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Microsoft powerpoint - les durani anti-depressants.ppt [compatibility mode]“Presenter’s Suicide preventable”: inquest Dragun was repeatedly prescribed anti-depressants from the age of 18 but she was actually suffering from a bipolar disorder when she jumped to her death at The Gap aged 29, a coronial inquest foundyesterday.” But he was urged not to, and watched her leap off the cliff as police tried to reach her.
Moments later, her mobile phone rang on the cliffs edge. It was her boyfriend Simon responding to a goodbye text she had sent him two minutes ear-lier; "Sime, I'm so sorry for what I'm about to do. I can't conquer my thoughts. Please know this is no In his report Mr MacPherson said some "vital" information about Dragun was not passed between the health professionals from whom she sought help. He stressed "the importance of health professionals treating patients with signs and symp-toms of depression to provide all relevant information to other health professionals to whom a patient may be referred for ongoing treatment".
"Whilst the diagnosis of depression that followed Char-maine since her teenage years may have been understandable, it was almost certainly wrong," Mr MacPherson found.
Dragun grew up in Perth and worked in radio, then as a reporter for Channel Ten, where she proved a good storyteller and strong under pressure.
Changes at the station meant she had to read the news from Sydney from July 2006.
Outside court, her mother said she hoped the medical pro-fession would take in the find-ings "and we will see a difference in medical healthcare • Many medicines are available to treat major depression. They all work by
affecting the balance of chemicals in the
brain, which are believed to contribute to
the physical and psychological symptoms
• There is a real world variation in the effectiveness of each class of anti-depressants and also within each class.
*There is a distinct gradient of effectiveness of the classes • TCA’S rate as most effective• Dual –Action rate second• SSRI’S rate third.
• Others :Mirtazine (Post-synaptic blockade of 5HT2/5HT3 receptors , pre-synaptic blockade central alpha-adrenergic).
• Reboxetine (mainly Noradrenaline reuptake inhibition) • Moclobemide ( being lowest in effectiveness.) * For Side Effects the gradient is virtually • Hence Depressive Disorders assume a set of non- melancholic conditions and two categorical depressive disorders (melancholic and psychotic).
• Hence a neurotransmitter perturbation contributing to a non-melancholic depression is principally Seretonergic where SSRI’S are principally used.
Recent anti-depressants introduced to the Australian market : Desvenlafaxine (the major and active metabolite of Venlafaxine ) and …. Both Dual action type inhibitors. (SNRI’s) Presently both these drugs appear to only broaden the range of the choice rather than be of a new innovative type.
• New Anti—depressants have come on the market allowing greater flexibility of suitabliity of the medication to each patient. (horses for courses) Prof Gordon Parker. Eg: for non-melancholic depression the class difference is less pronounced while for melancholic the Dual Action drugs or TCA’s have better efficacy.
• Within the class of SSRI’s in case of non-response a second SSRI is a logical step and then possibly a Dual Action drug.
• Bad compliance may indicate a longer acting Anti- depressant (e.g. Fluoxetine) but consideration of longer wash-out period is needed if trialed drug changes are anticipated.
• Resistance to taking medicines ( “Drugs”)• Yet natural remedies are sought • The HMR process acts as an invaluable tool to • A home interview for example of say a post- discharge ACS patient allows the Pharmacist to review the patient’s issues outside the hospital environment . • Interactions within the Family structure such as possible stress and new demands on family members etc. can be detailed back to the Prescriber suggesting possible interventions .
• Of the 400,000 HMR’s performed majority are performed Present data displays positive correlation of declining suicide rate with increasing Anti-depressant use .
• Further statistic of 100% drop in suicide rate in young males over the last 5 years correlating with greater : awareness; de-stigmatization; willingness to seek help.
• Recent data depict low compliance within the first month of initiated medication and low dispensing of repeat prescriptions issued (particularly so with Statins and Anti-Depressants).
CHAPTER 4 DRUGS AND MEDICATIONS Determining the Equine Drugs and Medications Designation for Each Breed or Discipline. Testing. Cooperation. Responsibility and Accountability of Trainers. Equine Drugs and Medications Testing in Connection with an Appeal Measurement. Results, Confirmatory Analysis, and Retest. Management Procedures. Interpretations of the Federa