enantiomerofcitalopram. • Enantiomer: non-superimposable mirror images of one another. This propertyisknownas “c hi r al i ty ” • EscitalopramisaselectiveserotoninreuptakeinhibitorSSRIindicatedfor:  Acute and Maintenance Treatment of Major Depressive Disorder MDD in adultsandadolescentsaged12-17years  AcuteTreatmentofGeneralizedAnxietyDisorderGADinadults

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WARNING PRECAUTIONS • Clinical Worsening/Suicide Risk: Monitor for clinical worsening suicidality and unusual change in behaviour especially during the initialfewmonthsoftherapyorattimesofdosechanges • Serotoninsyndrome • Seizures:Prescribewithcareinpatientswithahistoryofseizure • Activation of Mania/Hypomania: Use cautiously in patients with ahistoryofmania • Hyponatremia:CanoccurinassociationwithSIADH

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WARNING PRECAUTIONS • Abnormal Bleeding: Use caution in concomitant use with NSAIDs aspirin warfarin or other drugs that affect coagulation • Pregnancy category C: Use only if the potential benefit justifiesthepotentialrisktothefetus • Nursing Mothers: Caution should be exercised when administeredtoanursingwoman

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RATIONALITY OF L-METHYLFOLATE COMBINATION WITH ESCITALOPRAM • Depression is linked with folate deficiency and that patients with insufficient folate are lesslikelytorespondtotreatmentandmorelikelytoexperiencearelapse. • One theory of depression is that the brain is not developing enough neurotransmitters. ThismaybeduetoinsufficientamountsofL-methylfolateinthebrain. • L-methylfolate is needed to regulate serotonin norepinephrine and dopamine production. • Without enough L-methylfolate it may be difficult to produce enough neurotransmittersforantidepressantstoworkfully. • L-methylfolate is indicated for the distinct nutritional requirements of individualswhohavesuboptimalL-methylfolatelevelsintheCSFplasmaand/or red blood cells and have major depressive disorder with particular emphasis as adjunctivesupportforpatientstakingantidepressantmedications.

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RATIONALITY OF COMBINATION • ESCITALOPRAM being SSRI blocks reuptake of neurotransmitters while L-methylfolate augments the production of more neurotransmitters • Clinical trials suggest that L-methylfolate augments antidepressanteffectofSSRI/SNRI. • Combination is cost-effective option than second generation antidepressants. To conclude Adjunctive L-methylfolate at 7.5 mg/day may constitute an effective safe and relatively well tolerated treatment strategy for patients with major depressive disorder who have a partial response or no response toSSRIs.HenceitisrationaletocombineitwithESCITALOPRAM.

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desvenlafexine • Atypical antidepressant. • It is serotonin and norepinephrine reuptake inhibitor SNRI • Desvenlafaxine : major active metabolite of venlafaxine • Desvenlafaxine lacks significant affinity for numerous receptors including muscarinic-cholinergic H1 -histaminergic or α - adrenergic receptors in vitro. • Desvenlafaxine also lacks MAO inhibitory activity. • Efficacy demonstrated against vasomotor symptoms of menopause physical symptoms associated with depression somatic pain fatigue irritability etc.

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Desvenlafaxine vs. venlafaxine • No dose titration required starting dose is the target dose once-daily dosing. • Efficacy demonstrated against painful symptoms associated with depression. • Minimal hepatic metabolism no concerns about CYP 2D6 slow and extensive metabolizers. • Very small effect on pulse and BP at 50 mg/day. • Efficacy demonstrated against vasomotor symptoms of menopause

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Dosage and administration • Recommended dose: 50 mg once daily with or without food • Discontinuation: Reduce dose gradually whenever possible • Moderate renal impairment: Maximum dose 50 mg per day • Severe renal impairment and end-stage renal disease: Maximum dose 50 mg every other day. • Moderate to severe hepatic impairment: Maximum dose 100 mg per day.

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Adverse reactions • Nausea • Dizziness • Insomnia • Hyperhidrosis • Constipation • Somnolence • Decreased appetite • Anxiety and specific male sexual function disorders

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Warning precautions • Hyponatremia:Can occur in association with SIADH • Interstitial Lung Disease and Eosinophilic Pneumonia • Pregnancy category C: use only if the potential benefits justify the potential risks to the fetus. • Nursing Mothers: Discontinue drug or nursing taking into consideration importance of drug to mother • Geriatric Use: There is an increased incidence of orthostatic hypotension in desvenlafaxine treated patients ≥ 65 years

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Anxiety and Depression • Depression often accompanies anxiety disorders and when it does it needs to be treated as well • Symptoms of depression include feelings of sadness hopelessness changes in appetite or sleep low energy and difficulty concentrating. • Most people with depression can be effectively treated with antidepressant medications psychotherapy or a combination of both.

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Comorbid depression with anxiety • It is recommended that anxiety symptoms should be taken into account when assessing the most appropriate antidepressant agent for treating someone with depressiontooptimizetreatmentoutcomeandrecoveryrate • Escitalopram/paroxetine/desvenlafexine is extensively prescribed medicationformajordepression. • Clonazepam is a high-potency long-acting benzodiazepine with anxiolytic property. • Clonazepams long half-life of 20 to 80 hours render this compound especially promising for augmentation therapy in major depression because interdose fluctuationinmoodstateisless. • Hence it is rationale to combine it with SSRI for comorbid depression with anxiety.

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