Depression Lecture

Question 1

Define depression

Answer 1

an illness that involves the body, mood and thoughts

- Affects the way a person eats and sleeps, the way one fees about oneself and teh way one thinks about things

Question 2

At least one of the following symptoms have been present during the same 2 week period?

Answer 2

Depressed mood

Loss of interest of pleasure (anhedonia)

Question 3

What are other symptoms that at least 3 have to be present?

Answer 3

Change in weight/appetite
Altered sleep patterns
Psychomotor agitation or retardation
Fatigue/lack of energy
Feelings of worthlessness or excessive/inappropriate guilt
Difficulty concentrating and making decisions
Suicidal thoughts or plans

Question 4

What is the biogenic amine hypothesis?

Answer 4

Depression caused by decreased brain levels of neurotransmitters

• NE (regulates vigilance, motivation, energy, anxiety, irritability)
• Serotonin/5-HT (anxiety , irritability, impulsivity, appetite, aggression
• DA (appetite, aggression)

Question 5

What is the goals of depression treatment?

Answer 5

Response rate to meds are only up to 50%
Some argue effectiveness is overstated
Lots of side effects
Alternative therapies are warranted for treatment (CAMs)

Question 6

Define anxiety

Answer 6

unpleasant state of tension, apprehension, or uneasiness

• Not just nervousness or anxiousness
• Persistent, unremitting, debilitating and beyond control

Question 7

What are clinical presentations of anxiety?

Answer 7

Anxious
Physical (tachycardia, sweating, trembling, digestive issues, shortness of breath)
Anxiety disorders (generalized, panic disorder, social anxiety disorder, phobias)
OVER 6 MONTHS

Question 8

What are treatment targets for anxiety?

Answer 8

Noradrenergic model
GABA model

Increase GABA = less excitability of neurons
5-HT, NE, DA
Symptom controling

Question 9

Define noradrenergic model

Answer 9

Autonomic nervous system is hypersensitive and overreacts to stimuli

Question 10

Define GABA model

Answer 10

Major inhibitory neurtransmitter of CNS

Regulatory effect on 5-HT, NE, DA

Question 11

What is Complementary and Alternative Medicine

Answer 11

Not conventional medicine

• Natural products
• Mind-body medicine (cognitive and behavioral therapy)
• Manipulative and body-based practice (acupunture

Question 12

What are natural products for depression?

Answer 12

St. John’s Wort
SAMe
5-HTP
L-tryptophan

Question 13

Folic acid deficiencies?

Answer 13

Requierd for synthesis of DA, NE, and 5-HT

- Patients are 6X less likely to respond to anti-depressants

Question 14

Omega-3 FA deficiencies?

Answer 14

DHA & EPA are primary
Depression is less in place with high fish diets
Levels decreased in pregnancy

Question 15

What are natural products for anxiety?

Answer 15

Kava
Valerian
St. John's Wort
SAMe
5-HTP
L-tryptophan

Question 16

St. John’s Wort MOA and use?

Answer 16

- ONLY DEPRESSION
Increases CNS neurotransmitter levels
- Nonselective reuptake inhibition
- Decrease degradation of neurochemical
- Might inhibit uptake of GABA and L-glutamate

Question 17

St. John’s Wort active ingredients?

Answer 17

Xanthones
Hypericins
Hyperforin

Question 18

St John’s Wort clinical effects?

Answer 18

Improves mood, reducing insomnia and somatic symptoms of depression
More effective than placebo
Not recommended for anxiety
Mixed in OCD

Question 19

St. John’s Wort Adverse Effects?

Answer 19

Headache, nauseam dry mouth, photosensitivity
Serotonin syndrome (agitation, confusion, diarrhea, hyperthermia, rapid heartbeat, bp changes)

Question 20

St. John’s Wort Precautions?

Answer 20

History of bipolar disorder or schizophrenia
Drug interactions (induces CYP450 3A4 and PGP due to hyperforin)

Question 21

St John’s Wort drug interactions?

Answer 21

Immunosuppressants
Antiretrovirals
Chemotherapeutic agents
Warfarin
Oral contraceptives
SSRI's, TCA's, MOA-I

Question 22

St John’s Wort counseling?

Answer 22

Seek medical advice before use

Not for use in severe depression

Question 23

SAMe uses and MOA?

Answer 23

Depression + osteoarthritis

Gives methyl groups to neurotransmitters and catecholamines

Question 24

SAMe adverse effects and precautions?

Answer 24

Well tolerated (some nausea, diarrhea, heartburn, dry mouth, headache, insomnia, etc)

• May convert bipolar into mania
• Drug interactions with agents affecting 5-HT
• Caution in patients with diabetes
• Poor product quality
• High cost

Question 25

L-tryptophan or 5-HTP uses and MOA

Answer 25

Anxiety, depression, alleviate stress, induce sleep

• Precursor to serotonin
• Increases serotonin in CNS

Question 26

L-tryptophan and EMS?

Answer 26

1989, banned.
Development of EMS
Deaths reported

Question 27

Clinical effects and adverse effects of 5-HTP?

Answer 27

Unknown if effective at antidepressants

- Heartburn, stomach pain, belching, flatulence, diarrhea, anorexia

Question 28

Valerian uses?

Answer 28

Sedative-hypnotic

Anxiety

Question 29

Valerian MOA?

Answer 29

Inhibits metabolism of GABA

Question 30

Valerian clinical and adverse effects?

Answer 30

May decrease social anxiety and generalized anxiety disorder

- Hepatotoxicity, headache, excitability

Question 31

Valerian counseling points?

Answer 31

Restlessness
30 minutes before bedtime
More effective as a routine
Do not abruptly discontinue
Use caution that require alertness

Question 32

Kava Kava uses and MOA?

Answer 32

Stress relief, anxiety, tension, insomnia

• May increase GABA binding site
• No effects on benzodiazepine receptors

Question 33

Kava Kava active ingredients?

Answer 33

Kavalactones and kavapyrones

Question 34

Kava Kava clinical effects?

Answer 34

Positive on anxiety
Women and younger patients
Significant anxiolytic reduction

Question 35

Kava Kava adverse effects

Answer 35

Dizziness and drowsiness
Hepatotocity
Mouth ulcers and numbness
Skin reaction

Question 36

Kava Kava precautions

Answer 36

Interaction siwth other CNS depressants
Interaction of anticoagulants
CYP2E1, 2C9, 3A, 2D6 inhibitor

Question 37

Kava counseling points?

Answer 37

Not in patients with liver problems or concomitant hepatotoxic medications, or alcohol consumer
- Short term