Management of

Affective
Disorders Ronny T Wirasto
Program Studi Pendidikan Dokter
FMIPA
Universitas Tadulako
10/3/2017 2011
 Topik

Definisi
Gangguan
Diagnosis
Terapi

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 Most :
Depression
Mania
Bipolar

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 Depression
ANTI DEPRESAN
(BERDASARKAN SUSUNAN KIMIA)
POLICYCLIC
MONOAMINE
OXIDASE INHIBITOR
NEUROLEPTIK
L-TRYPTOPHAN
HORMON & VITAMIN
STIMULANT
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 NEUROLEPTIK DENGAN EFEK
ANTI DEPRESAN

THIORIDAZINE
CHLORPROMAZINE
THIOTHIXENE
LEVOMEPROMAZINE

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 HORMON & VITAMIN
THYROTROPIN
THYROXINE
PYRIDOXINE
------------------
STIMULANT :
- DEXAMPHETAMINE

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ANTI DEPRESAN BERDASAR FARMAKODINAMIK

TIMOLEPTIK : EFEK UTAMA MENINGKATKAN PERASAAN HATI

- DIBENZAZEPINE (IMIPRAMIN, OPIPRAMOL)
- DIBENZODIAZEPINE (DIBENZEPINE)
- DIBENZOCYCLOHEPTADINE (AMITRIPTYLINE)
- DIBENZOCYCLOHEPTATRINE (PROTRIPTYLINE)
- DIHYDROANTHACENE (MELITRACENE)

TIMERETIK : MENIADAKAN HAMBATAN PSIKIS (DISINHIBITING EFFECT)

- DERIVAT HYDRAZINE
- PHENILCYCLOPROPYLAMINE
- BENZYLMETHYL PROPINYLAMINE
- DERIVAT INDOL

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 Antidepressants:
Monoamine Reuptake Inhibitors
1st Generation of Antidepressants (TCA, TeCA)
Generic Name Trade Mark Doses (mg) Mechanism of
Efficacy
amitriptyline AMITRIPTYLIN 75-200
Inhibition of
nortriptyline NORTRILEN 50-150 Serotonin
and/or
imipramine MELIPRAMIN 75-250
Norepinephrine
clomipramine ANAFRANIL, 75-225 Reuptake
HYDIPHEN Followed by
Increase of
dosulepin PROTHIADEN 100-300
their
dibenzepine NOVERIL 240-720 Concentrations
in Synaptic
maprotiline LUDIOMIL, 75-150 Cleft
10/3/2017 MAPROTILINE
 1st Generation of Antidepressants

Mechanism of action:
Blockade of muscarine receptors
Histamine H1 receptors
Alpha 1 Adrenergic Receptors
Alpha 2 Adrenergic Receptors

Many Side Effects

Danger of Intoxication
Many Interactions
Prolonged Effect (after 3-6 Weeks)
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 2nd Generation of Antidepressants

2nd Generation of Antidepressants

Generic Name Trade Mark Mean Doses Mechanism
(mg)
viloxazine VIVALAN 100-300 Norepinephrine
Reuptake
Inhibition

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 3rd Generation of Antidepressants
Generic Name Trade Mark Mean Doses Mechanism
(mg)

SSRI

fluvoxamine FEVARIN 100-300

fluoxetine DEPREX, DEPRENON, 20-60

PROZAC, PORTAL,
FLOXET, FLUXONIL,
MAGRILAN
citalopram SEROPRAM, CITALEC, 20-60 Selective
CEROTER, PRAM Serotonin
escitalopram CIPRALEX 10-20 Reuptake
Inhibition

paroxetine SEROXAT, PAROLEX, 20-60

APO-PAROX, REMOD
sertraline ZOLOFT, SERLIFT, 50-200
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ASENTRA,
STIMULOTON
 3rd Generation of Antidepressants
Generic Name Trade Mark Mean Doses Mechanism
(mg)
SARI
Antidepressants with Doubled Serotonergic Efficacy
trazodone TRITTICO AC 4-8
Double Serotonergic
nefazodone SERZONE, 100-300 Efficacy
DUTONIN

NARI
reboxetine EDRONAX 4-8 Norepinephrine
Reuptake Inhibition

tianeptine COAXIL 75 Increasing of Serotonin

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Reuptake
 4th Generation of Antidepressants
Dual acting antidepressants
Mixed reuptake inhibitors
Generic Name Trade Mark Mean Doses Mechanism
(mg)

SNRI
venlafaxine EFECTIN 75-375

venlafaxine EFECTIN ER 75-225 Serotonin and

ER (extended Norepinephrine
relesase) Reuptake Inhibition
milnaciprane IXEL, 50-100
DALCIPRAN

DNRI
bupropione WELLBUTRIN 150-300 Dopamine and
ZYBAN Norepinephrine
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Reuptake Inhibition
 4th Generation of Antidepressants
Generic Name Trade Mark Mean Doses Mechanism
(mg)

Blockade of 2-adrenoceptors
mianserin LERIVON, 60-90 Increasing Synthesis
MIABENE and Releasing of
Norepinephrine,
Blockade Alpha-2
Adrenoceptors on
mirtazapine REMERON, 15-45 Serotonergic Neurons
ESPRITAL, and Increasing
REMERON Production and
sol. tab. Releasing of Serotonin

Other Monoamine Reuptake Inhibitors

hypericum JARSIN 900 Weak Inhibitor of NA,
perforatum
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5-HT, DA
 MAO Inhibitors
Non Selective and Irreversible: (IMAO A, IMAO B)

phenelzine NARDIL

isocarboxazid MARPLAN

nialamide NIAMID, NUREDAL

tranylcypromine PARNATE

Selective and Reversible

moclobemide AURORIX

MAO A brofaromine CONSONAR

toloxatone
HUMORYL

MAO
10/3/2017 B selegiline (L-deprenyl) SEPATREM, JUMEX
 Mania
Generic Name Trade Mark Doses (mg) Blood Serum
Concentration

LITHIUM 0.5 0.8

900 1000
CARBONICUM mmol/l
lithium
carbonicum
0.8 1.2
CONTEMNOL 1000 - 1500
mmol/l

BISTON,
5 10
carbamazepine TEGRETOL, 400 - 1500
ng/ml
TIMONIL

EVERIDEN, 50 - 100
valproic acid 900 - 2000
ORFIRIL, ng/ml
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 Bipolar
Antiepileptic
Antidepresan
Antipsikotik
ECT dan terapi yang lain
Intervensi psikologi

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antiepileptik
Lithium
depression episode
Profilaksi
Lamotigrine
an anticonvulsant with demonstrated efficacy in
treating generalized and partial seizures
Asam Valproate
Carbamazepine

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antipsikotik
Olanzapine
Quetiapine
Clozapine
effects on the dysphoric component of mania
Risperidone

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 Intervensi psikologis
CBT (Cognitive Behavior Therapy)

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