SKIP AHEAD: 2:20 – Mechanism of Antidepressants 3:16 – General Principles of Antidepressant Use: Suicide, Mania & Serotonin Syndrome 7:51 – Tricyclic Antidepressants 9:10 – TCA Side Effects 10:40 – SSRIs 11:47 – SSRI Side Effects 13:01 - SNRIs 13:33 – Atypicals: Bupropion, Mirtazapine & Trazadone Antidepressant mechanism - One hypothesis for the pathophysiology of depression is that it is due to low levels of monoamine neurotransmitters (mainly serotonin, norepinephrine and dopamine). That is why antidepressants aim to increase the levels of these neurotransmitters in the synaptic cleft. They do this by slowing the reuptake of the neurotransmitters so that they stay in the cleft longer and interact with post synaptic receptors more often. The first drugs in this group were non-specific and increased all of the monoamines, which lead to lots of side effects and safety issues related to toxicity. Newer antidepressants are more selective and mostly only effect 1 or 2 monoamines. General principles: Unfortunately, antidepressants take at least a month to start working. Good patient education about the delayed onset of effect and close monitoring of the patient during this initial period is extremely important. Patients can become hopeless if they expect the drug to start working right away. This may be one reason why antidepressants are associated with suicide, especially in patients 25 years old and younger. Another proposed mechanism is that a depressed person may have the energy to carry out their suicide once the medications start to work. There is now a black box warning for suicide on antidepressants. Some psychiatrists argue that they don’t actually see this association with suicide in clinical practice, and that the thing that really increases the risk for suicide is not treating a depressed person with the proper medications. However, it is still standard practice to have a close follow up with patients you are starting on antidepressants. Usually this will involve a follow up visit about 2 weeks after the medication is started. At this visit the drug will not have started working yet so you can’t evaluate efficacy, but you can monitor for side effects like suicidality. Another serious side effect you have to be on the lookout for soon after initiating treatment is mania. If a bipolar individual is incorrectly diagnosed as having depression, an antidepressant may induce a manic episode. Another very serious side effect that has to be considered for antidepressants is Serotonin Syndrome. This usually occurs when you combined multiple antidepressants at the same time or combine an antidepressant with another medication that increases serotonin such as dextromethorphan or an opioid. It presents with tremor, diaphoresis, tachycardia, flushing and hypertension. If not corrected it can progress to delirium, AMS and death. Treatment includes medication cessation and the use of Cyproheptadine (a serotonin antagonist). In order to prevent this from happening you should have about a month “Wash Out” period when you are switching between antidepressants. So you taper the 1st medication down and then stop it, give the patient at least a month with no antidepressant and then start adding the new medication slowly. Most side effects begin immediately after starting the medication, but diminish over the course of a month. This is another reason why patient compliance is poor with these meds. It makes them sick and the drug doesn’t work during the first few weeks. However, if they can stick with it the medications will likely start working and the side effects will diminish over time. A principle that applies to all of the antidepressants is “start low and go slow.” This means that you start with a lower dose and slowly increase it in order to decrease side effects and increase patient compliance. The dose you start the patient on may not even be at a therapeutic level, but every month or so you can increase the dose a bit. The text for this video is too long and exceeds the max allowed character length for Youtube. You can read the rest here http://www.stomponstep1.com/antidepressants-ssri-snri-tricyclic-antidepressants-citalopram-prozac-amitriptyline/ Pictures Used: • “SynapseSchematic” by Thomas Splettstoesser available at https://commons.wikimedia.org/wiki/File:SynapseSchematic_unlabeled.svg via Creative Commons 4.0 Attribution-Share Alike • “Zoloft Bottles” by Ragesoss available at https://commons.wikimedia.org/wiki/File:Zoloft_bottles.jpg via Public Domain
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This week Reactions takes a look at the science behind how Adderall works. There's a lot of chemistry in that little pill that affects your nervous system. More than 25 million people rely on Adderall™ and other similar drugs to help treat narcolepsy, depression and attention deficit and hyperactivity disorder (ADHD). But how does amphetamine, the active ingredient in Adderall™, work? This week, Reactions explains how amphetamine helps you focus--the chemistry of Adderall. Find us on all these places: Subscribe! http://bit.ly/ACSReactions Facebook! http://facebook.com/ACSReactions Twitter! http://twitter.com/ACSReactions Tumblr! http://tumblr.com/ACSReactions Cadillac Candy, Optimistic Ballroom, and Like That provided by AudioMicro Producer: Elaine Seward Scientific consultants: Tien Nguyen, Ph.D. Ryan Davison, Ph.D. Darcy Gentlemen, Ph.D. Writers: Tien Nguyen, Ph.D. Elaine Seward Noel Waghorn Executive Producer: Adam Dylewski
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A study has linked commonly used medicines, including over-the-counter treatments for conditions such as insomnia and hay-fever, to dementia. All of the types of medication in question are drugs that have an "anticholinergic" effect. Experts say people should not panic or stop taking their medicines.In the US study in the journal , higher doses and prolonged use were linked to higher dementia risk in elderly people. The researchers only looked at older people and found the increased risk appeared when people took drugs every day for three years or more. Side-effectsAll medicines can have side-effects and anticholinergic-type drugs that block a neurotransmitter called acetylcholine are no exception. Patient information leaflets accompanying such drugs warn of the possibility of reduced attention span and memory problems as well as a dry mouth. But researchers say people should also be aware that they may be linked to a higher risk of developing dementia.Dr Shelly Gray and colleagues from the University of Washington followed the health of 3,434 people aged 65 and older who had no signs of dementia at the start of the study. They looked at medical and pharmacy records to determine how many of the people had been given a drug with an anticholinergic effect, at what dose and how often and compared this data with subsequent dementia diagnoses over the next decade. Drugs in the studyThe US study does not name specific brands, but does outline the types of treatments investigated, which include: Tricyclic antidepressants for treating depression Antihistamines used to treat hay-fever and allergies Antimuscarinics for treating urinary incontinence Most of the drugs were given on prescription, rather than bought at the pharmacy over-the-counter.The most commonly used anticholinergic-type drugs were medicines for treating depression, antihistamines for allergies such as hay-fever or to aid sleep/promote drowsiness, and drugs to treat urinary incontinence. Nearly a fifth were drugs that had been bought over the counter. Over the course of the study, 797 of the participants developed dementia.'Not causal'The study estimated that people taking at least 10 mg/day of doxepin (antidepressant), four mg/day of diphenhydramine (a sleep aid), or five mg/day of oxybutynin (a urinary incontinence drug) for more than three years would be at greater risk of developing dementia. The researchers say doctors and pharmacists might want to take a precautionary approach and offer different treatments instead. And when there is no alternative, they could give the lowest dose for the shortest time possible.Dr Gray says some of the study participants have agreed to have an autopsy after their death. "We will look at the brain pathology and see if we can find a biological mechanism that might explain our results."Dr Simon Ridley, head of research at Alzheimer's Research , said the study was interesting but not definitive - there was, he said, no evidence that these drugs caus
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Please watch: "PM Modi on Frankly Speaking with Arnab Goswami | Exclusive Full Interview" ►http://bit.ly/297mDAR -~-~~-~~~-~~-~- Government's move to withdraw custom duty exemption of 76 life saving drugs is drawing criticism from several quarters. This spike in prices of medicines is going to cost patients of cancer, hemophilia and AIDS severely. TIMES NOW spoke to a patient of hemophilia, 42 year old Sunil Jadhav who now spends anything between 76 thousand to 96 thousand a month for his injection, but come April 1, he will have to pay over a lakh for the same medicine. While the Central government justifies move, calling it an aim to strengthen the 'make in India's campaign, the doctors too feel that cancer patients will be affected and the government should review this decision. Subscribe to Times Now | Click Here ► http://goo.gl/U9ibPb ‘Download the official TIMES NOW mobile app – Give a missed call on 1800 4190 300. Stay updated, stay ahead.’ Subscribe Now To Our Network Channels :- The NewsHour Debate : http://goo.gl/LfNgFF ET Now : http://goo.gl/5XreUq To Stay Updated Download the Times Now App :- Android Google Play : https://goo.gl/zJhWjC Apple App Store : https://goo.gl/d7QBQZ Social Media Links :- Facebook - http://goo.gl/CC7rGc G+ - http://goo.gl/O1iEp5 Twitter - http://goo.gl/uHYsqP Also visit our website - http://goo.gl/XPUXe8
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VLAN Foundation | Free Cisco CCNA: In this video, Imran introduces the concept of VLAN and how it is beneficial to use VLAN. He breaks the confusing topic of VLAN and makes it very easy for people to understand. A must-watch video. Website: www.nwking.org Facebook Page: https://www.facebook.com/NetworKingConsultant Youtube Page: https://www.youtube.com/user/NetworKingInc Channel Description: Want to become a CCNA? Cannot find any appropriate FREE video, that is legal? Cannot find any quality video that breaks down the learning process into simple to follow steps? Well, NetworKing came into being to bring quality training to students for FREE. We currently have a large database of different training videos covering almost all the major certifications in the world. Please subscribe to our YouTube channel to Watch the World's best training video, FREE for personal use! Get your CCNA certification in 30 days! Old Exam Code: 640-802 CCNA New Exam Code: 200-120 CCNA All our videos can be found in the following playlist: http://www.youtube.com/playlist?list=PLh94XVT4dq02frQRRZBHzvj2hwuhzSByN Copyright of NetworKing and Imran Rafai. Downloading this video from YouTube would be in violation of the copyright. Users are allowed to ONLY watch this video training from the above links. If you want to download the video, you can buy it by contacting 'firstname.lastname@example.org'. If this video is found on any other channel, please report to 'email@example.com'.
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Adquira o Seu Com Desconto Aqui: http://bit.ly/XtrasizeDesconto As pílulas do XtraSize, contém SOLANUM SESSILIFLORUM, um ingradiente SECRETO, extraído de uma fruta exótica da Amazônia, esse componente tem grande influência na circulação sanguínea, e aumento de testosterona, aumentando assim a saúde do usuário e do pênis, onde o mesmo aumenta a irrigação de sangue, causando assim melhores ereções e mais duradouras. Adquira o Seu Com Desconto Aqui: http://bit.ly/XtrasizeDesconto Sua fórmula é indicada por diversos profissionais da área, como a melhor solução, sem receita médica, para o tratamento da saúde sexual masculina. O XtraSize é aprovado pela Anvisa, e não possui contra indicações conhecidas, qualquer homem que deseja ter mais saúde sexual pode fazer o seu uso. No entanto, pessoas diabéticas, com doenças no fígado ou hipersensíveis a qualquer ingrediente do produto não devem tomar XtraSize. O sucesso do produto é conhecido mundialmente, e agora chegou o Brasil como uma forma de melhorar a vida de milhares de homens que por muitas vezes sofrem calados em relação aos seus problemas sexuais. Adquira o Seu Com Desconto Aqui: http://bit.ly/XtrasizeDesconto
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Tip 1: Using a syringe over a measuring spoon is better Tip 2: Give a dose at the pharmacy so you can have it flavored right there.
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