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Depression is a mood disorder characterized by sadness and pessimism. The causes of depression are unknown, but the basis of its pharmacotherapy is the hypothesis that the manifestations of the disease are due to a deficiency of dopamine, norepinephrine and serotonin in the brain or dysfunction of the receptors of these mediators. With major depression, the level of cortisol in the blood is increased by 50% and the circadian rhythm of its secretion is disturbed. When treating a disease, three classes of drugs are used: tricyclic antidepressants, monoamine oxidase inhibitors (MAO) and atypical antidepressants. The interaction of antidepressants with agents used in anesthesiology can cause significant complications. In severe drug-resistant depression, electroconvulsive therapy (ECT) is prescribed. General anesthesia for ECT has greatly contributed to the safety and widespread use of this technique.
Tricyclic antidepressants are indicated for the treatment of depression and chronic pain syndromes (Ch. 18). All tricyclic antideprents block the reverse neuronal capture or catecholamines, or serotonin, or both mediators at once (Table 18-7). Desipramine (norpramine) and nortripti-lin (pamelor) are used more often because they do not have a strong sedative effect, and their side effects are mild. Amitriptyline (elavil), imipramine (tofranil), protriptyline (vivactil), amoxapine (asendin) and doxepin (synekvan) have a stronger sedative effect. For the treatment of obsessive-compulsive disorders prescribed clomipramine (anafranil). Most tricyclic antidepressants block the m-cholinergic receptors, which causes dry mouth, blurred vision, slower evacuation from the stomach, and urinary retention. Some tricyclic antidepressants affect the heart like quinidine, causing tachycardia, flattening or inversion of the T wave, increasing the duration of the PQ, QRS and QT intervals. Amitriptyline is more effective than other drugs in its group, blocking m-cholinergic receptors, doxepin has the weakest effect on the heart.
In the perioperative period, the use of tricyclic antidepressants usually continues. These drugs increase the content of catecholamines in the brain, and therefore the need for anesthetics increases. Tricyclic antidepressants potentiate the action of m-anticholinergics that penetrate the blood-brain barrier (atropine and scopolamine), which increases the risk of confusion and delirium in the postoperative period. During anesthesia, an overly powerful response to indirect vasopressors and sympathetic stimulation develops. It is necessary to avoid the use of pancuronium, ketamine and solutions of local anesthetics containing adrenaline (especially against the background of anesthesia with ha-lotan). Tricyclic antidepressants reduce the threshold of convulsive readiness, therefore, based on theoretical considerations, enflurane is not recommended. Long-term treatment with tricyclic antidepressants causes depletion of the catecholamines in the heart, therefore the risk of circulatory depression caused by anesthetics increases. In case of arterial hypotension, low doses of direct-acting vasopressors are shown (it should not be resorted to vasopressors of indirect action)
Amitriptyline, blocking m-cholinergic receptors, can provoke the development of postoperative delirium.
Monoamine oxidase inhibitors (MAO)
MAO inhibitors are prescribed for depression combined with panic attacks and severe anxiety. MAO inhibitors block the oxidative deamination of amines. At least two MAO isoenzymes (type A and type B) with different substrate specificity are distinguished. MAO-A selectively deaminates serotonin, dopamine and norepinephrine, a MAO-B - tyramine and phenylethylamine. Existing MAO inhibitors used to treat depression are non-selective drugs. They include phenelzine (nardil), isocarboxazid (marplan) and tranylcypromin (parytes). Selective MAO-B inhibitors are ineffective in the treatment of depression. Non-selective drugs inhibit in addition to MAO and other enzymes. Side effects include orthostatic hypotension, agitation, tremor, convulsive seizures, muscle spasms, urinary retention, paresthesia and jaundice. The hypotensive effect is due to the accumulation of a false neurotransmitter (octopamine). The most serious complication is the hypertensive crisis that occurs when eating foods high in tyramine (cheeses and red wines).
The rule that it is recommended to stop taking MAO inhibitors 2 weeks before the operation is rather contradictory. With the exception of tranylcypromine, all drugs irreversibly inhibit MAO. A two-week break in reception is enough to synthesize the required amount of MAO. Research has shown that anesthesia is safe and without a two-week waiting period (at least for ECT). Phenelzine is able to reduce plasma cholinesterase activity and lengthen the time of action of succinylcholine. When treating with MAO inhibitors, one should refrain from opioids in order to avoid the development of rare but dangerous side effects. The most serious complications are due to the combination of MAO inhibitors with meperidine and are characterized by hyperthermia, convulsive seizures and coma. Prolonged use of MAO inhibitors (as well as tricyclic antidepressants) is fraught with an overly potent response to indirect vasopressors and sympathetic stimulation during anesthesia. Medications with adrenomimetic effect (pancuronium, ketamine, adrenaline solutions of local anesthetics) are contraindicated.
Most atypical antidepressants are selective serotonin reuptake inhibitors (SSRIs). HPIMs include fluoxetine (prozac), sertraline (zoloft) and paroxetine (pac-sil). Many doctors consider them the drugs of choice for treating depression. Serotonin reuptake inhibitors do not block (or very slightly block) CNS cholinergic receptors and do not affect the conductivity of the pulse in the heart. The main side effects are headache, agitation, sleep disturbances. Other atypical antidepressants include bupropion (velbutrin), venlafaxine (effexor), trazodone (desirel), nefazodone (serzon), fluvoxamine (luvox) and maprotilin (lyudiomil). Maprotiline often causes seizures, which narrows its scope. Bupropion inhibits dopamine reuptake. The interaction of atypical antidepressants with anesthetics has been little studied.
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Depression is a mental disorder, the main features of which are: a decrease in mood (hypothymia), a negative, pessimistic assessment of oneself, one’s position in the surrounding reality, one’s future. Along with this, depression is often accompanied by inhibition, a decrease in the motivations for activity, dysfunctions in the work of many organs and systems.
Depression is a condition characterized by a triad of symptoms: depressed, depressed, melancholy or anxious mood, decreased mental activity and decreased motor activity. The term depression comes from the Latin word deprimo, meaning "to oppress." This triad constitutes the core of the clinical picture. Accompanied by depression can be a variety of clinical
Physical blocking This description applies to those who have PSYCHOTICAL DEPRESSION. Those who suffer from temporary emotional depression caused by adverse life circumstances or some unpleasant event, it is better to refer to the articles AGORAHOBIA, ALARM or ANXIETY. The main symptoms of depression are: loss of interest in daily activities, feeling
The manifestations of depression are very diverse and vary depending on the form of the disease. The most typical symptoms of this disorder are listed below. The most typical manifestations of depression Emotional manifestations • Sadness, suffering, depressed, depressed mood, despair. • Anxiety, feeling of internal tension, waiting for trouble. • Irritability. • Guilt feelings, ideas of self-blame. •
Cause The most common cause of depression is mental stress. Also, depression is possible due to overwork, brain injury (possibly in the past), prolonged and severe disease of internal organs, surgery, prolonged pain, poor blood supply to the brain, congenital mental impairment of the integrity of the personality. Symptoms Depressed, joyless
- Depression Scale
The questionnaire was developed for the differential diagnosis of depressive states and conditions close to depression, for screening diagnostics in mass studies and for the purpose of preliminary, pre-medical diagnostics. Test adapted by T.I. Balashova. Full testing with processing takes 20-30 minutes. The subject marks the answers on the form. Depression level (UD) is calculated using the formula: UD
- 8.1. ALARM AND DEPRESSION
Among all psychopathological syndromes encountered in somatic practice, anxiety and depression are the most common. These disorders are usually considered in a single continuum. Anxiety and depression are often combined with somatic disorders (comorbid conditions), make them more severe, prognosis. Timely treatment of them significantly optimizes internal therapy.
Depressive syndrome - a combination of melancholy mood with a decrease in mental and physical activity. Assessment of the severity of depression is within the competence of the psychiatrist, since its external signs do not always reflect the severity of the condition and the risk of possible suicide. Suicidal attempts, refusal to eat, anxious motor excitation of the patient require urgent hospitalization in
- Treatment of depression
The leading treatment for depression today is psychopharmacotherapy. Along with medications, methods of physical, phyto, and psychotherapy with elements of psychocorrection and other socio-rehabilitation methods are widely used. Psychotherapy, conducted in conjunction with medicinal treatment, (mainly aimed at correcting depressive distortion of thinking, reducing aggression,
- Depression in patients with myocardial infarction
In recent decades, it has been established that depressive and anxiety disorders increase the risk of developing MI (Todaro JF et al., 2003). In a multicenter randomized study GISSI-2, it was found that 40% of patients in the preceding 3 months before the development of MI experienced a depressed mood. Other researchers report that depression develops as a result and complication of MI (Honig A. et.
- Depression of the ST segment as a manifestation of vegetative dystonia
Other changes in the ECG caused by impaired tone of the autonomic nervous system should include ST segment depression, which is noted in hypersympathicotonia. In the differential diagnosis takes into account the characteristic clinical picture; depression of the ST segment, revealed in young people, especially women, often with concomitant tachycardia, without typical angina pectoris manifestations. This
- Depression and mania alternately (cyclothymia)
Cause Cyclothymia or other mental illnesses and disorders in relatives. Symptoms Chronic instability of mood, frequent depression, alternating with elevation of mood. Instability usually develops at a young age and takes a chronic course. First aid. Needs psychological help, self-treatment.
- Postpartum depression
Most mothers go through a specific condition in the first or second week after giving birth. They feel sad, discouraged and anxious about their ability to care for a newborn baby. In part, hormones can be blamed, as well as lack of sleep. Your body is completely exhausted by pregnancy and childbirth, making you feel as if your life is completely
- From fashion to depression and disease
People who learn about what I do always ask me: “Doctor, what should I eat?” Americans are obsessed with the desire to find the right formula for nutrition. Since 1990, when I moved to New York, I witnessed the implementation of many bizarre theories that took hold of the minds of the entire country’s population, brought about industry restructuring and ultimately led to
- About depression in general. Let's talk?
This is what I want to draw your attention to now ... How do we experience bodily diseases? When we do not intend to be ill at your pleasure, of course. At the first sign of a cold, we climbed into a hot bath, had tea with raspberries and honey, poured mustard into our socks, drank a glass or two of vodka with pepper, covered ourselves warmly, and in the morning — like cucumbers! To whom such concern for themselves, swallow a couple or two