Pharmacological Treatment of Anxiety & Depressive Disorders

Size: px
Start display at page:

Download "Pharmacological Treatment of Anxiety & Depressive Disorders"

Transcription

1 Pharmacological Treatment of Anxiety & Depressive Disorders Dr Gary Jackson (MB BCh FRCPsych) Consultant Psychiatrist The Priory Hospital Chelmsford Wellesley Hospital Southend-on-Sea Medical Secretary: Jane Cusick (direct line: ) Private Enquiries/Referrals: 24/7 Telephone: Fax:

2 Scope Introduction General Principles of Treatment Psychological Therapy General Anxiety Disorder Panic Disorder (+/- Agoraphobia) Social Phobia Simple Phobia PTSD OCD Depression

3 General Treatment Principles Information to patients and carers Bibliotherapy Support groups Internet treatment packages National Associations etc. Monitoring Clinic reviews Standardised questionnaires Patient s own treatment preferences Exercise and Diet Reassurance and Encouragement

4 General Treatment Principles cont. Anxiety and depressive symptoms on a spectrum from transient / mild to chronic or severe. In mild, recent onset anxiety and depression overall usefulness of drugs not demonstrated. Reassurance and advice powerful. Watch and see. Need for drug treatment determined by chronicity / severity of symptoms, presence of co-morbid psychiatric disorder, level of disability, impact on functioning, other medications being used, patients history of tolerating drugs. Check for significant anxiety in patients presenting with depression and other psychiatric syndromes and vice versa. If moderate severe depression present with anxiety disorder, treat the depression too (specifically) and vice versa.

5 General Treatment Principles cont. Monitor patients on drugs 2 nd weekly until stable and then 6 12 weekly. Build up dose gradually. Escalate dose as necessary. If no progress change drug or swap to different treatment e.g.cbt. Treat for 6 months for a first episode. Consider long-term drug treatment for chronic / relapsing conditions. Be aware of co-morbid disorders ask for them.

6 Aetiology Genetic Environmental (life events) Personality

7 Psychlological Therapies Advice on General Stress Management Balance Pacing Communication Relaxation Training CBT & EMDR (eye movement desensitisation reprocessing) Other appropriate therapies Interpersonal Problem solving Couples counselling & family therapy Psychodynamic Behavioural activation

8 Mode of Action NA & 5HT reup inhib TCA / venlafaxine (high dose) / duloxetine / vortioxetine SSRI Low dose venlafaxine (<150mg) / citalopram / paroxetine / fluoxetine / sertraline NA reup inhib reboxetine 5-HT2 blockade & SSRI trazodone MAOI phenelzine Pre- synaptic alpha-2-autoreceptor block mirtazapine DA reup blockers buproprion

9 Treatment Duration First episode 6 months post recovery Second episode 2-3 yrs Third episode 5 yrs + Withdraw over 4 weeks +

10 Generalised Anxiety Disorder A vague feeling of threat, a generalised sense of menace, an ineffable state of dysphoria and intolerable, heightened, but unfocussed expectation, that is all pervasive and continuing. - Lasts more than 6 months - Not secondary to physical illness - Co-exists often with Substance misuse - Mood Disorder - Psychotic illness James Park

11 Generalised Anxiety Disorder cont. Prevalence - 4.5% point prevalence Females more than males Age of onset - 3 rd decade Natural history chronic recurring/continuous (for diagnosis symptoms need to be present continuously for 6 months and must not be secondary to some other cause e.g. medical illness or substance misuse)

12 Drug Treatments for Generalised Anxiety Disorder Acute Efficacy SSRI TCA s Other Escitalopram Paroxetine Sertraline Imipramine Venlafaxine CBT Buspirone Pregabalin Trifluoperazine Long-term Efficacy Escitalopram Paroxetine Venlafaxine CBT Relapse Prevention Paroxetine Escitalopram CBT NB No B Blockers No Benzodiazepines

13 Panic Disorder (with or without Agoraphobia) Recurrent unexpected severe anxiety with varying degrees of anticipatory anxiety between attacks. Physical symptoms sweating, palpitations, weakness and dizziness. Psychological symptoms e.g. fear of dying, making a fool of self, going mad, having a heart attack. Symptoms peak within 10 minutes and last minutes. 2/3 go on to develop agoraphobia a fear of places/situations from which escape might be difficult or where help won t be available. Such places are avoided or endured with dread.

14 Panic Disorder (+/- Agoraphobia) cont. Prevalence - 12% point prevalence Females more than males - 2:1 Age of onset - 2 nd or 3 rd decade Natural history - episodic over long-term Co-morbidity - Other Anxiety Disorders - Mood Disorders - Alcohol, cocaine, amphetamines

15 Drug Treatments for Panic Disorder Acute Panic Attack Acute Efficacy Long-term Efficacy SSRI TCA s Benzodiazepines Other Citalopram Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Citalopram Fluoxetine Paroxetine Sertraline Alprazolam Lorazepam Clomipramine Alprazolam CBT Imipramine Clonazepam Phenelzine Diazepam Moclobemide Lorazepam Mirtazapine Venlafaxine Reboxetine Clomipramine Alprazolam Moclobemide Imipramine CBT Paroxetine Sertraline Relapse Prevention Fluoxetine Paroxetine Sertraline Imipramine CBT NB Avoid anti psychotics - sedative antihistamines - b blockers

16 Social Phobia Marked, persistent, unreasonable fear of being observed or evaluated negatively by other people in social or performance situations. Associated with physical and anxiety panic symptoms. Feared situations avoided or endured with dread and distress.

17 Social Phobia cont. Prevalence - 2% point prevalence Female more than male - 2:1 Age of onset - 2 nd decade Natural history - chronic or natural decline over long term Co-morbidity - Other Anxiety Disorders - Substance Misuse - alcohol - cannabis - anxiolytics

18 Drug Treatments for Social Phobia Acute Efficacy Long-term Efficacy SSRI TCA s Benzodiazepines Other Escitalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Escitalopram Fluvoxamine Paroxetine Sertraline Moclobemide Bromazepam Clonazepam Moclobemide Venlafaxine Gabapentin CBT Phenelzine Pregabalin Olanzapine CBT Phenelzine Venlafaxine Relapse Prevention Escitalopram Paroxetine Sertraline Clonazepam CBT

19 Simple Phobia Excessive or unreasonable fear of animals, objects or situations (e.g. dentist, flying) which are avoided or endured with significant distress and dread.

20 Simple Phobias cont. Prevalence - 7% point prevalence Female more than male - 2:1 Age of onset - 2 nd or 3 rd decade Natural history - chronic Co-morbidity - Other Anxiety Disorders

21 Drug Treatments for Simple Phobia Most cases respond to CBT If drug treatment is necessary - SSRI

22 Post Traumatic Stress Disorder A history of exposure to an extraordinary trauma with a response of intense fear, helplessness or horror. Later development of re-experiencing symptoms (e.g. flashbacks), avoidance and hyperarousal.

23 Post Traumatic Stress Disorder cont. Prevalence - 1-2% point prevalence Female more than male - 1:1 Age of onset - any Natural history - half natural recovery - half chronic/relapsing Co-morbidity - Other Anxiety Disorders - Mood Disorders - Substance misuse

24 Drug Treatments for PTSD Prevention Acute Efficacy SSRI TCA s Benzodiazepines Other Fluoxetine Paroxetine Sertraline Amitriptyline Alprazolam Imipramine Hydrocortisone Propranolol Traumafocused CBT Traumafocused CBT EMDR Brofaromine Phenelzine Lamotrigine Mirtazapine Venlafaxine Long-term efficacy Relapse Prevention Sertraline Fluoxetine Sertraline CBT?

25 Obsessive Compulsive Disorder Recurrent obsessional thoughts, images or impulses. And/or physical or mental rituals which are distressing, time consuming and interfere with social and occupational functioning.

26 Obsessive Compulsive Disorder cont. Prevalence - 1 2% point prevalence Female more than male - 2:1 Age of onset - 2 nd or 3 rd decade Natural history - 2/3 episodes lat < 1 year. - majority chronic relapsing course Co-morbidity - Other Anxiety Disorders - Perfectionistic/obsessional personality - Tic disorders

27 Drug Treatments for OCD Acute Efficacy Long-term Efficacy Relapse Prevention SSRI TCA s Benzodiazepines Other Citalopram Fluoxetine Fluvoxamine Paroxetine Sertraline Fuoxetine Sertraline Fluoxetine Paroxetine Sertraline Clomipramine Clonazepam CBT Imipramine Clomipramine Clonazepam CBT CBT

28 Depression Symptoms Low mood Anxiety Negative cognitions Poor concentration Suicidal ideation Appetite loss Anhedonia Reduced libido Signs Weight loss Sleep disturbance Agitation Psychomotor retardation Tearfulness Irritability Social withdrawal

29 No Response:? Diagnosis ( Physical / Psychiatric )? Alcohol / Drugs? Perpetuating Factors? Compliance? Secondary Gain

30 Treatment Escalation SSRI Increase dose Switch to different SSRI Change class Venlafaxine Mirtazapine Duloxetine TCA MAOI Mega dose Combination Venlafaxine / Mirtazapine Augment Lithium Carbamazepine Olanzapine Risperidone Flupenthixol Tryptophan Combinations of anti depressants T4 Phenelzine/MAOI s ECT Deep brain stimulation Vagal nerve stimulation

31 Supplementation Lithium Carbonate 4 week trial Atypical Anti psychotic Olanzapine Quetiapine Risperidone Anti epileptics Lamotrigine

32 Other Physical Treatments ECT Deep Brain Stimulation

33 Special Cases Cardiac patients Epilepsy Pregnancy - SSRI s - Avoid TCA s - Avoid Venlafaxine - Most anti depressants can lower seizure threshold - Beware: drug interactions between anti depressants and anti epileptics. - TCA s - Fluoxetine Breast Feeding - Paroxetine - Sertraline

34 Anti depressant Drug Discontinuation Syndrome Uncommon but real Paroxetine & Venlafaxine +/- 10 x more likely to cause DS Tapering may reduce risk Usually onset once drug stopped Syndrome - G.I.T. e.g nausea Lasts 1 2 weeks - Dizziness If severe, re-increase dose - Gait problems - Odd shooting sensation in limbs - Sleep disturbance

35 Conclusion - Questions and Answers Thank You Dr Gary Jackson (MB BCh FRCPsych) Consultant Psychiatrist The Priory Hospital Chelmsford Wellesley Hospital Southend-on-Sea Medical Secretary: Jane Cusick (direct line: ) Private Enquiries/Referrals: GP@priorygroup.com 24/7 Telephone: Fax:

Introduction to Drug Treatment

Introduction 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 information

Panic disorder is a chronic and recurrent illness associated

Panic disorder is a chronic and recurrent illness associated CLINICAL PRACTICE GUIDELINES Management of Anxiety Disorders. Panic Disorder, With or Without Agoraphobia Epidemiology Panic disorder is a chronic and recurrent illness associated with significant functional

More information

Anxiety Disorders.

Anxiety Disorders. Anxiety 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 information

Mental illness A Broad Overview. Dr H Pathmanandam March 2017

Mental 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 information

DIAGNOSTIC CRITERIA (ICD 10)

DIAGNOSTIC CRITERIA (ICD 10) DEPRESSION Depression is a major public health problem around the world Affects 1:5 older people living in the community Affects 2:5 older people living in care homes Various treatment options available,

More information

Treatment of Anxiety (without benzos)

Treatment of Anxiety (without benzos) Treatment of Anxiety (without benzos) Alison C. Lynch MD MS Clinical Professor Departments of Psychiatry and Family Medicine University of Iowa Health Care None Disclosures Overview/objectives Review common

More information

Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services

Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services ANXIETY DISORDERS This guideline covers a range of anxiety disorders, including generalised anxiety disorder, social

More information

Medication management of anxiety & depression. Dr Katie Simpson GP Mental health lead East Berks CCG

Medication management of anxiety & depression. Dr Katie Simpson GP Mental health lead East Berks CCG Medication management of anxiety & depression Dr Katie impson GP Mental health lead East Berks CCG NICE guidelines for Anxiety tepped Care RIs and NRIs in Anxiety disorders RI ertraline Citalopram Fluoxetine

More information

PSYCHIATRIC MANAGEMENT IN PRIMARY CARE. Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust

PSYCHIATRIC MANAGEMENT IN PRIMARY CARE. Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust PSYCHIATRIC MANAGEMENT IN PRIMARY CARE Dr Fayyaz Khan MBBS, MRCPsych, MSc Consultant Psychiatrist (Locum) Mersey Care NHS Trust Areas to cover Mood Disorders Anxiety Disorders Miscellaneous Conditions

More information

Depression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms

Depression 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 information

How to Manage Anxiety

How to Manage Anxiety How to Manage Anxiety Dr Tony Fernando Psychological Medicine University of Auckland Auckland District Health Board www.insomniaspecialist.co.nz www.calm.auckland.ac.nz Topics How to diagnose How to manage

More information

The pharmacological management of anxiety disorders

The pharmacological management of anxiety disorders Stephen Bleakley MRPharmS, MCMHP Review in association with The pharmacological management of anxiety disorders Progress in Neurology and Psychiatry is running a series of articles on the major psychiatric

More information

Mental Health Pathway

Mental Health Pathway Mental Health Pathway Triggers for Mental Health Pathway Information for professionals Consider mainstream Mental Health Services (Green light Toolkit) Clinical Interface Protocol Clinical Assessment Information

More information

Depression Workshop 26 January 2007

Depression Workshop 26 January 2007 Depression Workshop 26 January 2007 Leslie G Walker Professor of Cancer Rehabilitation Donald M Sharp Senior Lecturer in Behavioural Oncology Mary B Walker Senior Clinical and Research Nurse Specialist

More information

Depression: selective serotonin reuptake inhibitors

Depression: selective serotonin reuptake inhibitors Depression: selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for the majority of patients with depression. citalopram and fluoxetine

More information

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX

CHILD & ADOLESCENT PSYCHIATRY ALERTS, VOLUME XIV, 2012 INDEX A Adderall Counterfeit, 31 addiction, internet CBT, 55 ADHD Adjunctive Guanfacine, 11 Counterfeit Adderall, 31 Developmental Trajectory and Risk Factors, 5 Dopamine Transporter Alterations, 14 Extended-Release

More information

Family Medicine Forum Montreal, Quebec November 11, Jon Davine, CCFP, FRCP(C) McMaster University

Family Medicine Forum Montreal, Quebec November 11, Jon Davine, CCFP, FRCP(C) McMaster University ANXIETY DISORDERS Family Medicine Forum Montreal, Quebec November 11, 2017. Jon Davine, CCFP, FRCP(C) McMaster University DISCLOSURE Speaker/Presenter Disclosure Not applicable Disclosure of Commercial

More information

Anxiety Disorders. Fear & Anxiety. Anxiety Disorder? 26/5/2014. J. H. Atkinson, M.D. Fear. Anxiety. An anxiety disorder is present when

Anxiety Disorders. Fear & Anxiety. Anxiety Disorder? 26/5/2014. J. H. Atkinson, M.D. Fear. Anxiety. An anxiety disorder is present when Anxiety s J. H. Atkinson, M.D. HIV Neurobehavioral Research Center University of California, San Diego Department of Psychiatry & Veterans Affairs Healthcare System, San Diego Materials courtesy of Dr.

More information

Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 3 October 2014)

Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 3 October 2014) Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 3 October 2014) Date of Preparation: September 2014 Date for next full

More information

Volume 4; Number 5 May 2010

Volume 4; Number 5 May 2010 Volume 4; Number 5 May 2010 CLINICAL GUIDELINES FOR ANTIDEPRESSANT USE IN PRIMARY AND SECONDARY CARE Lincolnshire Partnership Foundation Trust in conjunction with Lincolnshire PACEF have recently updated

More information

Reducing the Anxiety of Pediatric Anxiety Part 2: Treatment

Reducing 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 information

MEDICATION ALGORITHM FOR ANXIETY DISORDERS

MEDICATION 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 information

Treating Anxiety Disorders. Adil Virani, BSc (Pharm), Pharm D, FCSHP

Treating Anxiety Disorders. Adil Virani, BSc (Pharm), Pharm D, FCSHP Treating Anxiety Disorders Adil Virani, BSc (Pharm), Pharm D, FCSHP Outline! Michelle s Case! Types of anxiety disorders! Goals of therapy! Treatment options and guidelines! Pharmacological options! Benzodiazepines

More information

DEPRESSION Depression is a major public health problem around the world Affects 1:5 older people living in the community Affects 2:5 older people living in care homes Various treatment options available,

More information

FROM MEDICATION TO MINDFULNESS: NEW INSIGHTS INTO THE WORLD OF ANXIETY

FROM 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 information

Guidelines MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD)

Guidelines MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD) MANAGEMENT OF MAJOR DEPRESSIVE DISORDER (MDD) Guidelines CH Lim, B Baizury, on behalf of Development Group Clinical Practice Guidelines Management of Major Depressive Disorder A. Introduction Major depressive

More information

Treatment Options for Bipolar Disorder Contents

Treatment Options for Bipolar Disorder Contents Keeping Your Balance Treatment Options for Bipolar Disorder Contents Medication Treatment for Bipolar Disorder 2 Page Medication Record 5 Psychosocial Treatments for Bipolar Disorder 6 Module Summary 8

More information

Anti-Depressant Medications

Anti-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 information

Case #1. Case #1. Case #1. Discussion. DSM IV Overview of PD. Psychopharmacology of Panic Disorder and Generalized Anxiety Disorder 09/03/2012

Case #1. Case #1. Case #1. Discussion. DSM IV Overview of PD. Psychopharmacology of Panic Disorder and Generalized Anxiety Disorder 09/03/2012 Case #1 Psychopharmacology of Panic Disorder and Generalized Anxiety Disorder Smit S. Sinha MD Assistant Professor A 33 year old male engineer presents to an outpatient clinic for consultation for severe

More information

Depression in adults: treatment and management

Depression in adults: treatment and management 1 2 3 4 Depression in adults: treatment and management 5 6 7 8 Appendix V3: recommendations that have been deleted of changed from 2009 guideline Depression in adults: Appendix V3 1 of 22 1 Recommendations

More information

Psychopharmacology. Psychopharmacology. Hamish McAllister-Williams Reader in Clinical. Department of Psychiatry, RVI

Psychopharmacology. 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 information

Anxiolytics. What s new? Lindsey Sinclair

Anxiolytics. What s new? Lindsey Sinclair Anxiolytics Lindsey Sinclair David Nutt What s new? pregabalin has gained a licence for the treatment of generalized anxiety disorder new data support the use of escitalopram in several anxiety disorders

More information

KEY MESSAGES. It is often under-recognised and 30-50% of MDD cases in primary care and medical settings are not detected.

KEY MESSAGES. It is often under-recognised and 30-50% of MDD cases in primary care and medical settings are not detected. KEY MESSAGES Major depressive disorder (MDD) is a significant mental health problem that disrupts a person s mood and affects his psychosocial and occupational functioning. It is often under-recognised

More information

Doncaster Improving Access to Psychological Therapies (IAPT) Nurse Target September 2018 Dennis Convery

Doncaster Improving Access to Psychological Therapies (IAPT) Nurse Target September 2018 Dennis Convery Doncaster Improving Access to Psychological Therapies (IAPT) Nurse Target September 2018 Dennis Convery Aims of the session To introduce the role and function of Doncaster IAPT (improving access to psychological

More information

Index. Note: Page numbers of article titles are in boldface type. A ADHD. See Attention-deficit/hyperactivity disorder (ADHD) b-adrenergic blockers

Index. 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 information

Psychotropic Medication Use in Dementia

Psychotropic Medication Use in Dementia Psychotropic Medication Use in Dementia Marie A DeWitt, MD Diplomate of the American Board of Psychiatry and Neurology, Specialization in Psychiatry & Subspecialization in Geriatric Psychiatry Staff Physician,

More information

An update on the pharmacology of anxiolytics for the anxiety, obsessive compulsive and post-traumatic stress disorders

An update on the pharmacology of anxiolytics for the anxiety, obsessive compulsive and post-traumatic stress disorders An update on the pharmacology of anxiolytics for the anxiety, obsessive compulsive and post-traumatic stress disorders Kim Outhoff, MBChB, MFPM, Senior Lecturer, Department of Pharmacology, University

More information

VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress. Core Module

VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress. Core Module VA/DoD Clinical Practice Guideline for Management of Post Traumatic Stress Core Module Module A Acute Stress Continue Treatment for ASD Treatment for ACUTE Stress Disorder Module B PTSD Continue Treatment

More information

Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 4.

Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 4. Guidance on the use of Antidepressants for the Treatment of Unipolar Depression and Anxiety Spectrum Disorders in adults (Version 4.1 December 2018) Date of Preparation: January 2018 (with addition of

More information

Medication 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 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 information

Review 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) Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder

More information

A Basic Approach to Mood and Anxiety Disorders in the Elderly

A 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 information

Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services

Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services DEPRESSION Pharmacological Treatment of Depression NICE guidelines suggest the following stepped care model also

More information

Disclosure Information

Disclosure Information Disclosure Information I have no financial relationships to disclose. I will discuss the off label use of several depression and anxiety medications in pediatric population Pediatric Depression & Anxiety

More information

Panic Disorder with or without Agoraphobia

Panic Disorder with or without Agoraphobia Panic Disorder with or without Agoraphobia LPT Gondar Mental Health Group www.le.ac.uk Panic Disorder With and Without Agoraphobia Panic disorder Panic versus anxiety Agoraphobia Agoraphobia without panic

More information

Document Title Pharmacological Management of Generalised Anxiety Disorder

Document Title Pharmacological Management of Generalised Anxiety Disorder Document Title Pharmacological Management of Generalised Anxiety Disorder Document Description Document Type Policy Service Application Trust Wide Version 1.1 Policy Reference no. POL 201 Lead Author(s)

More information

PRACTICAL MANAGEMENT OF DEPRESSION IN OLDER ADULTS. Lee A. Jennings, MD MSHS Assistant Professor Division of Geriatrics, UCLA

PRACTICAL 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 information

Anxiety Disorders.

Anxiety Disorders. Anxiety Disorders Shamim Nejad, MD Medical Director, Division of Psychosocial Oncology Swedish Cancer Institute Swedish Medical Center Seattle, Washington Shamim.Nejad@swedish.org Epidemiology Lifetime

More information

Optimal Treatment of Anxiety Disorders

Optimal Treatment of Anxiety Disorders Optimal Treatment of Anxiety Disorders Franklin R. Schneier, MD Co-Director, Anxiety Disorders Clinic Research Psychiatrist New York State Psychiatric Institute Special Lecturer in Psychiatry Columbia

More information

Depression in Late Life

Depression 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 information

Managing Anxiety Disorder in Primary Care

Managing 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 information

Presenter Disclosure. Objectives 6/5/2017. Depression, Anxiety, PTSD: A Focus on Pharmacotherapy

Presenter Disclosure. Objectives 6/5/2017. Depression, Anxiety, PTSD: A Focus on Pharmacotherapy Depression, Anxiety, PTSD: A Focus on Pharmacotherapy Robert L Page II, Pharm.D., MSPH, FHFSA, FCCP, FAHA Professor of Clinical Pharmacy Clinical Specialist, Division of Cardiology University of Colorado

More information

AN OVERVIEW OF ANXIETY

AN OVERVIEW OF ANXIETY AN OVERVIEW OF ANXIETY Fear and anxiety are a normal part of life. Normal anxiety keeps us alert. Intervention is required when fear and anxiety becomes overwhelming intruding on a persons quality of life.

More information

Management Of Depression And Anxiety

Management 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 information

Psychological and Pharmacological Treatments for Adults with Posttraumatic Stress Disorder (PTSD)

Psychological and Pharmacological Treatments for Adults with Posttraumatic Stress Disorder (PTSD) 1 Psychological and Pharmacological Treatments for Adults with Posttraumatic Stress Disorder (PTSD) This continuing education monograph examines the results of a comparative effectiveness review to assess

More information

Appendix 4B - Guidance for the use of Pharmacological Agents for the Treatment of Depression in Adults (18 years and over)

Appendix 4B - Guidance for the use of Pharmacological Agents for the Treatment of Depression in Adults (18 years and over) Appendix 4B - Guidance for the use of Pharmacological Agents for the Treatment of Depression in Adults (18 years and over) Introduction / Background Treatment comes after diagnosis Diagnosis is based on

More information

Anxiolytics and anxiety disorders. MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno

Anxiolytics and anxiety disorders. MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno Anxiolytics and anxiety disorders MUDr. Vítězslav Pálenský Dept. of Psychiatry, Masaryk University, Brno Anxiety disorders 1. Panic disorders and agoraphobia 2. Specific phobia and social phobia 3. Obsessive

More information

DISEASES AND DISORDERS

DISEASES AND DISORDERS DISEASES AND DISORDERS 13. The mood (affective) disorders 99 14. The psychotic disorders: schizophrenia 105 15. The anxiety and somatoform disorders 111 16. Dementia and delirium 117 17. Alcohol and substance-related

More information

Mixing and Matching: Layering Medications as Family Physicians

Mixing 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 information

Psychobiology Handout

Psychobiology 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 information

Perinatal Mood and Anxiety Disorders Cort A. Pedersen, M.D. UNC Department of Psychiatry

Perinatal Mood and Anxiety Disorders Cort A. Pedersen, M.D. UNC Department of Psychiatry Perinatal Mood and Anxiety Disorders Cort A. Pedersen, M.D. UNC Department of Psychiatry Prevalence of Perinatal Depressive and Anxiety Disorders Depression: approximately 14% within the first 2-3 months

More information

Medications for Anxiety & Behavior in Williams Syndrome. Disclosure of Potential Conflicts. None 9/22/2016. Evaluation

Medications 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 information

Some newer, investigational approaches to treating refractory major depression are being used.

Some newer, investigational approaches to treating refractory major depression are being used. CREATED EXCLUSIVELY FOR FINANCIAL PROFESSIONALS Rx FOR SUCCESS Depression and Anxiety Disorders Mood and anxiety disorders are common, and the mortality risk is due primarily to suicide, cardiovascular

More information

PSYCHIATRY INTAKE FORM

PSYCHIATRY 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 information

Anxiety Disorders: Diagnosis and Treatment. Patricia Polgar, Istvan Bitter 24 October 2012

Anxiety Disorders: Diagnosis and Treatment. Patricia Polgar, Istvan Bitter 24 October 2012 Anxiety Disorders: Diagnosis and Treatment Patricia Polgar, Istvan Bitter 24 October 2012 Anxiety disorders in the DSM IV. Acute Stress Disorder Generalized Anxiety Disorder [GAD] Obsessive-Compulsive

More information

Antidepressant Selection in Primary Care

Antidepressant Selection in Primary Care Antidepressant Selection in Primary Care R E B E C C A D. L E W I S, D O O O A S U M M E R C M E B R A N S O N, M O 1 5 A U G U S T 2 0 1 5 Objectives Understand the epidemiology of depression. Recognize

More information

CHILDHOOD/ADOLESCENT ANXIETY DISORDERS: EVALUATION AND TREATMENT

CHILDHOOD/ADOLESCENT ANXIETY DISORDERS: EVALUATION AND TREATMENT CHILDHOOD/ADOLESCENT ANXIETY DISORDERS: EVALUATION AND TREATMENT PHILIP L. BAESE, MD ASSISTANT PROFESSOR OF PSYCHIATRY CHIEF, DIVISION OF CHILD AND ADOLESCENT PSYCHIATRY UNIVERSITY OF UTAH, SCHOOL OF MEDICINE

More information

Depression & Anxiety in Adolescents

Depression & 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 information

Medications and Children Disorders

Medications 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 information

Affective Disorders.

Affective Disorders. Affective Disorders http://www.bristol.ac.uk/medicalschool/hippocrates/psychethics/ Affective Disorders Depression Mania / Hypomania Bipolar mood disorder Recurrent depression Persistent mood disorders

More information

Jonathan Haverkampf PANIC ATTACKS PANIC ATTACKS. Christian Jonathan Haverkampf MD

Jonathan Haverkampf PANIC ATTACKS PANIC ATTACKS. Christian Jonathan Haverkampf MD Christian MD Panic attacks can be highly debilitating as they occur spontaneously and come with a dread of impending doom and often death. Their unpredictability and the strong feelings of anxiety can

More information

Antidepressants. Dr Malek Zihlif

Antidepressants. 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 information

BIOLOGICAL TREATMENT IN PSYCHIATRY. PTE ÁOK Dept.of Psychiatry Pécs

BIOLOGICAL TREATMENT IN PSYCHIATRY. PTE ÁOK Dept.of Psychiatry Pécs BIOLOGICAL TREATMENT IN PSYCHIATRY PTE ÁOK Dept.of Psychiatry Pécs 1 SGA effects pharmacokinetic effect chemical strucrure Receptor block D2 5-HT2 α1 H-1 M Selectíve DA (D2D3) antagonists Benzamids Amisulpiride

More information

Treatment-resistant depression in primary care

Treatment-resistant depression in primary care Treatment-resistant depression in primary care Interprofessional CME, October 2017 Brian J. Mickey, MD, PhD Associate Professor School of Medicine Department of Psychiatry Disclosures Speakers bureau:

More information

Treat mood, cognition, and behavioral disturbances associated with psychological disorders. Most are not used recreationally or abused

Treat 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 information

Anxiety Disorders: First aid and when to refer on

Anxiety Disorders: First aid and when to refer on Anxiety Disorders: First aid and when to refer on Presenter: Dr Roger Singh, Consultant Psychiatrist, ABT service, Hillingdon Educational resources from NICE, 2011 NICE clinical guideline 113 What is anxiety?

More information

SICKNESS AND HEALTH III. The following anxiety disorders are discussed on this website:

SICKNESS AND HEALTH III. The following anxiety disorders are discussed on this website: SICKNESS AND HEALTH III 8.1 CLINICAL ANXIETY AND HEALTH: Anxiety is a normal reaction to stress and can actually be beneficial in some situations. For some people, however, anxiety can become excessive.

More information

Bipolar and Affective Disorders. Harleen Johal

Bipolar and Affective Disorders. Harleen Johal + Bipolar and Affective Disorders Harleen Johal hkj1g11@soton.ac.uk + Affective (mood) disorders n Depression n Bipolar disorder n Anxiety n Treatment + Depression: Definition n Pervasiveand persistent

More information

A new Anatomy of Melancholy: rethinking depression and resilience

A new Anatomy of Melancholy: rethinking depression and resilience A new Anatomy of Melancholy: rethinking depression and resilience Prof Declan McLoughlin Dept of Psychiatry & Trinity College Institute of Neuroscience Trinity College Dublin St Patrick s University Hospital

More information

Antidepressant Treatment of Depression

Antidepressant Treatment of Depression Antidepressant Treatment of Depression PLEASE REFER TO INTEGRATED CARE PATHWAY FOR INFORMATION RELATING TO THE OVERALL MANAGEMENT OF DEPRESSION SSRI s are first choice agents because they are as effective

More information

Use of Psychotropic Medications in Older Adults with Dementia!

Use of Psychotropic Medications in Older Adults with Dementia! Use of Psychotropic Medications in Older Adults with Dementia! Deepa Pattani, PharmD, RPh Owner: PrevInteract Health Deepa.Pattani@PrevInteract.com 972-372-9775 About Me Deepa Pattani, PharmD, RPh with

More information

ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES MEDICATION FORMULARY

ALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES MEDICATION FORMULARY ANTIDEPRESSANTS Serotonin Selective Reuptake Inhibitors citalopram 10, 20, 40 mg, 10 mg/5cc $ 0.40 No escitalopram 10, 20 mg $ 2.60 Yes fluoxetine 10, 20 mg, 20 mg/5 ml $ 0.40 Yes fluvoxamine 25, 50, 100

More information

PSYCHIATRIC DRUGS. Mr. D.Raju, M.pharm, Lecturer

PSYCHIATRIC 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 information

WORKPLACE. Dr. ONG BENG KEAT Consultant Psychiatrist Psychological Medicine Clinic LohGuanLye Specialists Centre, Penang

WORKPLACE. Dr. ONG BENG KEAT Consultant Psychiatrist Psychological Medicine Clinic LohGuanLye Specialists Centre, Penang STRESS @ WORKPLACE Dr. ONG BENG KEAT Consultant Psychiatrist Psychological Medicine Clinic LohGuanLye Specialists Centre, Penang Outline Introduction: What is stress? Sources of stress Stress and productivity

More information

Start Low, Go Slow but Treat to Target

Start Low, Go Slow but Treat to Target Start Low, Go Slow but Treat to Target Pharmacotherapy for Depression, Anxiety and At-Risk Alcohol Use in Late Life September 29, 2014 Audio and Control Panel instruction On the phone? Raise your hand

More information

Pharmacotherapy of depression

Pharmacotherapy of depression Pharmacotherapy of depression Stuff you already know Stuff you probably know Stuff you possibly don t know Stuff you thought you knew but are mistaken about How long does it take for antidepressants

More information

Pregnancy. General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition)

Pregnancy. General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition) Pregnancy General Principles of Prescribing in Pregnancy (The Maudsley, 12 th Edition) In all women of child bearing potential Always discuss the possibility of pregnancy; half of all pregnancies are unplanned

More information

Medications Guide: Public Speaking And Social Anxiety

Medications 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 information

Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care

Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care Obsessive-Compulsive Disorder Clinical Practice Guideline Summary for Primary Care CLINICAL ASSESSMENT AND DIAGNOSIS (ADULTS) Obsessive-Compulsive Disorder (OCD) is categorized by recurrent obsessions,

More information

Major Depressive Disorder (MDD) in Children under Age 6

Major Depressive Disorder (MDD) in Children under Age 6 in Children under Age 6 Level 0 Comprehensive assessment. Refer to Principles of Practice on page 6. Level 1 Psychotherapeutic intervention (e.g., dyadic therapy) for 6 to 9 months; assessment of parent/guardian

More information

Richard Heidenfelder M.D. Child, Adolescent and Adult Psychiatry 447 9th Ave San Diego, CA

Richard 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 information

Non-A, non-b=hcv; IFN/RBV; DSM-5/Ham-D, OLT; SSRI, P450

Non-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 information

Psychiatric Medication Guide

Psychiatric 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 information

Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD

Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington. Approach for doing differential diagnosis of PTSD IN PRIMARY CARE June 17, 2010 Kari A. Stephens, PhD & Wayne Bentham, MD Psychiatry & Behavioral Sciences University of Washington Defining and assessing Approach for doing differential diagnosis of Best

More information

Obsessive/Compulsive Disorder

Obsessive/Compulsive Disorder Obsessive/Compulsive Disorder An Overview of the Diagnosis, Symptoms, Assessment and Treatment in Behavioral Health Martin J. Harrington M.D., Staff Child/Adolescent Psychiatrist Children s Hospital and

More information

Anxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM

Anxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE -NURSING PROGRAM Anxiety Pharmacology UNIVERSITY OF HAWAI I HILO PRE NURSING PROGRAM NURS 203 GENERAL PHARMACOLOGY DANITA NARCISO PHARM D Learning Objectives Understand the normal processing of fear vs fear processing

More information

Perinatal Mental Health: Prescribing Guidance for Trust Prescribers and GPs

Perinatal Mental Health: Prescribing Guidance for Trust Prescribers and GPs Perinatal Mental Health: Prescribing Guidance for Trust Prescribers and GPs (Version 3 January 2015) Principal Author: Dr Jenny Cooke Consultant Psychiatrist, Brighton & Hove Perinatal Mental Health Service

More information

Clinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg90

Clinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg90 Depression in adults: recognition and management Clinical guideline Published: 28 October 2009 nice.org.uk/guidance/cg90 NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).

More information

Family Medicine Forum November 10, 2017 Montreal., Quebec. Jon Davine, CCFP, FRCP(C) Associate Professor, McMaster University

Family 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 information