12.1.2 Mood Disorders & Neurotransmitters

Question 1

What is the monoamine hypothesis?

Answer 1

Suggests decreased levels of serotonin and NorAd lead to depression

Question 2

Where is serotonin produced?

Answer 2

Raphe nuclei (pons and medulla)
Distributed to the cortex and limbic system

Mesocortical and mesolimbic

Question 3

What is serotonin important for?

Answer 3

Sleep
Impulse control
Appetite
Mood

Question 4

What evidence is there for decreased serotonin in depression?

Answer 4

• Drugs that treat serotonin in the brain treat depression
• 5HIAA (serotonin metabolite) is low in CSF of patients with depression
• Tryptophan (serotonin precursor) depletion causes depression

Question 5

What features of depression are not explained by decreased serotonin?

Answer 5

Despite serotonin levels rising rapidly in SSRIs, symptoms only improve over a long period of time

May be that antidepressants change the levels of other neurochemicals or stimulating neurogenesis in the hippocampus through growth factors e.g. brain derived neurotrophic factor

Question 6

Where is NorAd produced?

Answer 6

Locus coerules of the brainstem and distributed to cortex and limbic system

Question 7

What is NorAd important for?

Answer 7

Mood
Arousal
Memory

Question 8

What evidence is there that decreased NorAd leads to depression?

Answer 8

• Drugs that increase levels of NorAd treat depression
• Patients who have recovered from depression but still have low levels of NorAd are at high risk of relapse
• Post-mortem studies show lower NorAd levels in those with depression

Question 9

What model is used to treat depression?

Answer 9

Biopsychosocial model

Question 10

Outline the biopsychosocial treatments used for treating depression

Answer 10

Biological
-Antidepressants, SSRIs are first line, consider electroconvulsive therapy for severe of refractory cases

Psychological
-Cognitive behavioural therapy, CBT

Social
-Help with social stressors such as isolation and financial worries

Question 11

How do you treat acute mania?

Answer 11

Biological
-Antipsychotics
-Mood stabilisers e.g. lithium

Psychological
-Unlikely to be helpful in acute phase
-Helpful to educate patients regarding recognising triggers and relapse signs

Social
-Patients need to kept safe, risk to self and others
-Implications of finance e.g. buying expensive cars when manic

Question 12

How do you treat acute bipolar depression?

Answer 12

Biological
-Use antidepressant with mood stabiliser cover (e.g. lithium)

Psychological
-CBT

Social
-Help with social stresses e.g. isolation and financial worries

Question 13

How do you treat maintaining stabilitiy?

Answer 13

Biological
-Mood stabiliser e.g. lithium or valproate with or without antipsychotic

Psychological
-Education
-CBT

Social
-Effects on employment
-Family support

Question 14

Why do you need to be careful when prescribing sodium valproate?

Answer 14

Highly teratogenic drug, 40% of the time causes effects

Does not mean it should not be prescribed as it is also highly effective, not educate patients well

Question 15

Why are benzodiazepines not recommended for long-term use in treating anxiety?

Answer 15

Can become highly addictive
Tolerance development, increasing risk of fatal overdose