抗抑郁药课件.ppt

Depression
王天晟, ., .
北京大学药学院
Additional Resources:
1. Mann JJ. The Medical Management of Depression. New England Journal of Medicine 2005;353:1819-34
2. Gelenberg AJ, Hopkins HS. Assessing and Treating Depression in Primary Care Medicine. American Journal of Medicine. 2007; 120:105-108
3. The Texas Implementation of Medication Algorithms: Update to the Algorithms for Treatment of Bipolar I Disorder. Suppes T., et al. Journal of Clinical Psychiatry 2005; 66: 870-886
Neurotransmitter
Neurotransmitter Pathway
Function
Removal Mechanism
Disease
Medication
Dopamine
(多巴***)
inhibitory
transporter
T
parkinson
schizophrenia
dopamine agonist
Serotonin (5-HT)
(5羟色***)
excititory
transporter
MAO
抑郁
anxiety
schizophrenia
SSRIs(选择性5HT再吸收抑制剂)
SNRIs(5-HT和NE双重再摄取抑制剂)
atypical
Noradrenergic
(去甲肾上腺素)
excititory
transporter
T
抑郁
bipolar
anxiety
TCAs(三环类抗抑郁)
GABA
(r-氨基丁酸)
inhibitory
transporter
seizure
疼痛
anxiety
parkinson
gabapentin(加巴喷丁)
Glutamate
excititory
transporter
alzheimer
pain
parkinson
memantine
synthesizing
packaging
releasing
binding
removal
Epidemiology
occurs in 1 in 8 individuals during their lifetime
2-3% of males; 5-9% of orbidities:
anxiety
impulse control disorder
substance abuse
Average Onset: mid-20s, but can manifest at any age
Epidemiology
triggering factors:
death of loved one,
divorce,
chronic medical conditions
endocrine disorder: Cushing’s dz, Addison’s dz, ....
Implication: > 50% pleted suicides involve depression
annual cost: $44 billion
Epidemiology
Course of illness
single episode
recurrent episodes
60% of Pts w/ single episode:
develop a 2nd episode
Pts w/ 2nd episode:
70% chance of having a 3rd episode
Pts w/ 3rd episode:
90% chance of having a 4th episode
Epidemiology
5-10% of Pts w/ single depressive episode:
will eventually experience manic episode
Ps w/ residual symptoms
more likely to suffer from future depressive episodes
Pathophysiology
exact etiology unknown
most likely multifa