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Depression is a mood disorder characterized by sadness and pessimism. Causes of depression are unknown, but the basis of its pharmacotherapy is the hypothesis that the manifestations of the disease are caused by a deficiency of dopamine, norepinephrine and serotonin in the brain or dysfunction of the receptors of these mediators. With a large depression, the level of cortisol in the blood was increased by 50% and the circadian rhythm of its secretion was disturbed. Three classes of drugs are used to treat the disease: tricyclic antidepressants, monoamine oxidase (MAO) inhibitors and atypical antidepressants. The interaction of antidepressants with the drugs used in anesthesiology can cause significant complications. In severe drug-resistant depression, electroconvulsive therapy (ECT) is prescribed. General anesthesia with ECT greatly contributed to the safety and wide dissemination of this technique.
Tricyclic antidepressants are indicated for the treatment of depression and chronic pain syndromes (Chapter 18). All tricyclic antidepressants block the reverse neuronal capture of either catecholamines or serotonin, or both mediators at once (Tables 18-7). Most often used desipramine (norpramine) and nortriptylin (pamelor), because they do not have a strong sedative effect, and their side effects are poorly expressed. A stronger sedative effect is possessed by amitriptyline (elavil), imipramine (tofranil), protriptyline (vivatil), amoxapine (asendin) and doxepin (synecan). To treat obsessive-compulsive disorders, appoint clomipramine (anafranil). Most tricyclic antidepressants block m-cholinergic receptors, which are caused by dry mouth, visual impairment, delayed 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 length of the PQ, QRS, and QT intervals. Amitriptyline is more effective than other drugs in its group, it blocks m-holinoretseptory, the weakest effect on the heart renders doxepin.
In the perioperative period, tricyclic antidepressant therapy usually continues. These drugs increase the content of catecholamines in the brain, and this increases the need for anesthetics. Tricyclic antidepressants potentiate the effect of m-cholinoblockers penetrating 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 vasopressors of indirect action 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 a hologram). Tricyclic antidepressants reduce the threshold of convulsive readiness, therefore, based on theoretical considerations, it is not recommended to use enflurane. Long-term treatment with tricyclic antidepressants causes depletion of catecholamines in the heart, therefore the risk of cardiovascular depression caused by anesthetics increases. With arterial hypotension, low doses of direct-acting vasopressors are indicated (it should not be resorted to indirect vasopressors).
Amitriptyline, blocking m-holinoretseptory, can provoke the development of postoperative delirium.
Inhibitors of monoamine oxidase (MAO)
MAO inhibitors are prescribed for depression, combined with panic attacks and severe anxiety. MAO inhibitors block the oxidative deamination of amines. There are at least two isoenzymes of MAO (type A and type B) with different substrate specificity. MAO-A selectively deaminates serotonin, dopamine and norepinephrine, and MAO-B is tyramine and phenylethylamine. The existing MAO inhibitors used to treat depression are non-selective drugs. They include phenelzine (nardyl), isocarboxazide (marplane) and tranylcypro-min (boyfriend). Selective MAO-B inhibitors are ineffective in the treatment of depression. Non-selective drugs inhibit besides MAO and other enzymes. Adverse events 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, according to which reception of MAO inhibitors is recommended to be discontinued 2 weeks before the operation, is rather contradictory. With the exception of tranylcypromine, all drugs irreversibly inhibit MAO. A two-week break in admission is sufficient to synthesize the necessary amount of MAO. Studies have established that anesthesia is safe and without a two-week waiting period (at least for ECT). Fenelzin is able to reduce the activity of cholinesterase in the plasma and prolong the duration 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 caused by a combination of MAO inhibitors with meperidine and are characterized by hyperthermia, convulsive seizures and coma. Long-term use of MAO inhibitors (as well as tricyclic antidepressants) is fraught with the emergence of an excessively potent response to indirect vasopressors and sympathetic stimulation during anesthesia. Contraindicated drugs with an adrenomimetic effect (pancuronium, ketamine, containing adrenaline solutions of local anesthetics).
Most atypical antidepressants are selective serotonin reuptake inhibitors (SSRIs). HPIM includes fluoxetine (Prozac), sertraline (zoloft), and paroxetine (pack-force). Many doctors consider them to be the drugs of choice in the treatment of depression. Serotonin reuptake inhibitors do not block (or very slightly block) the cholinergic receptors of the CNS 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 (venbutrin), venlafaxine (effector), trazodone (disiril), nefazodone (serzone), fluvoxamine (LuVox), and maprotiline (lyudomil). Maprotiline often causes seizures, which narrows the scope of its use. Bupropion inhibits the re-uptake of dopamine. Interaction of atypical antidepressants with anesthetics has been studied little.
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Depression is a mental disorder, the main signs of which are: a decrease in mood (hypotomy), a negative, pessimistic assessment of yourself, your position in the surrounding reality, your future. Along with this, depression is often accompanied by inhibition, a decrease in incentives for activity, dysfunctions in the work of many organs and systems
Depression is a condition characterized by a triad of symptoms: a depressed, depressed, dreary or anxious mood, a decrease in mental activity and a decrease in motor activity. The term depression comes from the Latin word deprimo, meaning "oppress". This triad forms the core of the clinical picture. Depression can be accompanied by a wide variety of clinical
Physical blockage This description applies to those who are suffering from PSYCHOTIC DEPRESSION. Those who suffer from temporary emotional depression, caused by unfavorable circumstances of life or some unpleasant event, it is better to refer to articles AGORAPHOBIA, ALARM or DISTURBANCE. 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 signs of this disorder are listed below. The most typical manifestations of depression Emotional manifestations • Longing, suffering, depressed, depressed mood, despair. • Anxiety, a feeling of inner tension, anticipation of trouble. • Irritability. • Feelings of guilt, ideas of self-blame. •
Cause The most common cause of depression is mental stress. Depression is also possible due to fatigue, brain trauma (possibly in the past), prolonged and severe internal disease, surgical operation, prolonged pain, poor blood supply to the brain, congenital mental disruption of the integrity of the individual. Symptoms: Oppressed, bleak
- Depression Scale
The questionnaire was developed for the differential diagnosis of depressive states and conditions close to depression for screening diagnostics in case of mass studies and for the purpose of preliminary, pre-medical diagnostics. The test is adapted by T.I. Balashovoy. Full testing with processing takes 20-30 minutes. The subject marks the answers on the form. The level of depression (UD) is calculated by the formula: UD
- 8.1. ALARM AND DEPRESSION
Among all the psychopathological syndromes that occur in somatic practice, anxiety and depression are the most frequent. These disorders, as a rule, are considered in a single continuum. Anxiety and depression are often combined with somatic disorders (comorbid conditions), weight their course, prognosis. Timely treatment of them significantly optimizes the therapy of internal
Depressive syndrome is a combination of dreary mood with a decrease in mental and physical activity. Evaluation of the severity of depression is in the competence of a 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 excitement of the patient require urgent hospitalization in
- Treatment of depression
The leading method of treatment of depression at the present stage is psychopharmacotherapy. Along with medicines, methods of physio-, phyto- and psychotherapy with elements of psychocorrection and other socio-rehabilitation methods are widely used. Carried out in conjunction with drug therapy, psychotherapy (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 GISSI-2 study, 40% of patients experienced a depressed mood in the preceding 3 months before the onset of MI. Other researchers report that depression develops as a result and a complication of MI (Honig A. et al.
- Depression of the st segment as a manifestation of autonomic dystonia
To other ECG changes, caused by a violation of the tone of the autonomic nervous system, one should include the depression of the ST segment, which is noted in hypersympathicotonia. Differential diagnosis takes into account the characteristic clinical picture; depression of the ST segment, found in young people, especially women, often with concomitant tachycardia, without typical stenocardic manifestations. This
- Depression and mania alternately (cyclothymia)
Cyclothymia or other mental illness and disorders in relatives. Symptoms Chronic instability of mood, frequent depression, followed by a rise in mood. Instability usually develops at a young age and takes on 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 childbirth. They feel sad, discouraged and worried about their ability to care for a newborn baby. Partly here can be blamed for hormones, as well as lack of sleep. Your body is completely exhausted by pregnancy and childbirth, causing a feeling as if your life is completely
- From fashion to depression and disease
People who find out about what I do, they always ask me: "Doctor, what should I eat?" Americans are obsessed with finding the right formula for nutrition. Since 1990, when I moved to New York, I witnessed the implementation of many bizarre theories that took possession of the minds of the population of the whole country, caused the restructuring of industry and eventually led to
- About depression in general. Will we 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 for our pleasure, of course. We will get into the hot bath at the first signs of a cold, drink tea with raspberries and honey, put mustard in our socks, we pour a glass of vodka and pepper, we'll cover up warmer, and in the morning - like cucumbers! To whom the burden of such care for themselves, swallow a couple or two