Koas Klender

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    PSIKOFARMAKA:

    OBAT ANTI DEPRESAN &

    MOOD STABILIZER

    Dr. Isa M. Noor, MSc, SpKJ

    Fakultas Kedokteran & Ilmu Kesehatan Universitas Islam Negeri

    Syarif Hidayatullah Banten2009

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    Obat Anti Depresan

    Anti Depresan Klasik Mixed uptake andneuroreceptor blockers

    Anti Depresan Inhibitor MAO Anti Depresan SSRI

    Anti Depresan Novel (Terbar!

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    Dasar Biologis Depresi

    Global burden of disease("#O! leadingcause of disease burden $epresi (%990 &no '! (2020 no 2!

    ipotesis$eisiensi nerotrans)iter)onoa)in

    Norepinerin (N*!+ serotonin !"T#$,$opa)in (DA!

    Mekanis)e aksi ar)akolo-is anti$epresan )ena)bah nerotrans)iter

    *n.i) MAO+ po)pa re-uptake(a)bilanke)bali!

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    Ne%roanatoi Depresi

    Sir'%it NE --n konsentrasi+ )e)ori+ atensi+arosal+ proses inor)asi+ )oo$ $epresi+retar$asi psiko)otor+ ati-e , ti$r

    Siste "Tfeeding+ berat ba$an+ a-resi+release kortisol+ $epresi+ /e)as+ panik+ O

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    Ne%ron & Ne%rotransiter

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    Anti Depresan Klasi'

    Anti $epresan trisiklik (TA! , heterosiklik

    Men-eblok po)pa transporter N*+ DA ,1#T , anti neri

    Men3a-a keterse$iaan nerotrans)iter $i/elah sinap reseptor

    A)itriptilin+ )aprotilin+ i)ipra)in+/lo)ipra)in

    Dirt( )r%g eek sa)pin- keti$akna)anan ainitas terha$ap reseptorkoliner-ik )skarinik lebi* besar

    Mlt kerin-+ pan$an-an kabr+ -an--an)e)ori+ retensi rin , konstipasi

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    Se$iaan Anti Depresan 4a)a

    (Trisiklik , Tetrasiklik!

    Aitriptiline trisiklik & 21 )-

    No)iensine ()erital!

    Mianserin (tolvon! tetrasiklik bereek

    se$asi %0+ 50 )-

    A)o6apine (asen$in! %00 )-

    +loipraine(anaranil! 21 )-

    Iipraine(toranil! 21 )-

    Maprotiline(l$io)il! %0+ 21+ 10 )-

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    Anti Depresan Trisi'li'

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    Anti Depresan Tetrasi'li'

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    Anti Depresan Tetrasiklik

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    Anti Depresan In*ibitor MAO

    *n.i) MAO $estrksi nerotrans)iter

    Men-ha)bat en.i) MAO an- )ersaknerotrans)iter )onoa)in

    7en-ha)bat )onoa)in oksi$ase reversible &

    irreversible Mo/lobe)i$e (arori6!

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    Anti Depresan SSRI

    Selective serotonin reuptake inhibitor(SSRI! inhibitor a)bilan ke)bali selektiserotonin

    E,e' saping & lebih $apat $iteri)a ,batas kea)anan lebih tin--i (toksisitas3antn- &! $epresi pa$a stroke , epilepsi

    8kan reseptor ala a$rener-ik (hipotensiortostatik &!

    A'ti-itas terape%ti' & )en-ha)batreuptakeserotonin ke $ala) ter)inal saraserotoner-ik presinaptik

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    +italopra

    FDAseba-ai terapi --n $epresi berat+

    $isti)ik+ /e)as+ -an--an bipolar $epresi

    Aksi ar)akolo-is+ $iabsorbsi baik per

    oral+ akt parh 51 3a) Metabolis)e hepatik+ $osis (%0&:0 )- per

    hari!

    Dosis aal $epresi berat (20 )- per hari!+$osis eekti (20&;0 )- per hari!

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    Fl%o.etine

    Aalna seba-ai terapi $epresi berat+FDA ---n obsesi ko)plsi , bli)ia nervosa

    Aksi ar)akolo-is+ absorbsi baik per oral+ekskresi ke air ss

    "akt parh %&5 hari stlh pe)b< 3an-kapen$ek $an '&: hari stlh pe)b< 3an-kapan3an-

    Dosis aal pasien $epresi berat (20 )- per

    hari!+ $osis eekti (1&;0 )- per hari! Dosis aal ba-i anak= re)a3a $an oran-ta%0 )- per hari

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    Fl%-o.aine

    Ter)inal sara serotoner-ik pre sinap

    >obia sosial+ -an--an )akan , --n

    psiko-enik

    SS7 >lvo6a)ine ? sakit kepala (22@!+

    )anik= hipo)anik (%@!+ ke3an- (0+2@!

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    Paro.etine

    SSRI an- palin- poten ? ha)batannorepinerin

    7e)berian 3an-ka pan3an- ? downregulation

    Menia$akan ainitas reseptor 1#T2 ,1#T% , ainitas ke/il reseptor)skarinik

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    Sertraline

    Metabolit 1&%0 6 lebih poten )en-ha)bat

    reuptakeserotonin

    Inhibitor le)ah reuptake$opa)in

    astrointestinal sertraline ? $iare (%B+B@! Disti)ia+ 7TSD+ -an--an $isorik

    pre)entrasi+ $epresi postpart)

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    Anti Depresan SSRI

    /eneri' Se)ati, Anti%s'arini'Serotonin NE Dopain Blo'a)e

    A0et(l

    0*oline

    Blo'a)eistain

    Metabolita'ti,

    Ort*ostati0bloo)

    press%re

    Dis,%ngsise's%al

    Fl%-o.aine

    Paro.etine

    Sertraline

    0

    0

    0

    0

    CCC

    CCCC

    CCC

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    CC

    C

    0

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    &

    &

    Des)etl

    C

    C

    (Katzung 2002, Rundell & Wise 1996, Bazine 2003, Arana & Rosenbaum, 2000)

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    SSRI ? ker-ian E titrasi+ onset

    la)bat+ biaa+ eek sa)pin- seksal

    ("ibisono+ Konas F 7DSKGI+ Me$an

    Gli 2001!

    >lvo6a)ine $i AS ? OD

    7aro6etine ? perta)a >DA -an--an

    panik , eek berat ba$an (Arana ,Rosenba)+ #an$book o 7s/hiatri/

    $r- Therap+ 2000!

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    Il%strasi Me'anise Obat SSRI

    Ilstrasi pa$a $aerah sinap sel sara otak sebel) , ses$ah obat SSRI ha$irIlstrasi pa$a $aerah sinap sel sara otak sebel) , ses$ah obat SSRI ha$ir

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    Me'anise Ker1a SSRI

    Sara, pra sinaps Sara, pas0a sinaps

    Triptopan Tp "T "T "T

    /%)ang Serotonin

    Degra)asi ole*

    MAO

    "T"T

    SSRI

    Popa Re23pta'e

    Reseptor

    Serotonin

    +ela* Sinaps

    "T

    "T

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    Anti Depresan No-el !Terbar%#

    Tianeptine(stablon! %2

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    Novel Anti Depresan

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    Novel Anti Depresan

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    Novel Anti Depresan

    Serotonin an$ norepinephrineReptake InhibitorsE $lo6etine+venlaa6ine

    Serotonin&2A blo/kersE nea.o$one+tra.o$one

    Spe/ii/ serotonin an$ a$rener-i/

    re/eptor blo/kerE )irta.apine Dopa)ine an$ Norepinephrine

    reptake inhibitorE bpropion

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    +operati-e Feat%res o, Anti

    Depressants

    +lass Dr%gs Se)ati-e Anti0*olinergi0 Ort*ostati0

    (potention

    SSRI >lo6etine

    >lvo6a)ine 4o Absent to ver lo Absent

    7aro6etine

    Sertralin

    SDRI 8propion 4o Fer lo Fer lo

    SARI Tra.o$one #i-h Mo$erate Mo$erate

    NaSSA Mirta.epine #i-h Mo$erate 4o

    NSA A)itriptlin #i-h #i-h #i-h

    I)ipra)ine to to toMaprotilin )o$erate Mo$erate )o$erate

    RIMA Mo/lobi)i$e 4o Mo$erate 4o

    MAOI 7henel.ine 4o #i-h 4o

    Iso/arbo6a.i$

    (#)an S* et

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    /angg%an Bipolar

    an--an )anik $epresi "ixed episode(%&%+:@!

    Episo)e ani':)erasa H#igh+ ephoria+

    iritabel+ se$ikit ti$r+ banak sekali ener-i 8erbi/ara san-at /epat+ ber-anti&-anti

    topik

    Merasa )e)pnai ke)a)pan san-at

    lebih (power$ greatness$ i"portance! Se)brono , kass parah E $isertai -e3ala

    psikotik

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    Bipolar Depresi

    Episo)e )epresiE )erasa san-at se$ih(sad$ blue$ down!+ ti$ak tertarik pa$a

    banak hal

    Ssah ti$r ata ti$r terlal banak

    #ilan- selera ata banak )akan

    8er)asalah $en-an konsentrasi $anpen-a)bilan keptsan

    Merasa ti$ak berarti $an har-a $iri an-ren$ah

    Dapat ter3a$i bnh $iri= ke)atian

    Jan- parah E ter$apat halsinasi = $elsi

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    Moo) Stabili4er

    Penstabil oo) (sasana perasaan!

    olon-an KonvensionalE/arba)a.epine

    olon-an No-el(terbar!E FalproateA/i$= So$i) Divalproe6 , 4ithi)arbonate+ O6/arba)a.epine

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    +arbaa4epine

    Khasiat anti konvlsan= epilepsi+ anti neri , terapi

    -an--an bipolar , anti )anik

    Ski.orenia+ ski.oaekti , --n i)pls

    Metabolit akti

    Absorbsi konsentrasi plas)a 2&; 3a)+ akt

    parh 2: 3a)

    Senaa antara ? o6/arba)a.epine

    Sela)a ha)il terato-enik E,e' saping aler-i (Steven Gohnson Sn$ro)e!

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    %anutan

    Se$iaan E

    ? tablet knah %00 , 200 )-

    ? tablet lepas la)bat %00+ 200 , '00 )-

    ? sspensi %00 )- per 1 )l

    *piso$e )anik aal '00&:00 )- (5&'6

    per hari!

    Tablet lepas pan3an- kons)si 26 sehari arba)a.epine $isekresi pa$a ASI

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    Moo) Stabili4er Lain

    Falproate A/i$= So$i) Divalproate se$iaan 210 )-+ 100 )- tablet ,sspensi 210 )-

    O6/arba)a.epine

    4ithi) arbonate se$iaan 200 )- rtin /ek n-si hati )onitor plas)a

    abapentin+ topira)ate

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    Novel Moo$ Stabiliser

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    The Expert Consensus Guideline Series

    Treatment of Bipolar Disorder 2004

    bold italics treatment o! "#oi"e

    Clinical Presentation Preferred MS Alternate MS

    Euphoric classic! Mania Lithium

    Di"alproex

    Mania #ith ps$chosis Di"alproex

    %ithium

    D$sphoric mania or true mixed mania Divalproex %ithium

    Car&ama'epine

    Mania #ith histor$ of rapid c$clin( Di"alproex %ithium

    Car&ama'epine

    )$pomania in &ipolar ** disorder Lithium

    #ithout a histor$ of rapid c$clin( Di"alproex

    )$pomania in &ipolar ** disorder Divalproex Car&ama'epine

    #ith a histor$ of rapid c$clin( %ithium

    Pili*an Moo) Stabili4er

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    Pili*an Moo) Stabili4erAeri0an Ps(0*iatri0

    Asso0iation !APA#Pra0ti0e /%i)elines ,or t*e Treatent o, Patients 6it*Bipolar Disor)er$ April 7887

    Manic+Mixed Depressi"e ,apid C$clin(

    Acute Se"ere 1$ %it#ium or %amotrigine 1$ Di"alproateor %it#iu

    1$ %it#ium & Anti's("#oti" 2$ %amotrigine2$ Di"alproate& Anti's("#oti" 3$ )ombination

    %ess Se"ere

    1$ Di"alproateor %it#ium

    2$ *lanza'ine

    Mixed1$ Di"alproate or %it#ium

    2$ Anti's("#oti"

    Maintenance 1$ Di"alproateor %it#ium

    2$ %amotrigine

    3$ )ombination

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    9Berobatla* 'a%$ 'arena Alla* ST ti)a'enga)a'an s%at% pen(a'it$ elain'an

    tela* enga)a'an p%la obatn(a;