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Bipolar Disorder 

How we function in a chaotic world

 

 
 
Tags:  Schizophrenia  Zoloft  Depression  Anxiety  Bipolar  Mental Illness  Bipolar Disorder  Suicidal  Depressed  Serotonin 
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Published:  January 14, 2012
 
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Slide 1: ==== ==== You and your children have legal rights http://fboptins.com/go.php?id=600 ==== ==== Antidepressants are thought to act on neurotransmitters at the site of the synaptic cleft. Neurotransmitter release and re-uptake are the neurons' ways of communicating with each other. Low levels of neurotransmitters, in particular serotonin, noradrenaline and dopamine are thought to be associated with depressive disorders. Antidepressants are thought to inhibit re-uptake, boost production or prevent the breakdown of neurotransmitters thus boosting their action to regulate mood and alleviate depression. There are at least 20 different antidepressants available. Although all (to some extent) will potentially alleviate the symptoms of depression, choosing the right antidepressant for a specific patient is dependent upon a number of factors such as the type of depressive disorder, possible side-effects, interactions with other medications and other medical conditions. Antidepressants may be grouped into four main classes: 1. Monoamine oxidase inhibitors (MAOIs) 2. Tricyclic antidepressants (TCAs) 3. Selective serotonin reuptake inhibitors (SSRIs) 4. Atypical antidepressants But there are two other types of medications also used in the treatment of mood disorders: dualaction antidepressants and mood stabilisers. Monoamine oxidase inhibitors (MAOIs) were some of the earliest medications to be used as antidepressants in the 1950s. These medications work by inhibiting the action of an enzyme called monoamine oxidase which destroys norepinephrin. By preventing the destruction of these neurotransmitters, these chemicals are able to remain in the synaptic space for a longer period of time and thus help to alleviate depression. The oldest and most common drugs of this class are Nardil (phenelzine) and Parnate (tranylcypromine) which irreversibly bind to the enzyme MAO. However, MAO is also responsible for regulating a number of other biological processes including the metabolism of tyramine which is found in many foods, and to metabolise sympathomimetic amines which are found in many decongestants, cold and flu remedies, allergy medications and appetite suppressants. Problems, such as high blood pressure, occur when tyramine and other substances are unmetabolised causing headache, nausea, vomiting, stroke or death in some cases. Thus it is extremely important that patients disclose to their general practitioner all other medications that may be ingested.
Slide 2: These are some of the foods that need to be avoided in conjunction with the older MAOIs: oAll cheeses except cottage cheese and cream cheeses oBeer and red wine, some spirits, liqueurs and nonalcoholic beer oSoybeans, fava beans and bean curd oSmoked, fermented, aged, or pickled fish oGinseng, St. John's wort, and medication containing 5-HTP oSauerkraut oShrimp paste oAged or processed meats such as sausage or salami oYeast extract or brewer's yeast oOther foods such as some white wines and port, caffeine, chocolate, dairy products, nuts, raspberries, and spinach can only be consumed in small quantities. Because of their potential risks, the older MAOIs tend only to be used if the other antidepressant classes have been trialled and have failed. MAOIs may be effective in the treatment of melancholic depression, when SSRIs and other narrow action and dual action drugs have failed, because of their broad range of action on the different neurotransmitter systems. Newer MAOIs, which are reversible inhibitors of the enzyme MAO, are safer and include medications such as moclobemide (Aurorix). Tricyclic Antidepressants (TCAs) were developed in the 1950s originally as a treatment for schizophrenia. Until the advent of the SSRIs, however TCAs were the treatment of choice for depressive disorders. The TCAs which include drugs such as Tofranil (imipramine), Allegron (nortriptyline), Sinequan (doxepin) and Endep (amitryptyline) are thought to inhibit the reuptake of neurotransmitters in the synaptic cleft and thus relieve depression. They can also stimulate appetite, increase activity levels, and improve sleep. Because of their broad range of action of the different neurotransmitter pathways, tricyclic antidepressants are also particularly useful in the treatment of melancholic depression when SSRIs have failed. While safer in some respects than the MAOIs, the TCAs are not recommended for people with glaucoma, heart disease, a history of seizures, hyperthyroidism, or urinary retention. In addition, they are contraindicated for people with liver or kidney disease. Often people complain that they feel hung over or overly sedated with the TCAs and in the elderly this side effect together with another side effect of lowered blood pressure can result in falls and fractures. Overdose with TCAs can be fatal making them unsuitable for depressed people with a high suicide risk. If by accident they are used with MAOIs, the results can be fatal (seizures and stroke). Toxic blood levels can also occur if they are taken with antiarrhythmic drugs.
Slide 3: Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac (fluoxitine), Zoloft (sertraline), Cipramil (citalopram), Luvox (fluvoxamine), Lexapro (escitalopram) and Aropax (paroxetine) act on blocking the reuptake of serotonin and thus help to alleviate depressed mood. Not only are SSRIs safer than the MAOIs and the TCAs but they also cause fewer and less disturbing side effects. However, the problems of sexual dysfunction (such as the inability to reach orgasm, erection problems, loss of lubrication in women and decreased libido) affecting up to 50% of patients following the use of this class of medications can lead to its discontinuation. The combination of SSRIs with MAOIs is lethal but they also should not be taken with TCAs, antipsychotic, or anticonvulsant drugs, as they inhibit the liver's ability to metabolise them. Thus toxic levels of SSRIs can build up in the blood. A condition known as serotonin syndrome (described later) can develop, especially if these drugs are ingested with St John's Wort. Dual-action antidepressants Some of the newer antidepressants target more that one neurotransmitter system (usually serotonin and noradrenaline) in the brain. Medications that fall into this group are venlafaxine (Efexor) and mirtazapine (Avanza). Venlafaxine is also thought to block the reuptake of dopamine, especially in high doses, while in low doses only the serotonin system may be affected and at medium doses both the serotonin and noradrenalin systems may be affected. Atypical antidepressants are so named because they do not fit into the usual drug classes described above. One of these medications is Zyban (buproprion) which inhibits the reuptake of both noradrenalin and dopamine, and which is mainly used to help people quit smoking, but causes serious problems such as seizures if taken with alcohol and other adverse reactions if taken with MAOIs. People taking this medication can return abnormal ECGs and demonstrate a drop in their white blood cell count. Mood Stabilisers Among people who are suffering from a depressive disorder within a bipolar illness, antidepressants such as tricyclics and MAOIs can cause a rapid shift into mania (referred to as Bipolar III) or increase the frequency of cycling between depression and mania. If antidepressants are used, these potential mood shifts need to be closely monitored. There are other medications which may also be used to treat bipolar disorder including antiepileptics such as Tegretol (carbamazepine), Epilim (sodium valproate) and Lamictal (lamotrigine). Treatment with Tegretol can sometimes result in lowered concentrations of red and white blood cells and the medication can interfere with the effects of birth control pills. Treatment Regimen The aim of antidepressant medication therapy is to achieve the best result with the lowest dose possible and the fewest or least disabling side-effects. Starting doses for the antidepressants are usually low so that patients can be monitored for side-effects, get used to the medication regimen and gradually build up their blood levels of the drug. The earliest signs of improvement following the commencement of antidepressant treatment are mainly in sleep and appetite. Improvements in mood occur gradually and changes are usually first noticed by friends and family. Patients usually notice an improvement in 2 to 3 weeks and the full effects of the medication should be felt by 6 weeks. Most patients will remain on antidepressants for several months even after remission of symptoms. However, the length of time that anyone remains on any one medication is dependent upon a number of factors including whether or not their stressors (if any) have resolved, if they have a strong family history of depressive disorders, and whether they suffer
Slide 4: from recurrent bouts of depression. The SSRIs tend to be used as first-line antidepressants and a few may be trialled before settling on one. If they are ineffective however, then the atypical antidepressants or TCAs, and more rarely the MAOIs, may be used. Sometimes, doctors may prescribe a combination of medications to achieve the best results. When switching classes of medications, patients may have to undergo a "washout" stage during which they may have to gradually reduce the dose of their original medication and experience a short drug-free period. During this time, depressive symptoms may worsen and patients may experience some withdrawal effects such as dizziness, headaches, sleep disturbances, nausea, or gastrointestinal upset. A/Professor Vijaya Manicavasagar PhD, is the Director of Psychological Services at the Black Dog Institute, a not-for profit, educational, research, clinical and community-oriented facility dedicated to improving the understanding, diagnosis and treatment of depression and bipolar disorder. For more information or to find out your personality style visit http://www.blackdoginstitute.org.au Article Source: http://EzineArticles.com/?expert=Vijaya_Manicavasagar ==== ==== You and your children have legal rights http://fboptins.com/go.php?id=600 ==== ====

   
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