Depression drug-induced

Fatigue, drowsiness, as adjunct in analgesic formulation, respiratory depression Drug-induced postanesthesia, drug-induced respiratory depression, acute respiratory insufficiency superimposed on COPD Narcolepsy... 

Doxapram is used to treat drug-induced respiratory depression and to temporarily treat respiratory depression in patients with chronic pulmonary disease This drug also may be used during the postanesthesia period when respiratory depression is caused by anesthesia It also is used to stimulate deep breathingin patients after anesthesia... 

The patient experiences anxiety, apathy, bradyphrenia (slowness of thought processes), confusional state, dementia, depression, hallucinosis/psychosis (typically drug-induced), and sleep disorders (excessive daytime sleepiness, insomnia, obstructive sleep apnea, and rapid eye movement sleep behavior disorder). 

When a patient presents with depressive symptoms, it is necessary to investigate the possibility of a medical-, psychiatric-, and/or drug-induced cause (Table 70-2). 

Modified and reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.r text revision. Washington, DC American Psychiatric Association, 2000 Sofuoglu M, Dudish-Poulsen S, Poling J, et al. The effect of individual cocaine withdrawal symptoms on outcomes in cocaine users. Addict Behav 2005,30 1 125-1134 and Patten SB, Barbui C. Drug-induced depression a systematic review to inform clinical practice. Psychoth Psychosom 2004 73 207-215. 

In order for a drug to induce CNS depression it must either faciiitate neuronai inhibition or inhibit the neuronai excitation. There are a few mechanisms by which these may occur, and CNS depressant drugs may possess one or more of these mechanisms. 

Drugs that may interact with buprenorphine hydrochloride include barbiturate anesthetics, benzodiazepines, CNS depressants, CYP3A4 inducers and inhibitors, and MAOIs. 

A stands for provision of airway B stands for breathing and ventilation C stands for circulation support D stands for drug-induced depression (central nervous and respiratory system) and E for electrolyte and metabolic abnormalities and... 

The piperidines, e.g. thioridazine, pipothiazine and pericyazine, have the lowest potential to cause extrapyramidal effects. Thioridazine is one of the most sedative phenothiazines. It may decrease the inotropic activity of digitalis by its quinidine-like action, which can cause myocardial depression, decreased efficiency of repolarization, and increased risk of tachyarrhythmias. With thioridazine drug induced sexual dysfunction and especially cardiotox-icity with prolongation of the QT-interval are more frequently seen than with other phenothiazines. For the above reasons thioridazine is withdrawn from the market in many countries. 

Cardiac toxicity is generally the result of drug-induced depression of cardiac conduction (e.g., atrioventricular block, intraventricular conduction block) and systemic vasodilation. These effects may progress to severe hypotension and cardiac arrest. 

Luo, J., J. H. Yin, H. Z. Wu, and Q. Wei. Extract from Fructus cannabis activating calcineurin improved learning and memory in mice with chemical drug-induced dysmnesia. Acta Pharmacol Sin 2003 24(11) 1137-1142. Degenhardt, L., W. Hall, and M. Lynskey. Exploring the association between cannabis use and depression. Addiction 2003 98(11) 1493-1504. Zajicek, J., P. Pox, H. Sanders, et al. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study) multicentre randomised placebo-controlled trial. Lancet 2003 362(9395) 1517-1526. 

Drug-induced CNS depression IV Injection Initially, 1-2 mg/kg, repeat after 5 min. May repeat at 1-2 hour intervals, until sustained consciousness. Maximum 3 g/day. IV Infusion Initially bolus dose of 2 mg/kg, repeat after 5 min. If no response, wait 1 -2 hrandrepeat. If stimulation is noted, initiate infusion at l-3mg/min. Infusion should not be continued for more than 2 hr Maximum 3 g/day. 

These data and findings from serotonin depletion studies show that, in patients treated successfully, NA and serotonin systems are involved in maintenance of drug-induced remission. However, the absence of an increased severity in depressive symptoms in drug-free patients with depression suggests that alterations in serotonin and catecholamine release may not be causally involved in the pathophysiology of mood disorders. 

Note. BP = bipolar disorder D/C = discontinue Dep = depression Li = lithium M = mania SA = schizoaffective RBD = recurrent brief depression UP = unipolar. Drug-induced hypomania. 

Though some differences between CNS depressant drugs do exist, as a group the effects induced are very similar. They cause a state of intoxication, with signs and symptoms of euphoria, mental confusion, loss of motor coordination, blurred vision, slurred speech, nausea, vomiting, impaired judgment, decreased attention span, and amnesia. The drugs also decrease blood pressure, heart rate, and respiration. 

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