Depression Lecture Flashcards
Define depression
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
At least one of the following symptoms have been present during the same 2 week period?
Depressed mood
Loss of interest of pleasure (anhedonia)
What are other symptoms that at least 3 have to be present?
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
What is the biogenic amine hypothesis?
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)
What is the goals of depression treatment?
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)
Define anxiety
unpleasant state of tension, apprehension, or uneasiness
- Not just nervousness or anxiousness
- Persistent, unremitting, debilitating and beyond control
What are clinical presentations of anxiety?
Anxious
Physical (tachycardia, sweating, trembling, digestive issues, shortness of breath)
Anxiety disorders (generalized, panic disorder, social anxiety disorder, phobias)
OVER 6 MONTHS
What are treatment targets for anxiety?
Noradrenergic model
GABA model
Increase GABA = less excitability of neurons
5-HT, NE, DA
Symptom controling
Define noradrenergic model
Autonomic nervous system is hypersensitive and overreacts to stimuli
Define GABA model
Major inhibitory neurtransmitter of CNS
Regulatory effect on 5-HT, NE, DA
What is Complementary and Alternative Medicine
Not conventional medicine
- Natural products
- Mind-body medicine (cognitive and behavioral therapy)
- Manipulative and body-based practice (acupunture
What are natural products for depression?
St. John’s Wort
SAMe
5-HTP
L-tryptophan
Folic acid deficiencies?
Requierd for synthesis of DA, NE, and 5-HT
- Patients are 6X less likely to respond to anti-depressants
Omega-3 FA deficiencies?
DHA & EPA are primary
Depression is less in place with high fish diets
Levels decreased in pregnancy
What are natural products for anxiety?
Kava Valerian St. John's Wort SAMe 5-HTP L-tryptophan
St. John’s Wort MOA and use?
- ONLY DEPRESSION Increases CNS neurotransmitter levels - Nonselective reuptake inhibition - Decrease degradation of neurochemical - Might inhibit uptake of GABA and L-glutamate
St. John’s Wort active ingredients?
Xanthones
Hypericins
Hyperforin
St John’s Wort clinical effects?
Improves mood, reducing insomnia and somatic symptoms of depression
More effective than placebo
Not recommended for anxiety
Mixed in OCD
St. John’s Wort Adverse Effects?
Headache, nauseam dry mouth, photosensitivity Serotonin syndrome (agitation, confusion, diarrhea, hyperthermia, rapid heartbeat, bp changes)
St. John’s Wort Precautions?
History of bipolar disorder or schizophrenia Drug interactions (induces CYP450 3A4 and PGP due to hyperforin)
St John’s Wort drug interactions?
Immunosuppressants Antiretrovirals Chemotherapeutic agents Warfarin Oral contraceptives SSRI's, TCA's, MOA-I
St John’s Wort counseling?
Seek medical advice before use
Not for use in severe depression
SAMe uses and MOA?
Depression + osteoarthritis
Gives methyl groups to neurotransmitters and catecholamines
SAMe adverse effects and precautions?
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
L-tryptophan or 5-HTP uses and MOA
Anxiety, depression, alleviate stress, induce sleep
- Precursor to serotonin
- Increases serotonin in CNS
L-tryptophan and EMS?
1989, banned.
Development of EMS
Deaths reported
Clinical effects and adverse effects of 5-HTP?
Unknown if effective at antidepressants
- Heartburn, stomach pain, belching, flatulence, diarrhea, anorexia
Valerian uses?
Sedative-hypnotic
Anxiety
Valerian MOA?
Inhibits metabolism of GABA
Valerian clinical and adverse effects?
May decrease social anxiety and generalized anxiety disorder
- Hepatotoxicity, headache, excitability
Valerian counseling points?
Restlessness 30 minutes before bedtime More effective as a routine Do not abruptly discontinue Use caution that require alertness
Kava Kava uses and MOA?
Stress relief, anxiety, tension, insomnia
- May increase GABA binding site
- No effects on benzodiazepine receptors
Kava Kava active ingredients?
Kavalactones and kavapyrones
Kava Kava clinical effects?
Positive on anxiety
Women and younger patients
Significant anxiolytic reduction
Kava Kava adverse effects
Dizziness and drowsiness
Hepatotocity
Mouth ulcers and numbness
Skin reaction
Kava Kava precautions
Interaction siwth other CNS depressants
Interaction of anticoagulants
CYP2E1, 2C9, 3A, 2D6 inhibitor
Kava counseling points?
Not in patients with liver problems or concomitant hepatotoxic medications, or alcohol consumer
- Short term
