Safety and Efficacy of Antidepressants and Antipsychotics too
|
|
- Rebecca Jones
- 6 years ago
- Views:
Transcription
1 California Association of Toxicologists Annual Meeting (June 9, 2006) Safety and Efficacy of Antidepressants and Antipsychotics too Patrick R. Finley, Pharm.D. BCPP Professor of Clinical Pharmacy Psychopharmacology and Behavioral Health University of California at San Francisco
2 Efficacy of Antidepressants in Treating Major Depression 100% 80% 60% 65% 40% 20% 35% 0% Therapeutic Response >50% decrease sx Achieve Remission HAMD < 7
3 Evaluation of Outcomes with Citalopram for Depression Using Measurement-Based Care in STAR*D: Implications for Clinical Practice Trivedi MH et al. Am J Psychiatry 2006; 163:5-7 Methods 2876 depressed patients enrolled from 23 psychiatric, 18 primary care settings into rigid treatment protocol Pts treated initially with citalopram for up to 14 weeks Pts randomized to other treatment thereafter if unsuccessful Results (Level 1) Avg of 4.8 visits during tx phase Avg citalopram dose = 41.8 mg/day 33 % achieved remission ( 5 on QIDS-SR) 47 % had therapeutic response ( 50% decline QIDS-SR) 4.1% had serious adverse effects (no suicides reported)
4 The majority majority of patients prescribed antidepressants will need a change in their regimen* * - dosage adjustment, augmentation, or switch antidepressants
5 Outcomes of Depressed Patients: Therapeutic Response vs Remission Paykel et al. Psychol Med 1995 Pts Maintaining Response Months Remission (HAMD<7) Residual Sx (HAMD>7)
6 Residual Symptoms of Depressed Patients Who Respond Acutely to Fluoxetine (n=108) Nierenberg A et al. J Clin Psychiatry 1999;60: Percentage of Patients Mood Interest Weight Sleep Psychomotor Fatigue Guilt Concentration Suicidal Ideation
7 Suggestion #1: Go for the Gold!! (ie remission)
8 Suggestion #2: Don t t Forget About Psychotherapy
9 Serotonin Norepinephrine Reuptake Inhibitors (SNRI) (Venlafaxine, Duloxetine) Selective Serotonin Reuptake Inhibitors (SSRI) Norepinephrine Reuptake Inhibitors (NRI) (Bupropion) Serotonin Antagonists (Trazodone) oradrenergic and pecific Serotonin ntidepressants (Mirtazapine) Depression Tricyclic Antidepressants (TCA) Monoamine Oxidase Inhibitors (MAOI) Other Lithium Thyroid Modafinil Lamotrigine Atypical Antipsychotics
10 Antidepressant Selection May be Influenced by the Following: Family History Adverse Effects Medical Co-Morbidities Psychiatric Co-morbidities Depression Subtypes Anergic/Amotivational Anxious/Irritable Severe or Tx-Resistant Gender Other (drug interactions, cost etc)
11 SSRI: : Common Adverse Effects Gastrointestinal nausea, diarrhea (fluox, sert), constipation (parox) Central Nervous System headache insomnia/agitation >>> sedation Hierarchy: fluox > sert > escital > cital > parox > fluvox [Prozac > Zoloft > Lexapro > Celexa > Paxil > Luvox} Sexual Effects
12 SSRI/SNRI and Sexual Dysfunction Epidemiology Approximate incidence (new-onset) = 50 % (range: 2 % - 75 %); Hierarchy: parox > fluox sert, cital, escital > fluvox Incidence slightly higher in men (?) Severity slightly higher in women (?) Types of Sexual Dysfunction libido problems more common with depression orgasm problems more common with antidepressant (eg - delayed ejaculation or anorgasmia) erectile problems uncommon with SSRI [Patient Counseling: This medication may change your sexual functioning ]
13 Effect of SSRI Antidepressants on Ejaculation Waldinger et al. J Clin Psychopharmacol 1998; 18: Methods Double-blind placebo-controlled RCT Compared effects of fluoxetine (20mg), fluvoxamine (100mg), paroxetine (20mg) and sertraline (50mg) on ejaculatory delay Patient Population: men with premature ejaculation (n=60) Results (increase in ejaculatory latency time from baseline) fluoxetine = 117 secs* (p < 0.001) paroxetine = 100 secs* (p < 0.001) sertraline = 65 secs* (p = 0.017) fluvoxamine = 9 secs placebo = 7 secs * statistically significant difference
14 SSRI/SNRI and Sexual Dysfunction Management Patience Drug holidays (?) Reduce dose Antidotes (ie - augmentation) Examples: bupropion, sildenafil, amantadine, buspirone, yohimbine, cyproheptadine, nefazodone, stimulants, granisetron, gingko biloba Switching antidepressants Examples: bupropion, mirtazapine
15 SSRI: Other Adverse Effects Sweating Bruxism Weight Gain Extrapyramidal Side Effects SIADH GI Bleeds (?) Suicide (?) Prozac Poop-out (ie tachyphylaxis)?
16 Fluoxetine Versus Sertraline and Paroxetine in Major Depressive Disorder: Changes in Weight with Long-term Treatment [7 month RCT; n=139] Fava M et al. J Clin Psychiatry 2000; 61: Pct > 7% gain Fluoxetine 42 mg/d Sertraline 94 mg/d Paroxetine 37 mg/d
17 Use of Selective Serotonin Reuptake Inhibitors and Risk of Upper Gastrointestinal Bleeding Dalton SO et al. Arch Intern Med 2003; 163: Observed/Expected (O/E) Ratio for GI Bleeds O/E 9 7 Antidepressant 5 3 Antidepressant + NSAID 1 SSRI (20/7565) TCA (13/4778) Other (4/2117)
18 Antidepressants and Suicide What s s the Evidence? Adults 2% of outpatients & 4% of inpatients treated for depression will commit suicide 5-15 % of patients with untreated depression will commit suicide Clinical trials: > 20,000 adult subjects received SSRI in trials Significant decline in suicidality reported Study limitations are substantial homogenous patient populations suicidality assessed by 1 item embedded in depression rating scales (eg HAMD) inconsistent definition of suicidal behavior brief follow-up period distinguish treatment effect from withdrawal effect
19 Antidepressants and Suicide What s s the Evidence? Children and Adolescents Suicide is 3 rd leading cause of death in adolescents Suicide rate 33% over last years Clinical trials (Columbia study) 4,250 children in 25 studies of 9 antidepressants No successful suicides reported Nonsignificant increase in suicidal behavior (RR=1.78) Effexor, Paxil > Celexa, Zoloft Prozac
20 Antidepressants and Suicide Why would risk be greater in children & adolescents than adults? Artifact (ie - preliminary data only) Depressed children/adolescents are more impulsive Children are receiving proportionately higher doses Antidepressants have different PK/PD properties in children Greater influence/activity of 5HT system in children
21 Antidepressants and Suicide Summary Preliminary data in children and adolescents suggests higher risk of suicidal behavior after initiation (or dosage change) with ALL antidepressants Increased suicidal behavior may be attributed to lack of response to prescribed antidepressant extreme agitation or akathisia delayed response (somatic sx better before cognitive) misdiagnosis (eg - bipolar depression, personality d/o) Pharmaceutical manufacturers should be required to disclose ALL results of clinical trials Clinical trial methodology is antiquated naturalistic element must be integrated into RCT more sensitive measures of suicidal behavior needed patient population must be more representative Untreated depression much more likely to induce suicide than any antidepressant
22 SSRI Withdrawal Phenomenon Symptoms: dizziness lethargy nausea paresthesias insomnia Onset: hours Duration: 5-7 days Worse with paroxetine, venlafaxine Minimal risk with fluoxetine
23 Serotonin Syndrome Rare, idiosyncratic, sometimes fatal Mechanism: 5HT excess Symptoms: MS changes, chills/sweating, myoclonus, autonomic instability ( or BP & HR), fever (malignant hyperthermia) Medications: Most Commonly Associated: MAOI (Nardil, Parnate) Commonly Associated: SSRI (all), Clomipramine (Anafranil), Venlafaxine (Effexor), Tramadol (Ultram), Selegiline, Sibutramine (Meridia), Detromethorphan Occasionally Associated: Meperidine (Demerol), Trazodone Rarely Associated: Sumatriptan (Imitrex), St. John s Wort
24 Clinical Significance of Drug Interactions with SSRI potent inhibitors of Cytochrome P450 significant differences among potential Cyt 1A2: fluvox >> fluox, parox, sert, cital, escital substrates: TCA, haldol, clozapine, olanzapine, theophylline Cyt 2D6: fluox, parox, dulox, buprop >> sert, cital, escital substrates: β-blockers, narcotics (codeine, hydrocodone, tramadol), TCA Cyt 3A4: norfluox, fluvox >> fluox, parox, sert, cital, escital substrates: CCB, estrogen, corticosteroids, statins, protease inhibitors, alprazolam, triazolam, buspirone, sildenafil in vitro affinity different than in vivo wide interpatient variability
25 Suggestion #3: Do No Harm
26 SSRI: Dosing Guidelines for Primary Care* *note: Dosing may be higher for severe depression or in psychiatric settings SSRI Initial Dose Maintenance Dose Fluoxetine 10 mg mg/d Sertraline 25 mg mg/d Paroxetine 10 mg mg/d Citalopram 10 mg mg/d Escitalopram 5 mg 5 10 mg/d Fluvoxamine 25 mg mg/d (divided) Recommendation: Take with breakfast exception: take fluvoxamine at HS
27 VENLAFAXINE (Effexor ) Therapeutic Use MOA: blocks reuptake of 5HT and NE (dose-dependent) Adverse Effects: similar to SSRI* (including withdrawal) *note: HTN commonly seen with doses > 150 mg/d Dosing & Administration Initiate treatment at 37.5 mg QD (XR) Usual therapeutic dose = mg/d Maximum Daily Dose XR (package insert) = 225mg/day (?!) May be preferred if Severe or treatment-resistant depression
28 Incidence of Sustained Hypertension with Venlafaxine* (Effexor Package Insert, Wyeth 2004) * - defined as Diastolic BP > 90 AND change in Diastolic BP > 10 x 3 consecutive visits 14% 12% 10% 8% 6% 4% 2% 0% 100 mg/d 300 mg/d > 300 mg/d
29 DULOXETINE (Cymbalta( ) Therapeutic Use MOA: blocks reuptake of 5HT and NE Adverse Effects: similar to SSRI* (including withdrawal) hepatotoxicity (1.0% incidence of 3-fold in ALT vs 0.2% placebo) Pharmacokinetics: Plasma Half-life = 12 hrs; linear Cytochrome P450 2D6 inhibitor Dosing & Administration Initiate treatment at 30 mg/d Usual therapeutic dose = 60 mg/d May be preferred if severe or treatment-resistant depression Other Indications: neuropathic pain
30 BUPROPION (Wellbutrin( or Zyban ) Therapeutic Use MOA: enhances NE/DA transmission Adverse Effects: insomnia, HA, nausea, rash, seizures Contraindications: h/o eating d/o, seizure d/o Dosing & Administration Sustained-release (SR): initiate with 150mg in AM and increase to 150mg BID after 3 days; Doses must be separated by 8hrs; Maximum daily dose = 400mg Extended-release (XL): initiate with 150mg in AM and increase to 300mg in AM after 3 days; Doses must be separated by 24 hrs; Maximum daily dose = 450 mg May be preferred if low energy, predominant anhedonia pt requests med without sex dysfunction or weight gain SSRI augmentation
31 MIRTAZAPINE (Remeron( ) Therapeutic Use MOA: blocks α2 receptors, 5HT2, 5HT3 receptors Adverse Effects: sedation, weight gain, chol/tg Dosing & Administration Initiate treatment with 15mg HS Maximum daily dose = 45 mg (?) note: 30mg associated with less sedation May be preferred if tx-resistant depression pts with sex dysfunction weight gain or sedation desirable
32 Suggestion #3: Tailor Antidepressant to Specific Patient
33 Targeted Treatment of Depression Medical Comorbidity Psychiatric Comorbidity Depression Subtype
34 Prevalence of Depression with Medical Illnesses* * - Point prevalence; Mean of range cited when applicable Finley PR. Rx Consultant 2004; 13 (6):1-8 50% 40% 30% 20% 10% 0% HIV Parkinsons Dementia Epilepsy Stroke Cancer Diabetes CAD General Population
35 Antidepressants and Medical Co-Morbidity Cardiovascular Disease TCA - increased risk of cardiac events SSRI decrease risk of cardiac events (?) fluoxetine, paroxetine, duloxetine, bupropion - inhibit metabolism of beta blockers norfluoxetine, fluvoxamine - inhibit metabolism of Ca channel blockers Hypertension SNRI (venlafaxine, duloxetine) - increased blood pressure/heart rate bupropion - increased blood pressure/heart rate Cerebrovascular Disease TCA - superior efficacy vs SSRI (?) SSRI preliminary efficacy in prophylaxis Diabetes TCA, mirtazapine, paroxetine - weight gain norfluoxetine, fluvoxamine, nefazodone - inhibit metabolism of sulfonylureas
36 Antidepressants and Medical Co-Morbidity: Continued Breast Cancer, Menopause SSRI, SNRI - may benefit hot flashes Parkinson s Disease bupropion - may benefit dopamine transmission Peptic Ulcer Disease Dementia AIDS SSRI, SNRI may increase bleeding risk (?) TCA, paroxetine avoid antidep with antichol effects SSRI, bupropion may be less likely to cloud sensorium fluvoxamine, nefazodone - inhibit metabolism of protease inhibitors TCA, mirtazapine, paroxetine - weight gain may benefit some patients bupropion, stimulants - may benefit anergic depression
37 The Epidemiology of Major Depressive Disorder Results of National Comorbidity Survey Replication Kessler RC et al. JAMA 2003; 289: Methods: face-to-face household survey; N=9090 Results Lifetime prevalence of MDD = 16.2 % 12 month prevalence = 6.6 % 12 month Ψ comorbidity prevalence = 78.5 % Note: 51% of depressed pts had comorbid anxiety disorders Percent of depressed pts receiving tx = 51.6 % Percent of treated depressed pts receiving adequate tx = 41.9 % Percent of all depressed pts receiving adequate tx = 21.7 %
38 FDA Approved Uses of SSRI and Venlafaxine SSRI MDD GAD Panic OCD Social Phobia PTSD PMDD Fluoxetine X X X Sertraline X X X X Paroxetine X X X X X X Fluvoxamine X Citalopram Escitalopram X X Venlafaxine X X X
39 SSRI in the Management of Anxiety Disorders General Treatment Considerations If 1 SSRI is FDA-approved ALL appear to be effective Start low and go slow Onset of tx effect slower for anxiety d/o (vs MDD) Higher doses required for anxiety d/o: OCD, Panic D/O Important considerations in choosing SSRI drug interactions tolerability
40 Relationship of Antidepressant Mechanism to Target Symptoms Does Selectivity Matter? Theory A: Antidepressants should be tailored to target symptoms Anxious and/or Irritable 5HT agents (SSRI) Anergic and/or Amotivational NE/DA agents (bupropion, amantadine, modafinil) Severe and/or Melancholic 5HT/NE agents (?) (TCA, high-dose venlafax, duloxetine) Theory B: If the antidepressant successfully relieves the depression, all symptoms will resolve regardless of the mechanism.
41 Does Pretreatment Anxiety Predict Response to Either Bupropion SR or Sertraline? HAMD Response Rate Rush AJ et al. J Affect Dis 2001; 64: Bupropion Sertraline Placebo Baseline HAMA scores < > 23
42 Are you more worried worried or tired? - Owen Wolkowitz M.D. - SSRI preferred in worried patients - Bupropion preferred in tired patients
43 Comparison of Gender Response Rates: Sertraline vs Imipramine Kornstein et al. Am J Psychiatry 2000; 157: sertraline imipramine women men
44 Minimal Response to Antidepressant Treatment Alternatives to SSRI Ensure completion of therapeutic trial (4-6 wks) Ensure optimal dose of antidepressant Partial Response augmentation Bupropion Other (lithium, T3, lamotrigine, modafinil, other) Nonresponse switch Other SSRI Other antidepressants (SNRI, bupropion, other)
45 Suggestion #4: Optimize Monotherapy (ie don t t be afraid to dose)
46 Augmentation Strategies and Other Alternatives Bupropion Lithium Thyroid supplementation (T3) Buspirone Pindolol Lamotrigine Stimulants Modafinil Amantadine, Pramipexole Atypical Antipsychotics Other: folic acid, omega 3, inositol, sex hormones, DHEA, SAMe
47 Medication Augmentation after the Failure of SSRIs for Depression Trivedi MH et al (STAR*D). NEJM 2006; 354: Methods 2876 depressed patients enrolled from 23 psychiatric, 18 primary care settings into rigid treatment protocol 565 pts failing to achieve remission after 11.9 wks citalopram (55 mg/d) Pts randomized to bupropion SR (267 mg/d) or buspirone (41 mg/d) Results Reduction in depressive symptoms (QIDS-SR): bupropion (25.3 %) vs buspirone (17.1 %) p <0.04 Rates of Remission (QIDS-SR): bupropion (39.0%) vs buspirone (32.9%) ns Discontinuation due to side effects: bupropion (12.5 %) vs buspirone (20.6%) p <
48 Switching within the SSRI Class Thase M. APA Annual San Francisco 2003 Brown, Harrison (1995) Fluox Sert 71 % (79/112) Zarate (1996) Fluox Sert 42 % (13/31) Thase (1997) Sert Fluox 63 % (67/106) Thase (2001) Fluox Cital 62 % (35/57) Thase (2002) Parox Cital 62 % (32/51) Calabrese (2003) Fluox Cital 65 % (36/65)
49 Nelson JC. J Clin Switching to an SNRI Clin Psychiatry 2003; 64 [suppl[ 1]: Nierenberg (1994) SSRI Venlafaxine 33% (28/84) DeMontigny (1999) SSRI Venlafaxine 58% (88/152) Kaplan (2002) SSRI Venlafaxine 87 % (63/73) Poirer (1999) Various Venlafaxine 52 % (32/61) or Parox 33 % (20/61)
50 Bupropion-SR, Sertraline or Venlafaxine-XR after the Failure of SSRIs for Depression Rush AJ et al (STAR*D). NEJM 2006; 354: Methods 2876 depressed patients enrolled from 23 psychiatric, 18 primary care settings into rigid treatment protocol 727 pts failing to achieve remission or couldn t tolerate citalopram Pts randomized to bupropion-sr (283 mg/d), sertraline (135 mg/d) and venlafaxine-xr (194 mg/d) Results No significant differences between treatments in any primary outcomes Reduction in depressive symptoms (QIDS-SR): bupropion-sr (16.4 %) vs sertraline (21.9 %) vs venlafaxine-xr (16.9%) Rates of Remission (QIDS-SR): bupropion-sr (25.5 %) vs sertraline (26.6 %) vs venlafaxine-xr (25.0%) Discontinuation due to side effects: bupropion-sr (27.2 %) vs sertraline (21.0 %) vs venlafaxine-xr (21.2%)
51 Atypical or 2 nd Generation Antipsychotics (SGA) Introduction Empiric Definition: Atypical Antipsychotics do NOT induce catalepsy (ie - parkinsonism) increase prolactin upregulate D2 receptors (ie - tardive dyskinesia) Working Definition: cause less EPS, TD than conventional agents Mechanism Dopamine (D2) plus Serotonin (5HT2a) blockade D2 blockade in mesolimbic area relieves positive symptoms 5HT2 blockade in mesocortical area facilitates DA release to relieve negative symptoms (esp cognition) 5HT2 blockade in nigrostriatum prevents EPS effects
52 2 nd nd Generation Antipsychotics (SGA) Relative Advantages Safety less extra-pyramidal side effects (EPS) less tardive dyskinesia (TD) less cognitive impairment Efficacy uniquely effective for tx-resistant schizophrenia more effective vs negative symptoms more effective for cognitive symptoms other indications Bipolar disorder (esp mania) Dementia (?) Depression (?)
53 A Novel Augmentation Strategy for Treating Resistant Major Depression Methods: Shelton RC et al. Am J Psychiatry 2001; 158: patients identified with h/o tx-resistance and HAMD > 20 open label phase consisted of 6 wk escalating dose fluoxetine (20-60 mg/d) responders were excluded remainder of patients randomized to 8 week trial of olanzapine plus placebo olanzapine plus fluoxetine fluoxetine plus placebo N = 28
54 2 nd nd Generation Antipsychotics (SGA) Relative Disadvantages Safety metabolic effects (weight gain, diabetes, hyperlipidemia) other: orthostasis, sedation Efficacy limited research data in dementia (behavioral disturbances) limited research data in bipolar disorder (maintenance treatment) virtual absence of RCT data in depression inappropriate prescribing (eg Seroquel for insomnia) Cost!!
55 Weight Gain with Antipsychotic Drugs [Meta-analysis analysis at 10 weeks] adapted from Allison et al. Am J Psychiatry 1999;156: lbs Placebo Control Haloperidol Ziprasidone Molindone Clozapine Olanzapine Quetiapine Risperidone
56 Metabolic Effects of 2 nd Generation Antipsychotics Consensus Statement Diabetes Care 2004; 27: Weight Gain Increased risk: family hx, underweight, ethnicity Dose-dependent (?) Effect plateaus at weeks (?) Diabetes Case reports of DKA with all SGA Not necessarily associated with weight gain Atherogenic Lipid Profile triglycerides, LDL, HDL
57 2 nd Generation Antipsychotics (SGA) Monthly Cost of Therapeutic Dose AWP. First Data Bank. Feb 2004 $700 $600 $500 $400 $300 $200 $100 $0 $622 $476 $433 $374 $274 $465 $292 $329 Aripiprazole (20 mg/day) Aripiprazole (15 mg/day) Ziprasidone (160mg/day) Quetiapine (600mg/day) Olanzapine (20 mg/day) Olanzapine (15 mg/day) Risperidone (4mg/day) Clozapine (300mg/day)
58 Summary Recommendations Target antidepressants to specific populations Based on comorbidity and target symptoms Ensure adequate trial ( 4 weeks) Optimize Monotherapy ( dose if tolerated) Partial Response (augmentation) Strong Evidence: lithium, T3, bupropion Moderate Evidence buspirone, lamotrigene, modafanil Preliminary Evidence amantadine Nonresponse to SSRI (switch) Switch to different SSRI (if tolerated) Switch to other classes: SNRI, bupropion, mirtazapine 3 rd line: TCA, MAOI, SGA (?)
59 Coming Attractions Generics: sertraline (2006?), venlafaxine XR (2008?) NK1 or Substance P antagonists (Emend ) Selegiline (Emsam ) Glucocorticosteroid antagonists (eg - mifepristone, ketoconazole, metyrapone) CRF antagonists* BDNF enhancers* * - denotes product not currently available in United States
60 Transdermal Selegiline (EMSAM ) Overview MOA Nonspecific MAO inhibitor at high doses (eg MAO-A & MAO-B) Transdermal delivery results in minimal MAO inhibition in GI tract Pharmacokinetics Plasma half-life of hours Metabolized via Cyt P450 system (Cyp 2A6, 2B6, 3A4) Multiple active metabolites (including methamphetamine) Drug/Dietary Interactions Avoid concurrent administration of SSRI, SNRI, TCA, bupropion, mirtazapine, SJW, sibutramine, tramadol, meperidine, dextromethorphan and cyclobenzaprine Washout: 4 half-lifes after D/C of drugs above 2 weeks after D/C of EMSAM Low tyramine diet NOT necessary with 6mg patch Low tyramine diet IS recommended with 9mg and 12mg patches Adverse Effects Application site reactions (31% vs 15% with placebo) Other: dizziness, insomnia, sexual dysfunction Dosing and Administration Apply 6mg patch (20mg/cm 3 ) to upper torso every 24 hours
Safety and Efficacy of Antidepressants and Antipsychotics too
California Association of Toxicologists Annual Meeting (June 9, 2006) Safety and Efficacy of Antidepressants and Antipsychotics too 100% Efficacy of Antidepressants in Treating Major Depression Patrick
More informationQuick Guide to Common Antidepressants-Adults
Quick Guide to Common Antidepressants-Adults Medication Therapeutic Range (mg/day) Initial Suggested Serotonin Reuptake Inhibitors (SSRIs) All available as generic FLUOXETINE (Prozac) CITALOPRAM (Celexa
More informationAntidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry
Antidepressant Medication Strategies We ve Come a Long Way or Have We? Joe Wegmann, PD, LCSW The PharmaTherapist Joe@ThePharmaTherapist.com 504.587.9798 www.pharmatherapist.com Are you receiving our free
More informationCOMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications*
COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS NAME Generic (Trade) DOSAGE KEY CLINICAL INFORMATION Antidepressant Medications* Bupropion (Wellbutrin) Start: IR-100 mg bid X 4d then to 100 mg tid; SR-150
More informationAugmentation and Combination Strategies in Antidepressants treatment of Depression
Augmentation and Combination Strategies in Antidepressants treatment of Depression Byung-Joo Ham, M.D. Department of Psychiatry Korea University College of Medicine Background The response rates reported
More informationPsychiatry in Primary Care: What is the Role of Pharmacist?
Psychiatry in Primary Care: What is the Role of Pharmacist? Benjamin Chavez, PharmD, BCPP, BCACP Clinical Associate Professor Director of Behavioral Health Pharmacy Services January 12, 2019 Disclosure
More informationPsychiatry curbside: Answers to a primary care doctor s top mental health questions
Psychiatry curbside: Answers to a primary care doctor s top mental health questions April 27, 2018 Laurel Ralston, DO Psychiatrist, Taussig Cancer Institute Objectives Review current diagnostic and prescribing
More informationPHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES
PHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES Table of Contents Print TABLE OF CONTENTS Drug Page Number Anafranil... 2 Asendin... 4 Celexa... 4 Cymbalta... 6 Desyrel... 8 Effexor...10 Elavil...14
More informationManagement of SSRI Induced Sexual Dysfunction. Serotonin Reuptake Inhibitors*
Management of SSRI Induced Sexual Dysfunction John J. Miller, M.D. Medical Director, Center for Health and WellBeing Exeter, NH Serotonin Reuptake Inhibitors* fluoxetine clomipramine sertraline paroxetine
More informationCommon Antidepressant Medications for Adults
(and Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluoxetine Weekly (Prozac Weekly) 20 in AM w/ food (10 mg in elderly or those w/ panic disorder) 20 40 40 (If age >60yo, max 20) 10 10
More informationPresentation is Being Recorded
Integrated Care for Depression & Anxiety Psychotropic Medication Management for Primary Care Providers Los Angeles County Department of Mental Health September 20, 2011 Presentation is Being Recorded Please
More information9/20/2011. Integrated Care for Depression & Anxiety: Psychotropic Medication Management for PCPs. Presentation is Being Recorded
Integrated Care for Depression & Anxiety Psychotropic Medication Management for Primary Care Providers Los Angeles County Department of Mental Health September 20, 2011 Presentation is Being Recorded Please
More informationDaniel Suzuki, MD Adjunct Clinical Associate Professor of Psychiatry, USC Keck School of Medicine Clinical Adjunct Professor/Faculty, Graduate School
Daniel Suzuki, MD Adjunct Clinical Associate Professor of Psychiatry, USC Keck School of Medicine Clinical Adjunct Professor/Faculty, Graduate School of Psychology, Fuller Theological Seminary Medical
More informationTreat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused
Psychiatric Drugs Psychiatric Drugs Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally or abused Benzodiazepines
More informationChildren s Hospital Of Wisconsin
Children s Hospital Of Wisconsin Co-Management Guidelines To support collaborative care, we have developed guidelines for our community providers to utilize when referring to, and managing patients with,
More informationPSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer
PSYCHIATRIC DRUGS Mr. D.Raju, M.pharm, Lecturer PSYCHIATRIC DRUGS Treat mood, cognition, and behavioral disturbances associated with psychological disorders Psychotropic in nature Most are not used recreationally
More informationDepression & Anxiety in Adolescents
Depression & Anxiety in Adolescents Objectives 1) Review diagnosis of anxiety and depression in adolescents 2) Provide overview of evidence-based treatment options 3) Increase provider comfort level with
More informationReducing the Anxiety of Pediatric Anxiety Part 2: Treatment
Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment Lisa Lloyd Giles, MD Medical Director, Behavioral Consultation, Crisis, and Community Services Primary Children s Hospital Associate Professor,
More informationIntroduction to Drug Treatment
Introduction to Drug Treatment LPT Gondar Mental Health Group www.le.ac.uk Introduction to Psychiatric Drugs Drugs and Neurotransmitters 5 Classes of Psychotropic medications Mechanism of action Clinical
More informationDiagnosis & Management of Major Depression: A Review of What s Old and New. Cerrone Cohen, MD
Diagnosis & Management of Major Depression: A Review of What s Old and New Cerrone Cohen, MD Why You re Treating So Much Mental Health 59% of Psychiatrists Are Over the Age of 55 AAMC 2014 Physician specialty
More informationSchedule FDA & literature based indications
Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for
More informationBRIEF ANTIDEPRESSANT OVERVIEW. Casey Gallimore, Pharm.D., M.S.
BRIEF ANTIDEPRESSANT OVERVIEW Casey Gallimore, Pharm.D., M.S. Antidepressant Medication Classes First Generation Tricyclic Antidepressants (TCAs) Monoamine Oxidase Inhibitors (MAOIs) Second Generation
More informationA Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer
A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.
More informationPRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS. Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA
CASE #1 PRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA OBJECTIVES Epidemiology Presentation in older adults Assessment Treatment
More informationDepression: Identification, Evaluation and Management in Primary Care
Depression: Identification, Evaluation and Management in Primary Care Primary Care Medicine: Update 2010 Rena K. Fox, M.D. Associate Professor of Clinical Medicine University of California, San Francisco
More informationOptimal Use of Antidepressants: Focusing on SNRI, NDRI and SSRE
Optimal Use of Antidepressants: Focusing on SNRI, NDRI and SSRE Chan-Hyung Kim, MD Severance Mental Health Hospital Institute of Behavioral Science in Medicine Diagnostic Criteria Pyramid Etiologic Pathophysiologic
More informationAnti-Depressant Medications
Anti-Depressant Medications A Introduction: This topic may be a little bit underestimated here in Jordan, while in western countries it has more significance. The function of anti-depressants is to change
More informationDementia Medications Acetylcholinesterase Inhibitors (AChEIs) and Glutamate (NMDA) Receptor Antagonist
Dementia Medications Acetylcholinesterase Inhibitors (AChEIs) and Glutamate (NMDA) Receptor Antagonist Medication Dosage Indication for Use Aricept (donepezil) Exelon (rivastigmine) 5mg 23mg* ODT 5mg Solution
More informationGuide to Psychiatric Medications for Children and Adolescents
Guide to Psychiatric Medications for Children and Adolescents by Glenn S. Hirsch, M.D. The following guide includes most of the medications used to treat child and adolescent mental disorders. It lists
More informationNon-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450
James A. Bourgeois, O.D., M.D. Vice Chair Clinical Affairs and Director, CL Service University of California San Francisco Non-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450 Localize! Sequence! 1
More informationIndex. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers
Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) a-adrenergic blockers for PTSD, 798 b-adrenergic blockers for PTSD, 798 Adrenergic
More informationMedications and Children Disorders
Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for
More informationMedication for Anxiety and Depression. PJ Cowen Department of Psychiatry, University of Oxford
Medication for Anxiety and Depression PJ Cowen Department of Psychiatry, University of Oxford Topics Medication for anxiety disorders Medication for first line depression treatment Medication for resistant
More informationTreatment of Depression in the Primary Care Office
Treatment of Depression in the Primary Care Office Paul E.A. Glaser, MD, PhD Departments of Psychiatry, Pediatrics and Anatomy & Neurobiology University of Kentucky November 5, 2010 Disclosures of Potential
More informationPharmacotherapy of Anxiety Disorders (GAD, Panic, & SAD) Declaration of Interests
Pharmacotherapy of Anxiety Disorders (GAD, Panic, & SAD) University of Texas Health Science Center San Antonio Pharmacotherapy Education and Research Center (PERC) 7703 Floyd Curl Drive - MSC 6220 San
More informationAdult Depression - Clinical Practice Guideline
1 Adult Depression - Clinical Practice Guideline 05/2018 Diagnosis and Screening Diagnostic criteria o Please refer to Attachment A Screening o The United States Preventative Services Task Force (USPSTF)
More informationMedications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation
Medications for Anxiety & Behavior in Williams Syndrome Christopher J. McDougle, M.D. Director, Lurie Center for Autism Professor of Psychiatry and Pediatrics Massachusetts General Hospital and MassGeneral
More informationDepression: Identification, Evaluation and Management in Primary Care
Depression: Identification, Evaluation and Management in Primary Care Primary Care Medicine: Update 2012 Rena K. Fox, M.D. Associate Professor of Clinical Medicine University of California, San Francisco
More informationDepression. University of Illinois at Chicago College of Nursing
Depression University of Illinois at Chicago College of Nursing 1 Learning Objectives Upon completion of this session, participants will be better able to: 1. Recognize depression, its symptoms and behaviors
More informationPsychiatric Medication Guide
Psychiatric Medication Guide F O R : N E O N P R I M A R Y H E A L T H C A R E P R O V I D E R S B Y : M I C H E L L E R O M E R O, D O M A Y, 2 0 1 3 Anti-depressants TCA s & MAOI s (Tricyclic Antidepressants
More informationPsychobiology Handout
Nsg 85A / Psychiatric Page 1 of 7 Psychobiology Handout STRUCTURE AND FUNCTION OF THE BRAIN Psychiatric illness and the treatment of psychiatric illness alter brain functioning. Some examples of this are
More informationMixing and Matching: Layering Medications as Family Physicians
Mixing and Matching: Layering Medications as Family Physicians Family Medicine Forum Vancouver, B.C. November 9-12, 2016. Jon Davine, CCFP, FRCP(C) McMaster University Objectives Discuss different examples
More informationMood Disorders.
Mood Disorders Shamim Nejad, MD Medical Director, Psycho-Oncology Services Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Disclosures Neither I nor my spouse/partner
More informationAntidepressant Pharmacology An Overview
Figure 1. Antidepressant Pharmacology An Overview Source: NEJM 2005;353:1819-34 Figure 2. 1 Figure 3: Antidepressant Pharmacology pictures: Weak inhibition Bupropion NOTE: CYP enzymes noted are those inhibited
More informationReview of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder
More informationRealities of Depression in Primary Care Setting
Realities of Depression in Primary Care Setting Jaroslava Salman, MD Department of Supportive Care Medicine Division of Psychiatry Click to edit Master Presentation Date August 4 th 2018 Disclosure I have
More informationDepression: Identification, Evaluation and Management in Primary Care
Depression: Identification, Evaluation and Management in Primary Care Primary Care Update: 2013 I have nothing to disclose Rena K. Fox, M.D. Associate Professor of Clinical Medicine University of California,
More informationPsychiatric Illness. In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis
Psychiatric Illness In the medical arena psychiatry is a fairly recent field A challenging field Numerous diagnosis 12,000,000 children infants through 18 y/o nation wide 5,000,000 suffer severely Serious
More informationAntidepressants. Dr Malek Zihlif
Antidepressants The optimal use of antidepressant required a clear understanding of their mechanism of action, pharmacokinetics, potential drug interaction and the deferential diagnosis of psychiatric
More informationClinical Update on Management of Depression and Anxiety in the Primary Care Setting. Objectives: Why Is This Important?
Clinical Update on Management of Depression and Anxiety in the Primary Care Setting Kirstyn Kameg, DNP, PMHNP, BC University Professor PMHNP Program Coordinator Robert Morris University November 4, 2017
More informationA Basic Approach to Mood and Anxiety Disorders in the Elderly
A Basic Approach to Mood and Anxiety Disorders in the Elderly November 1 2013 Sarah Colman MD FRCPC Clinical Fellow, Geriatric Psychiatry Mount Sinai Hospital, University of Toronto Disclosure No conflict
More informationDepression in Late Life
Depression in Late Life Robert Madan MD FRCPC Geriatric Psychiatrist Key Learnings Robert Madan MD FRCPC Key Learnings By the end of the session, participants will be able to List the symptoms of depression
More informationGuilt Suicidality. Depression Co-Occurs with Medical Illness The rate of major depression among those with medical illness is significant.
1-800-PSYCH If you are obsessive-compulsive, dial 1 repeatedly If you are paranoid-delusional, dial 2 and wait, your call is being traced If you are schizophrenic, a little voice will tell you what number
More informationTreatment of Major Depressive Disorder
Treatment of Major Depressive Disorder Sarah Mullowney, MD PGY3 Psychiatry Resident, University of Utah Paula Gibbs, MD Medical Director of 5 West at UUMC Clerkship Director MS III Psychiatric Rotation
More informationMental illness A Broad Overview. Dr H Pathmanandam March 2017
Mental illness A Broad Overview Dr H Pathmanandam March 2017 Introduction Mental disorders are common in primary and secondary care Many are not recognised and not treated Some receive unnecessary or inappropriate
More informationESCITALOPRAM. THERAPEUTICS Brands Lexapro see index for additional brand names. Generic? Yes
ESCITALOPRAM THERAPEUTICS Brands Lexapro see index for additional brand names Generic? Yes Class SSRI (selective serotonin reuptake inhibitor); often classified as an antidepressant, but it is not just
More informationFROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD OF ANXIETY
13 th Pearl Leibovitch Clinical Day November 18th, 2014 Mounir H. Samy, MD, FRCP(C) Associate Professor of Psychiatry McGill University (ret.) FROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD
More informationThe Context: Why is this so important to treat?
Depression for PG1s Ian A. Cook, M.D. UCLA Department of Psychiatry Laboratory of Brain, Behavior, and Pharmacology Semel Institute for Neuroscience & Human Behavior DepressionLA.com PsychiatryGuidelines.com
More informationMentoring Session: Participant Cases
Handout for the Neuroscience Education Institute (NEI) online activity: Mentoring Session: Participant Cases The Case: 55-year-old patient with depression and anxiety The Question: What to do when antidepressants
More informationDr.Rahiminejad Roozbeh Hospital TUMS
Dr.Rahiminejad Roozbeh Hospital TUMS Psychiatric disorders, particularly depression, anxiety and eating disorders, are prevalent in diabetes. Mental illness increases risk of diabetes and diabetic complications.
More informationMedications Guide: Public Speaking And Social Anxiety
AnxietyHub.org Dr. Cheryl Mathews Medications Guide: Public Speaking And Social Anxiety Copyright 2016 AnxietyHub Medications Specifically for Public Speaking and Social Anxiety This is not intended to
More informationManagement Of Depression And Anxiety
Management Of Depression And Anxiety CME Financial Disclosure Statement I, or an immediate family member including spouse/partner, have at present and/or have had within the last 12 months, or anticipate
More informationAntipsychotics. Something Old, Something New, Something Used to Treat the Blues
Antipsychotics Something Old, Something New, Something Used to Treat the Blues Objectives To provide an overview of the key differences between first and second generation agents To an overview the newer
More informationDrugs for Emotional and Mood Disorders Chapter 16
Drugs for Emotional and Mood Disorders Chapter 16 NCLEX-RN Review Question 1 Choices Please note Question #1 at the end of Ch 16 pg 202 & Key pg 805 answer is #4 1. Psychomotor symptoms 2. Tachycardia,
More informationJudges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children
Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages 13-17
More informationFamily Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University
APPROACH TO DEPRESSION IN PRIMARY CARE Family Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University DISCLOSURE Speaker/Presenter Disclosure
More informationClinical Significance of Anxiety in Depressed Patients Selecting an Antidepressant
The Clinical Significance of Anxiety Disorders and the DSM-5 Anxious Distress Specifier in Depressed Patients Clinical Significance of Anxiety in Depressed Patients Selecting an Antidepressant Rhode Island
More informationPrepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D.
Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Sources: National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and from the American Psychological Association
More information3. Atypical antidepressants
3. Atypical antidepressants Bupropion, mirtazapine, nefazodone & trazodone. Mixed group that act at several different sites. Bupropion Acts as a weak dopamine & NE reuptake inhibitor. Has short half-life.
More informationPSYCHIATRY INTAKE FORM
Please complete all information on this form. PSYCHIATRY INTAKE FORM Name Date Date of Birth Primary Care Physician Current Therapist/Counselor What are the problem(s) for which you are seeking help? 1.
More informationMajor Depressive Disorder: Diagnosis, Treatment & Impact on Rural Communities
Page 1 Major Depressive Disorder: Diagnosis, Treatment & Impact on Rural Communities Elizabeth Montagnese, M.D. Adult, Child and Adolescent Psychiatrist This program has been supported by an educational
More informationAnxiety Disorders- OCD. Peter Giacobbe MD FRCPC L. Ravindran MD FRCPC
Anxiety Disorders- OCD Peter Giacobbe MD FRCPC L. Ravindran MD FRCPC Anxiety Disorders - Epidemiology Anxiety disorders are the most common class of mental disorders Estimated lifetime prevalence rates
More informationAnti- Depressants, Mood Stabilizers: What Works Best For Bipolar Disorder? Date: March 30, 2007 Source: NIH/National Institute of.
30-3-2007 Anti- Depressants, Mood Stabilizers: What Works Best For Bipolar Disorder? Date: March 30, 2007 Source: NIH/National Institute of. 30-3-2018 C. Psychiatric drugs: controlled trial demonstrated
More information90 dosage units per 90 days OR. Extended-release Formulations Ultram ER 90 dosage units per 90 days OR
Pre - PA Allowance 12 years of age or older Quantity Immediate-release Formulation Ultracet 720 dosage units per 90 days OR Ultram 720 dosage units per 90 days Extended-release Formulations Ultram ER 90
More informationManual of Clinical Psychopharmacology
Manual of Clinical Psychopharmacology Fourth Edition Alan F. Schatzberg, M.D. Kenneth T. Norris, Jr., Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Stanford University School
More informationTreating Depression in Adults
Treating Depression in Adults By Deborah Christensen, Ph.D., M.S.C.P. Depressive Disorders represent a broad and heterogeneous group of commonly diagnosed psychological disorders. The DSM adequately describes
More informationRichard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA
*We are not accepting any New Patients who are currently taking any controlled pain medications *We are *Note: not completion accepting of the any following New Patients paperwork who and Initial are Screening
More informationAntidepressants Choosing the Right One
Antidepressants Choosing the Right One Dr Lim Boon Leng Consultant Psychiatrist Dr BL Lim Centre For Psychological Wellness #09-09, Gleneagles Medical Centre, 6 Napier Rd, S258499 www.psywellness.com.sg
More informationPsychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI
Regional Affective Disorders Service Psychopharmacology Northumberland, Tyne and Wear NHS Trust Hamish McAllister-Williams Reader in Clinical Psychopharmacology Department of Psychiatry, RVI Intro NOT
More informationLinda Sobeski Farho, PharmD, BCPS Assistant Professor, Pharmacy Practice UNMC College of Pharmacy Critical Issues in Geriatrics June 24, 2010
Pharmacologic Treatment of Depression Linda Sobeski Farho, PharmD, BCPS Assistant Professor, Pharmacy Practice UNMC College of Pharmacy Critical Issues in Geriatrics June 24, 2010 1 Disclosure I have no
More informationGeneralized Anxiety Disorder ( DSM -IV) is characterized by excessive anxiety and worry (apprehensive expectation) that is persistent for at least 6
Generalized Anxiety Disorder ( DSM -IV) is characterized by excessive anxiety and worry (apprehensive expectation) that is persistent for at least 6 months and which the person finds difficult to control.
More informationPharmaceutical Interventions. Collaborative Model of Mental Health Care for Older Iowans Des Moines May 18, 2007
Pharmaceutical Interventions Collaborative Model of Mental Health Care for Older Iowans Des Moines May 18, 2007 Outline Overview Overview of initial workup and decisions in elderly depressed individual
More informationHow to treat depression with medication: Some rules of thumb
How to treat depression with medication: Some rules of thumb R. Hamish McAllister-Williams, MD, PhD, FRCPsych Reader in Clinical Psychopharmacology Newcastle University Hon. Consultant Psychiatrist Regional
More informationDepression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms
Depression and Anxiety By Christopher Okiishi, MD Spring 2016 What is Depression? Not just being sad A syndrome of symptoms Depressed mood Sleep disturbance Decreased interest in usual activities (anhedonia)
More informationEffective Health Care
Number 7 Effective Health Care Comparative Effectiveness of Second- Generation Antidepressants in the Pharmacologic Treatment of Adult Depression Executive Summary Background Depressive disorders such
More informationReviews/Evaluations. Use of Selective Serotonin Reuptake Inhibitors in Pediatric Patients. Pharmacotherapeutic Options
Reviews/Evaluations Use of Selective Serotonin Reuptake Inhibitors in Pediatric Patients Childhood major depressive disorder (MDD) has become recognized as a serious and common illness affecting between
More informationIt is the policy of health plans affiliated with Centene Corporation that Seroquel XR is medically necessary when the following criteria are met:
Clinical Policy: (Seroquel XR) Reference Number: CP.PMN.64 Effective Date: 12.01.14 Last Review Date: 02.18 Line of Business: Commercial, Health Insurance Marketplace, Medicaid Revision Log See Important
More informationMental Illness. Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling
Mental Illness Doreen L. Rasp, APN, FNP, PMHNP Advanced Behavioral Counseling Moodiness Changing Bodies Narcissism Self-Esteem Ignorant Naïve Insecure Self-Centered Independent Adolescence Disorders Affecting
More informationDrugs, Sleep & Wakefulness. Brian Koo Reena Mehra MD MS Kingman Strohl MD
Drugs, Sleep & Wakefulness Brian Koo Reena Mehra MD MS Kingman Strohl MD Things To Keep In Mind Many drugs effect sleep either causing insomnia or sedation Disruption of sleep and wakefulness may not be
More informationClass: Treatment with Medication:
Class: As we have not finished all the material covering disorders, I wanted to give you and overview of some disorders we have not had a chance to discuss. I feel you are well prepared in different types
More informationMEDICATION ALGORITHM FOR ANXIETY DISORDERS
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences MEDICATION ALGORITHM FOR ANXIETY DISORDERS RYAN KIMMEL, MD MEDICAL DIRECTOR HOSPITAL PSYCHIATRY UNIVERSITY OF WASHINGTON
More informationStudy Guidelines for Quiz #1
Annex to Section J Page 1 Study Guidelines for Quiz #1 Theory and Principles of Psychopharmacology, Classifications and Neurotransmitters, Anxiolytics/Antianxiety/Minor Tranquilizers, Stimulants, Nursing
More informationSUTTER PHYSICIANS ALLIANCE (SPA) 2800 L Street, 7 th Floor Sacramento, CA 95816
SUTTER PHYSICIANS ALLIANCE (SPA) 2800 L Street, 7 th Floor Sacramento, CA 95816 SPA PCP Treatment & Referral Guideline Managing Depression in Older Adults Developed March 1, 2003 Revised September 21,
More informationDisclosures. Questions. A Developmental Approach. Goals and objectives 4/3/2018 FEARS AND TEARS: TREATING ANXIETY AND DEPRESSION IN PRIMARY CARE
Disclosures FEARS AND TEARS: TREATING ANXIETY AND DEPRESSION IN PRIMARY CARE I have no financial interests I WILL be talking about non FDA approved uses of medications for anxiety and depression in children
More informationAntidepressant Selection in Primary Care
Antidepressant Selection in Primary Care Rebecca D. Lewis, DO OOA Summer CME Oklahoma City, OK 6 August 2017 Objectives Understand the epidemiology of depression. Recognize factors to help choose antidepressants.
More informationOverview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials
SPEAKER NOTES Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials Summarized by Thomas T. Thomas New psychotropic medications are coming on the
More informationManaging Anxiety Disorder in Primary Care
Saturday General Session Managing Anxiety Disorder in Primary Care Chris Ticknor, MD Private Practice, Psychiatry Adjunct Professor of Psychiatry UT Health Science Center at San Antonio San Antonio, Texas
More informationMajor Depressive Disorder
Major Depressive Disorder HEDIS Measures And Clinical Practice Guidelines Jennifer Highley, PMHNP-BC Behavioral Health West Point Healthcare Effectiveness Data and Information Set (HEDIS) Performance measures
More informationObjectives. Diagnostic Criteria DSM 5. Before we begin I should tell you that. General Diagnostics for Anxiety Disorders 08/02/2014
Before we begin I should tell you that ANTIDEPRESSANT USE IN ANXIETY, DEPRESSION AND BIPOLAR: HELPFUL OR HARMFUL? Rania Kattura, PharmD, MS, BCPP Clinical Assistant Professor University of Texas at Austin
More information