Transcript F_Trp_depresi

FARMAKOTERAPI
DEPRESI
DEFINISI
• Sindroma ansietas dan depresi merupakan
penyakit gangguan psikosomatik
• keluhan yang sering terjadi adalah sakit kepala
anoreksia, cepat lelah , konstipasi, insomnia, sesag nafas
berkeringat , nyeri ulu hati.
• untuk mengenali depresi lebih mudah terdapat trias
depresi yaitu :
1. tidak bisa menikmati hidup
2. tidak ada perhatian terhadap lingkungan
3. lelah sepanjang hari
Ciri ciri sindroma ansietas adalah
Cemas, khawatir , tidak bisa rileks atau tengang yang
belangsung lebi dari 3 bulan yang disebabkan karena
akibat ketidak seimbangan syaraf otonom.
Gejala : gemeteran, otot tegang, kelelahan , berkeringat,
sulit tidur.
• Perbedaan depresi dan ansietas
Ansietas
Depresi
Pola tidur
Sulit
Cepat bangun
Rasa lelah
-
+
Waktu terjadi tidak
nyaman
Sore hari
Pagi hari
Rasa kasih sayang
+
-
Perhatian hobi
+
-
Humor
+
-
Tujuan hidup
+
-
Menangis
-
+
Menyalahkan diri
-
+
Somatis :
Psikis :
PATOFISIOLOGI
adanya gangguan ketidakseimbangan saraf otonom vegetatif
karena faktor psikis seperti konflik emosional, frustasi,
ketegangan yang berlangsung lama dan berbagai stress.
atau lesi pd otak akan menimbulkan aktivitas
serangan kejang akibat naiknya potensial listrik
Manifestasi klinik ketidakseimbangan vegetatif adalah :
Hipertoni simpati, hipotoni simpati, hipotoni parasimpati,
ataksia vegetatif yaitu apabila koordinasi antara simpati dan
parasimpatis sudah tidak ada lagi.
PATOFISIOLOGI
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Gangguan vegetatif autonom terjadi karena adanya
gangguan konduksi impuls saraf di celah celah sinaps
antara neuron neuron.
Gangguan tersebut terjadi karena kelebihan / kekurangan
neurotransmiter dipresinaps atau gangguan sensitivitas
pada reseptor reseptor post sinaps.
Neurotransmiter tersebut adalah noradrenalin, dopamin
dan seretonin .
Pada pasien depresi terjadi defisit atau kekurangan tiga
neurotransmiter tersebut.
SASARAN TERAPI
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Aspek organobiologik disesuaikan dengan
kelainan medis internis dan somatis
Aspek psiko edukatif melakukan edukasi
terhadap pasien tentang pendapat pasien yang
salah , memberi pengertian dan keyakinan
Aspek sosio kultural dengan memperbaiki
kondisi sosio ekonomi , kesulitan yang dialami,
penyesuaian dengan lingkungan.
TERAPI
1. MIXED SEROTONIN AND NOREPINEPHRINE REUPTAKE
INHIBITORS
TCAs potentiate the activity of NE and 5-HT by blocking
their reuptake.
However, the potency and selectivity of TCAs for the
inhibition of reuptake of NE and 5-HT vary greatly among these
agents. TCAs affect other receptor systems including the
cholinergic, neurologic, and cardiovascular systems, adverse
events are reported frequently during TCA therapy.
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Venlafaxine inhibits 5-HT reuptake at low doses, with additional NE
reuptake at higher doses; thus, it is referred to as a serotoninnorepinephrine reuptake inhibitor (SNRI).
Duloxetine is also an SNRI with both 5HT and NE reuptake inhibition
across all doses. Some studies suggest
that the SNRIs can be associated with higher rates of response and
remission than other antidepressants; however, most of these
studies involved venlafaxine and not all studies support this
conclusion.
2. SELECTIVE SEROTONIN REUPTAKE INHIBITORS
 The efficacy of selective serotonin reuptake inhibitors
(SSRIs) is superior to placebo and comparable to
other classes of antidepressants
in treating patients with major depression.
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SSRIs are generally chosen as first-line
antidepressants because of their safety in overdose
and improved tolerability.
3. TRIAZOLOPYRIDINES
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Trazodone and nefazodone have dual actions on
serotonergic neurons, acting as both 5-HT receptor
antagonists and 5-HT reuptake a inhibitors. They can also
enhance 5-HT -mediated neurotransmission.
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Trazodone blocks adrenergic and histaminergic receptors
leading to increased side effects (e.g., dizziness and
sedation) that limit its use as an antidepressant.
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Nefazodone’s use as an antidepressant has declined as well
after reports of hepatic toxicity began to emerge.
The FDA-approved nefazodone labeling includes a black box
warning describing rare cases of liver failure.
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The triazolopyridines are effective agents in treating major
depression; however, they both carry risks that limit their
usefulness as antidepressants.
4. MINOKETONE
 Bupropion has no appreciable effect on the
reuptake of 5-HT, where as having reuptake
properties at both the NE and DA reuptake
pumps.
 These pharmacologic properties make bupropion
unique among all currently available
antidepressants.
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DA: dopamine
DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders,
4th ed., Text Revision
ECT: electroconvulsive therapy
5-HT: serotonin
HAMD: Hamilton Depression scale
MAOI: monoamine oxidase inhibitor
NE: norepinephrine
NIH: National Institutes of Health
REM: rapid eye movement
SNRI: serotonin-norepinephrine reuptake inhibitor
SSRI: serotonin-selective reuptake inhibitor
STAR* D: Sequenced Treatment Alternatives to Relieve Depression
TCA: tricyclic antidepressant
TRD: treatment-resistant depression