DEPRESSION

Battung, Jan Rae Y.

 DEPRESSION
Depressed mood most of the day nearly everyday.
Markedly diminished interest or pleasure in all, or
almost all, activities every day
Significant weight loss when not dieting or weight gain
Sleep disturbances
Psychomotor agitation or psychomotor retardation
 DEPRESSION
Fatigue, or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate
guilt nearly every day
Diminished ability to think or concentrate, or
indecisiveness, nearly every day
Recurrent thoughts of death
 BASIS OF THE PROBLEM

CHIEF COMPLAINT
Lump in her breast

PMI:
Depression (11 years)
Use of Fluoxetine 40mg PO q 24H
HPI:
Premenopausal
 BASIS OF THE PROBLEM

Social History:

 Works 70-90hours per week

 Smoking for 5 years
 Drinks 3-4 hard drinks/week

Mood affect: Slightly absent

 THERAPEUTIC OBJECTIVES

Come up with a therapeutic regimen that won’t complicate

other conditions
 Relieving the signs and symptoms of depression
Maintenance therapy to prevent relapse and recurrence
 NON-PHRAMACOLOGICAL
TREATMENT

Psychotherapy
Exercise
Getting enough sleep
Family Support
Lifestyle modification
PHARMACOLOGIC TREATMENT

1. Selective Serotonin Reuptake Inhibitors (SSRIs)

(Fluoxetine, Paroxetine, Sertraline, Citalopram, Escitalopram)

2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

A. Selective serotonin-norepinephrine Reuptake Inhibitors

(Venlafaxine, Levomilnacipran, Milnacipran)

B. Tricyclic Antidepressants
(Imipramine, Amityptyline, Doxepin)

3. 5-HT2 Receptor Modulators

(Trazodone, Nefazodone, Vortioxetin)
 PHARMACOLOGIC TREATMENT

4. Tetracyclic and Unicyclic Antidepressants

(Bupropion, Mirtazapine, Amoxapine)

5. Monoamine Oxidase Inhibitor

(Selegiline, Isocarboxacid)
 PHARMACOLOGIC TREATMENT
SSRI SNRI 5-HT2 MAOI Tetracyclic
Modulators And
Unicyclic

+++ +++ +++ +++ ++

Efficacy

+++ ++ + + +
Suitability

+++ + + + +
Safety
+++ ++ ++ ++ +
Cost
 PHARMACOLOGIC TREATMENT

Escitalopram Citalopram Fluoxetine Paroxetine Sertraline

Efficacy +++ +++ ++ ++ ++

Suitability +++ ++ + + +

Safety +++ ++ ++ ++ ++

Cost 12-21 php

Escitalopram

Pharmacokinetics
 Bioavailability - 80%
 T ½ - 27-32 hours
 Protein binding – 80%
 Modest CYP interaction
Escitalopram

Pharmacodynamics

 Inhibition of neuronal uptake of serotonin thru binding of SERT receptor

 Modest effects on other neurotransmitters; no evidence that they affect B

adrenoreceptors or norepinephrne transporter, NET
Escitalopram

Adverse Effects
 Dry mouth
 Stomach pain
 Nausea
 Changes in sex drive
Contraindications:
 Low magnesium in the blood
 Low potassium in the blood
 Increased risk of bleeding
 FATIMA UNIVERSITY MEDICAL CENTER
120 McArthur Highway, Marulas, Valenzuela City

Patient: LJ Date: February 08, 2019

Age: 56 Sex: Female

RX
Escitalopram 10 mg/tablet
#30

Sig. Take one tablet orally daily

Jan Rae Y. Battung M.D.

Lic. No. 123456
PTR No. 123456