AEFFECTIVE DISORDERS: DEPRESSION

Question 1

Which group is most likely to be affected by depression

Answer 1

women, more specifically black and mixed race women

Question 2

depression

Answer 2

• broad and heterogenous diagnosis
• Central to its depressed mood and/or loss of pleasure in most activities
• symptoms should be present for at least 2 weeks at sufficient severity for most of every day

Question 3

diagnostic systems for depression

Answer 3

ICD-10/11 and the DSM-5 classification system

severity is determined by both the number and severity of symptoms

Question 4

bipolar I disorder

Answer 4

where a person has had at least one manic episode and periods of significant depression, each usually lasting for an extended period

Question 5

bipolar II disorder

Answer 5

the person has never had a manic episode, but has had at least one hypomanic episode and at least one period of significant depression

Question 6

cyclothymia

Answer 6

similar to bipolar but with lower extremes

Question 7

euthymia

Answer 7

period without mood disturbances

Question 8

aetiology of bipolar disorder

Answer 8

strong genetic component - inheritability

usually diagnosed in late teens

Question 9

use of lithium in bipolar disorder

Answer 9

• used to calm manic patients and prophylactically as a mood stabiliser
• results observed relatively quick and are considered safe (no overdose risk)

Question 10

lithium potential moa

Answer 10

• modulation of glutamate, GABA and DA neurotransmission
• inhibition of inositol triphosphate formation
• interference of cAMP formation
• accumulation of Li+ in cell leading to sustained depolarisation

Question 11

side effects of lithium

Answer 11

long half-life leads to common side effects such as nausea, thirst, tremor and mental confusion

Question 12

key symptoms for major depressive disorder (MDD)

Answer 12

• persistent sadness or low mood
• loss of interests or pleasure
• fatigue or low energy

Question 13

associated symptoms of major depressive disorder (MDD)

Answer 13

• disturbed sleep
• poor concentration or indecisiveness
• low self-confidence
• poor or increased appetite
• suicidal thoughts or acts
• agitation or slowing of movements
• guilt or self-blame

Question 14

degrees of depression

Answer 14

not depressed - <4
mild depression - 4 symptoms
moderate depression - 5 or 6
severe depression - >7 symptoms with or without psychotic symptoms

Question 15

monoamine hypothesis

Answer 15

• suggests that depression results from deficient monoamine transmission
• monoamine oxidase inhibitor developed for TB, elevated the mood of the treated patients
• thus the Amine hypothesis proposes that depression occurs due to decreased levels of amines (NA, 5-HT and DA) in the CNS

Question 16

problems with the monoamine hypothesis

Answer 16

• drug action is relatively fast (hours) but relief of symptoms takes longer (weeks)
• antidepressants have differing mode of action but work similarly on symptoms

Question 17

noradrenergic system neuromodulation in the brain

Answer 17

locus coeruleus

Question 18

serotenergic system neuromodulation in the brain

Answer 18

raphe nucleus

Question 19

dopaminergic system neuromodulation in the brain

Answer 19

ventral tegmental area (VTA) and substantial nigra (SN)

Question 20

antidepressant groups

Answer 20

selective serotonin reuptake inhibitors (SSRIs)
serotonin noradrenaline reuptake inhibitors (SNRIs)
monoamine oxidase inhibitors (MAOIs)
tricyclic antidepressants (TCAs)

Question 21

psychotherapies for depression

Answer 21

• behavioural therapy
• interpersonal therapy
• group therapy
• cognitive behavioural therapy (CBT)
• mindfulness based cognitive therapy (MBCT)

Question 22

brain stimulation methods in depression

Answer 22

• electroconvulsive therapy (ECT)
• vagus nerve stimulation (VNS)
• transcranial magnetic stimulation (TMS)
• deep brain stimulation (DBS)

Question 23

benefits and risks of SSRIs

Answer 23

• better tolerated and reduced risk of overdose
• increased risk of bleeding esp. in older pts/those taking anticoagulants
• less sedating and fewer antimuscarinic and cardiotoxic effect than TCAs
• sertraline safe with cardio issues (do not use citalopram)
• fluoxetine, fluvoxamine and paroxetine have higher drug interactions than other SSRIs

Question 24

benefits and risks of TCAs

Answer 24

• similar to SSRIs but adverse effects
• antimuscarinic side effects - dry mouth, urinary retention, blurred vision etc.
• cardiotoxicity
• sedation
• weight gain
• risk of overdose
• increased risk of coma/seizure, and potentially fatal cardiac arrhythmia/arrest

Question 25

benefits and risks of MAOIs

Answer 25

• should only be prescribed by specialists
• hepatotoxicity (isocarboxazid and phenelzine)
• dangerous interactions with some food and drugs > hypertensive crisis - ‘cheese reaction’

Question 26

use of electroconvulsive shock treatment (ECT)

Answer 26

• even most severe bouts of depression are usually responsive to ECT
• still used to day in cases of very severe depression with a high risk of suicide, where there has been no response to drug treatments

Question 27

first line for depression

Answer 27

sertraline + CBT/IPT

Question 28

how long do you continue on an antidepressant before switching to a different kind

Answer 28

6-9 months (assess efficacy after 1-4 weeks)

Question 29

novel treatments: ketamine and esketamine

Answer 29

• single dose of NMDA inhibitors can cause a rapid (next day) antidepressant effect in pts with MDD
• primarily used in treatment resistant depression (resistant to 2 or more antidepressants)

Question 30

SSRI drugs

Answer 30

fluoxetine
citalopram
escitalopram
paroxetine
sertraline

Question 31

SNRI drugs

Answer 31

duloxetine
venlafaxine

Question 32

TCA drugs

Answer 32

amitriptyline
clomipramine
dosulepin
imipramine
lofepramine
nortitriptyline

Question 33

MAOI drugs

Answer 33

tranylcypromine
phenelzine
isocarboxazid