FARMAKOTERAPI DEPRESI

DEFINISI Sindroma ansietas dan depresi merupakan penyakit gangguan psikosomatik keluhan yang sering terjadi adalah sakit kepala anoreksia, cepat lelah , konstipasi, insomnia, sesag nafas berkeringat , nyeri ulu hati.

untuk mengenali depresi lebih mudah terdapat trias depresi yaitu : 1. tidak bisa menikmati hidup 2. tidak ada perhatian terhadap lingkungan 3. lelah sepanjang hari Ciri ciri sindroma ansietas adalah Cemas, khawatir , tidak bisa rileks atau tengang yang belangsung lebi dari 3 bulan yang disebabkan karena akibat ketidak seimbangan syaraf otonom. Gejala : gemeteran, otot tegang, kelelahan , berkeringat, sulit tidur.

Perbedaan depresi dan ansietas Somatis : Pola tidur Sulit Cepat bangun Rasa lelah - + Waktu terjadi tidak nyaman Sore hari Pagi hari Psikis : Rasa kasih sayang Perhatian hobi Humor Tujuan hidup Menangis Menyalahkan diri

PATOFISIOLOGI adanya gangguan ketidakseimbangan saraf otonom vegetatif karena faktor psikis seperti konflik emosional, frustasi, ketegangan yang berlangsung lama dan berbagai stress. atau lesi pd otak akan menimbulkan aktivitas serangan kejang akibat naiknya potensial listrik Manifestasi klinik ketidakseimbangan vegetatif adalah : Hipertoni simpati, hipotoni simpati, hipotoni parasimpati, ataksia vegetatif yaitu apabila koordinasi antara simpati dan parasimpatis sudah tidak ada lagi.

PATOFISIOLOGI Gangguan vegetatif autonom terjadi karena adanya gangguan konduksi impuls saraf di celah celah sinaps antara neuron neuron. Gangguan tersebut terjadi karena kelebihan / kekurangan neurotransmiter dipresinaps atau gangguan sensitivitas pada reseptor reseptor post sinaps. Neurotransmiter tersebut adalah noradrenalin, dopamin dan seretonin . Pada pasien depresi terjadi defisit atau kekurangan tiga neurotransmiter tersebut.

SASARAN TERAPI Aspek organobiologik disesuaikan dengan kelainan medis internis dan somatis Aspek psiko edukatif melakukan edukasi terhadap pasien tentang pendapat pasien yang salah , memberi pengertian dan keyakinan Aspek sosio kultural dengan memperbaiki kondisi sosio ekonomi , kesulitan yang dialami, penyesuaian dengan lingkungan.

TERAPI 1. MIXED SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS TCAs potentiate the activity of NE and 5-HT by blocking their reuptake. However, the potency and selectivity of TCAs for the inhibition of reuptake of NE and 5-HT vary greatly among these agents. TCAs affect other receptor systems including the cholinergic, neurologic, and cardiovascular systems, adverse events are reported frequently during TCA therapy.

Venlafaxine inhibits 5-HT reuptake at low doses, with additional NE reuptake at higher doses; thus, it is referred to as a serotonin-norepinephrine reuptake inhibitor (SNRI). Duloxetine is also an SNRI with both 5HT and NE reuptake inhibition across all doses. Some studies suggest that the SNRIs can be associated with higher rates of response and remission than other antidepressants; however, most of these studies involved venlafaxine and not all studies support this conclusion.

2. SELECTIVE SEROTONIN REUPTAKE INHIBITORS The efficacy of selective serotonin reuptake inhibitors (SSRIs) is superior to placebo and comparable to other classes of antidepressants in treating patients with major depression. SSRIs are generally chosen as first-line antidepressants because of their safety in overdose and improved tolerability.

3. TRIAZOLOPYRIDINES Trazodone and nefazodone have dual actions on serotonergic neurons, acting as both 5-HT receptor antagonists and 5-HT reuptake a inhibitors. They can also enhance 5-HT -mediated neurotransmission. Trazodone blocks adrenergic and histaminergic receptors leading to increased side effects (e.g., dizziness and sedation) that limit its use as an antidepressant. Nefazodone’s use as an antidepressant has declined as well after reports of hepatic toxicity began to emerge. The FDA-approved nefazodone labeling includes a black box warning describing rare cases of liver failure. The triazolopyridines are effective agents in treating major depression; however, they both carry risks that limit their usefulness as antidepressants.

4. MINOKETONE Bupropion has no appreciable effect on the reuptake of 5-HT, where as having reuptake properties at both the NE and DA reuptake pumps. These pharmacologic properties make bupropion unique among all currently available antidepressants.

DA: dopamine DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision ECT: electroconvulsive therapy 5-HT: serotonin HAMD: Hamilton Depression scale MAOI: monoamine oxidase inhibitor NE: norepinephrine NIH: National Institutes of Health REM: rapid eye movement SNRI: serotonin-norepinephrine reuptake inhibitor SSRI: serotonin-selective reuptake inhibitor STAR* D: Sequenced Treatment Alternatives to Relieve Depression TCA: tricyclic antidepressant TRD: treatment-resistant depression