Depression and Anxiety Flashcards
List some mood/affective disorders?
Major depressive disorder Bipolar mood disorder Dysthymia Mood disorder secondary to medical conditions Substance induced mood disorder
Can antidepressants be given in bipolar patients? Why or why not?
No. It may precipitate a manic episode.
Examples of drugs (prescription or OTC) that may cause drug-induced depression?
Beta-blockers Calcium channel blockers Benzodiazepines L-dopa M-dopa Corticosteroids / anabolic steroids
Explain the monoamine hypothesis in terms of drug induced depression?
Decreased/lack of monoamine neurotransmitters as a result of the drug leads to depression
Upregulation of receptors as a result of decreased neurotransmitters results in further greater depression
List the classes of antidepressants?
SSRI's (selective serotonin re-uptake inhibitors) TCA (tricyclic antidepressants) SNRI's Monoamine inhibitors Atypical antidepressants
Examples of SSRI’s?
Fluoxetine
Citalopram
MoA of SSRI’s?
Inhibition of the serotonin transporter SERT, resulting in increased concentration of serotonin in the synaptic cleft
ADR of SSRI’s?
GIT - nausea, vomiting
Sexual - decreased libido, anorgasmia, delayed ejaculation
CNS - agitation, anxiety, restlessness, akathasia, movement disturbances, parkisonism, dystonic reactions)
Syndrome Syndrome - clinical presentation and causes?
Diaphoresis (sweating) Mydriasis (pupil dilatation) Agitation Hyperflexia Tremor Clonus Increased bowel sounds Autonomic instability Tachycardia
Causes: congenital or drug induced
Examples of TCA’s?
Amytriptaline
Imipramine
Indications for the use of TCA?
Depressive disorders Anxiety disorders Nocturnal enuresis Analgesia Insomnia
Side effects of TCA’s?
Weight gain Drowsiness Dizziness Blurred vision Dry mouth Constipation Hypotension
TCA overdose clinical presentation?
Coma
Seizure
Arrythmia
Cardiac arrest
Contraindications to TCA’s?
Elderly
Co-morbidities - glaucoma, cardiovascular disease, BPH
Suicidal ideation
In a healthy patient with depression alone - SSRI or TCA?
SSRI - less side effects
Role of lithium in mood disorders?
Mechanism not well understood
Not protein bound, thus widely distributed throughout
Indicated for mood stabilisation in bipolar patients and for use as an anticonvulsant
Narrow therapeutic index
Can cause thyroid dysfunction
Can also causes diabetes insipidous
Requires therapeutic drug monitoring
When to refer a patient to a psychiatrist?
First line medication not tolerated
Suicidal ideation
Bipolar suspicion
Co-morbidities
How long until patients experience clinical improvement on antidepressant medication?
2-6 weeks
Treatment of choice for anxiety?
SSRI’s:
Effective in reducing symptoms of anxiety an fear
Slow onset of action, thus minimal efficacy in acute anxiety
Benzodiazepines
MoA of benzodiazepines?
Enhances the effect of GABA (inhibitory) neurotransmitter, resulting in a sedative, hypnotic and anxiolytic effect
GABA:
Allosteric enhancement of Cl- conduction, increasing the frequency of channel opening events, resulting in hyperpolarisation
Examples of benzodiazepines?
Ultra-short acting: midazolam
Short acting: oxazepam
Intermediate acting: lorazepam
Long acting: diazepam
ADR’s of benzodiazepines?
Common:
Drowsiness
Oversedation
Amnesia (common)
Uncommon: Depression Confusion Disorientation Ataxia
Paradoxical effect in children: results in hyper-excitability, depression and dependence
Overdose antidote for benzodiazepines?
Flumazenil
What is depression clinically?
Intense feeling of sadness, hopelessness and despair
Inability to experience pleasure with usual activities (anhedonia)
Changes in appetite, weight and sleep patterns
Loss of energy
Suicidal thoughts
