25: Disorders of Mood - Jennisch Flashcards
diagnostic criteria for MDD
at least 2 weeks
5 or more symptoms
at least one of symptoms is depressed mood or loss of interest/pleasure
more likely to experience MDD
women
bipolar disorder is equally common in men and women
untreated episodes of MDD last…
at least 4 months, but will typically (75%) eventually remit spontaneously
primary tx MDD
psychopharmacology and psychotherapy
phenelzine, selegiline =
impipramine, amitriptyline =
citalopram, ecitalopram, fluoxetine, fluvoxamie, paroxetine, sertraline =
venlafaxine, desvenlafaxine, duloxetine, levomilnacipran =
MAOIs (drug-drug, food interactions)
TCAs (chronic pain)
SSRIs (take while to work, sexual dysfunction)
SNRIs (also first line, weight gain, sexual dyfunction)
most common first-line tx for MDD
SSRIs
SNRIs are also used as first-line treatment
Bupropion =
Ne and DA reuptake inhibitor
no sexual dysfunction or WG
does not help with anxiety, increases energy
useful in pts with MDD where insomnia and loss of appetite are prominent
mirtazapine
diagnosis of bipolar disorder requires
presence of manic or mixed episode; no depressive episode is required
criteria for a manic episode
distinct epriod of abnormally elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy lasting at least one week and at least three additional symptoms
same symptoms as manic episode but less severe, 4 days or more
hypomanic episode
does not markedly impair functioning
criteria are met for both a depressive episode and a manic episode simultaneously for at least a week
mixed
tx bipolar disorder
lithium and some anti-convulsants
do NOT use antidepressives alone (trigger manic episode)
therapy and good sleep habits help
one or more major depressive episodes without any manic, hypomanic or mixed episodes
MDD
chrnic, low-level depressed mood most days for at least 2 yrs
persistent depressive disorder
