Board Certified in General Psychiatry Board Certified in Consult Liaison Psychiatry Disclosure I Ha VU do not have relationships with commercial interests Horror Stories of Antidepressants ID: 909017
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Slide1
Ha Vu D.O.
Meier Clinics
Board Certified in General Psychiatry
Board Certified in Consult Liaison Psychiatry
Slide2Disclosure
I, Ha VU, do not have relationship(s) with commercial interests.
Slide3Horror Stories of Antidepressants
Slide4Objectives:
Approximate the gap of mental health perspectives:
Highlight common mental health illnesses
Highlight some common characteristics of “antidepressant”
Slide5Doctor Visit
HPI: 18
y.o
. single CF, lives with family, home-schooled, works at restaurant, presented to clinic for worsening of depression and anxiety past few months, no clear precipitating factor. No previous psych
eval
/treatment
+ Panic: episodes of SOB, sweats, palpitation, crying, fear, lasting 10 min
+ Generalized Anxiety: “worrier”, affects sleep.
+
Emetophobia
: fear of vomiting situations -> poor appetite, weight loss.
+ Depression symptoms:
1.
Depressed
mood
2. Markedly
diminished interest
or pleasure in all
3.
Social isolation
4. Feelings of worthlessness or
guilt,
burdance
to family
5. Diminished ability to think or
concentrate
.
+ Social anxiety
History otherwise negative.
Appearance: overly anxious. Underweight. Pleasant.
Slide6Psychotic D/O:
Mood D/O
:
Anxiety D/O:
Misc.
Subs
antipsychotic
antidepressant
Mood
stablizer
antidepressant
anxiolytic
antidepressant
stimulant
Psychotropic Meds
MDD
Bipolar D/O
G.A.D.
Panic D/O
OCD
Social phobia
PTSD
Schizophrenia
Schizophreniform
Brief Psychotic
Schizoaffective
Eating D/O
ADD/ADHD
PSYCHIATRIC DISORDERS
Slide7Psychotic D/O:
Mood D/O
:
Anxiety D/O:
Misc.
Subs
MDD
Bipolar D/O
G.A.D.
Panic D/O
OCD
Social phobia
PTSD
Schizophrenia
Schizophreniform
Brief Psychotic
Schizoaffective
Eating D/O
ADD/ADHD
PSYCHIATRIC DISORDERS
HPI: 18
y.o
. single CF, lives with family, home-schooled, works at restaurant, presented to clinic for worsening of depression and anxiety past few months, no clear precipitating factor. No previous psych
eval
/treatment
+ Panic: episodes of SOB, sweats, palpitation, crying, fear, lasting 10 min
+ Generalized Anxiety: “worrier”, affects sleep.
+
Emetophobia
: fear of vomiting situations -> poor appetite, weight loss.
+ Depression: low mood, diminished interest, Social isolation, guilt, concentration
+ Social anxiety
Slide8Key Neurotransmitters
Serotonin
Norepinephrine
Dopamine
Slide9Antidepressants
SSRI
Citalopram
(
Celexa
)
Escitalopram
(
Lexapro
)
Fluoxetine
(Prozac) Fluvoxamine (
Luvox)Paroxetine (Paxil)Sertraline (Zoloft)
SNRIDuloxetine
(Cymbalta)Venlafaxine
(Effexor)Desvenlaxine
(Pristiq)Levomilnacipran (Fetzima)
NDRI
Bupropion (Wellbutrin)MISC.Trazadone
(Desyrel)Mirtazapine
(Remeron)Vilazodone (
Viibryd)Vortioxetine (
Trintellix)
ADVERSE EFFECTS:
USE
:
Depression, Bipolar, GAD, OCD, Social, PTSD, SAD, Eating , Impulse
CLASSIFICATION :
Anticholinergic
: dry mouth, blurred vision, constipation, urinary retention
Antihistamine: sedation, weight gain
Alpha 1 blockage: Orthostatic
hypotention, sedation, sexual dysfunction
Serotonergic: GI (nausea, diarrhea), insomnia, agitation, headache,
sx dysfx
Discontinuation: dizziness, fatigue, nausea, shock-like (paxil)
Slide10Older Antidepressants
TCA
Amitriptyline
(
Elavil
)
Clomipramine
(
Anafranil
)
Desipramine
(Norpramin)
Doxepin (Sinequan, Adapin,
Silenor)Imipramine (
Tofranil)Nortriptyline (Aventyl
, Pamelor)Protriptyline
(Vivactil)Trimipramine (Surmontil)
ADVERSE EFFECTS
…additionally… MAOI
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Selegiline (Ensam)
CLASSIFICATION
:
USE:
Unipolar
, Bipolar, GAD, OCD, PTSD, SAD, Eating d/o, Impulse control
TCA may slow cardiac conduction, prolongation of the QT interval, SZ
MAOI increases risk for hypertensive crisis if foods with high
tyramine or sympathomimetic
drugs are consumed
Slide11Psychotic D/O:
Mood D/O
:
Anxiety D/O:
Misc.
Subs
antipsychotic
antidepressant
Mood
stablizer
antidpressant
anxiolytic
antidepressant
stimulant
Psychotropic Meds
MDD
Bipolar D/O
G.A.D.
Panic D/O
OCD
Social phobia
PTSD
Acute Stress
Schizophrenia
Schizophreniform
Brief Psychotic
Schizoaffective
Eating D/O
ADD/ADHD
PSYCHIATRIC DISORDERS
Slide12Anxiolytics
*
Buspirone
(
BuSpar
):
BENZODIAZAPINE
Oxezepam
(
Serax
)
Alprazolam
(Xanax)Triazolam (
Halcion)Lorazepam (
Ativan)Clonazepam (
Klonopin)Clorazepate (Tranxene
)Diazepam (Valium)Chlordiazepoxide (Librium)Halazepam (
paxipam)
ADVERSE EFFECTS:Use
:
Anxiety, insomnia, SZ, alcohol detox, adjunct for psychotic agitation
Sedation, cognitive dysfunction (amnesia), ataxia, slurred speech
Respiratory depression at high doses or if combined with alcohol, or w
resp d/o
Indicated for GAD
Slide13Case Study II
HPI: 37
y.o
. CM, previously worked in customer service, switched to sale past year. Presented with distraction, unable to complete tasks, “racing thoughts”.
Appearance: overweight, anxious.
Vitals: 145/100
Psychotic D/O:
Mood D/O
:
Anxiety D/O:
Misc.
Subs
MDD
Bipolar D/O
G.A.D.
Panic D/O
OCD
Social phobia
PTSD
Acute Stress
Schizophrenia
Schizophreniform
Brief Psychotic
Schizoaffective
Eating D/O
ADD/ADHD
Diagnosis?
Treatment?
Slide14Psychotic D/O:
Mood D/O
:
Anxiety D/O:
Misc.
Subs
antipsychotic
antidepressant
Mood
stablizer
antidpressant
anxiolytic
antidepressant
stimulant
Psychotropic Meds
MDD
Bipolar D/O
G.A.D.
Panic D/O
OCD
Social phobia
PTSD
Acute Stress
Schizophrenia
Schizophreniform
Brief Psychotic
Schizoaffective
Eating D/O
ADD/ADHD
PSYCHIATRIC DISORDERS
Slide15Objectives:
Approximate the gap of mental health perspectives:
Highlight common mental health illnesses
Highlight some common characteristics of “antidepressant”
Horror Stories of Antidepressants
Ha Vu D.O.
Meier Clinics
Board Certified in General Psychiatry
Board Certified in Consult Liaison Psychiatry
Slide16Reference
Lieberman, Jeffrey A. “Handbook of Psychiatric Drugs.” John Wiley & Sons. 2006
Hahn, Rhoda K. “Psychiatry on Call.” Current Clinical Strategies Publishing. 2008.
Procyshyn, Ric
M. “Clinical Handbook of Psychotropic Drugs.” 2015