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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+ $epresi postpart)
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Anti Depresan SSRI
/eneri' Se)ati, Anti%s'arini'Serotonin NE Dopain Blo'a)e
A0et(l
0*oline
Blo'a)eistain
Metabolita'ti,
Ort*ostati0bloo)
press%re
Dis,%ngsise's%al
Fl%-o.aine
Paro.etine
Sertraline
0
0
0
0
CCC
CCCC
CCC
0
CC
0
0
0
0
CC
C
0
0
&
&
Des)etl
C
C
(Katzung 2002, Rundell & Wise 1996, Bazine 2003, Arana & Rosenbaum, 2000)
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SSRI ? ker-ian E titrasi+ onset
la)bat+ biaa+ eek sa)pin- seksal
("ibisono+ Konas F 7DSKGI+ Me$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;
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