北医药物治疗学-抗抑郁药(1).ppt

Depression;Additional Resources: 1. Mann JJ. The Medical Management of Depression. New England Journal of Medicine 2005;353:1819-34 2. Gelenberg AJ, Hopkins HS. Assessing and Treating Depression in Primary Care Medicine. American Journal of Medicine. 2007; 120:105-108 3. The Texas Implementation of Medication Algorithms: Update to the Algorithms for Treatment of Bipolar I Disorder. Suppes T., et al. Journal of Clinical Psychiatry 2005; 66: 870-886;Neurotransmitter;;synthesizing packaging releasing binding removal;Epidemiology;Epidemiology;Epidemiology;Epidemiology;Pathophysiology;Pathophysiology;Diagnosis;Diagnosis;;General Treatment Principles;Duration of Use;;Response;6-12 weeks;Discontinuation/Withdrawal syndrome;Suicidality;Black Box Warning: ↑25岁患者自杀风险 @治疗的第一个月 自杀风险： 无治疗治疗;Serotonin Syndrome;Serotonin Syndrome;Video;Antidepressants (ADs);Tricyclic Antidepressants;TCAs;TCAs;Disadvantages;Disadvantages;Advantages;Selective Serotonin Reuptake Inhibitors;MOA;Treatment of Choice;Treatment of Choice;5-HT Side effects;5-HT Side effects;Interactions;Interactions;Dosing;;Fluoxetine;Serotonin Norepinephrine Reuptake Inhibitors;MOA of SNRIs;Venlafaxine;Venlafaxine;Desvanlafaxine;Duloxetine;2nd Generation ADs;Bupropion;Bupropion;Mirtazapine;Mirtazapine;Nefazodone;Monoamine Oxidase Inhibitors;MAOIs;Side Effects;Interactions = numerous;Selegiline;Augmentation Options in Treatment of Depression;Lithium(锂): treat bipolar, mania, schizoaffective d/o Thyroid homone(甲状腺激素) Buspirone(丁螺环酮): treat anxiety Atypical Antipsychotics: aripiprazole(阿立哌唑) Psychostimulant Drugs: dextroamphetamine/amphetamine;Nonpharmacologic Treatment of Depression ;ECT (electrocompulsive treatment) most effect Tx for MDD (95%) Phototherapy especially for seasonal affective disorder rTMS (repetitive Transcranial Magnetic Stimulation);Choice of Antidepressant;非复杂的单相抑郁: 所有抗抑郁药视为等效 exceptions: (level of evidence is not great) TCAs clearly efficacious in severe depression bupropion may theoretically work