Lecture 11: Mood Disorders Part 1 COPY Flashcards
Define mood.
Overall state of emotion at a given time.
Define mood disorder.
A condition affecting a person’s everyday emotional state/mood.
Sometimes known as affective disorders.
Comes as primary and secondary.
How common are mood disorders?
1 in 4 adults.
What are the 3 main NTs that regulate mood?
Serotonin
NE
Dopamine
What falls under depressive disorders?
MDD (Major Depressive Disorder)
Dysthymia/Persistent Depressive Disorder
SAD (Seasonal Affective Disorder)
PMDD (Premenstrual Dysphoric Disorder)
Disruptive Mood Dysregulation Disorder
What falls under bipolar disorders?
Bipolar I Disorder
Bipolar II Disorder (Cyclothymia)
What are the two main things we use to diagnose psychiatric conditions?
DSM (Diagnostic and Statistical Manual of Mental Disorders)
ICD (International Statistical Classifications of Diseases and Related Health Problems)
What is required to make a criteria-based decision according to the DSM?
Meeting all 3 of these conditions:
The condition is not caused by the direct effects of any drug or external exposure.
The disorder is not caused by effects of a medical condition.
There is SIGNIFICANT IMPAIRMENT of social functioning, occupational functioning, or both.
How common is MDD?
21% lifetime prevalence in the US.
At what age is MDD most common?
25-44, with an average onset age of 30.
Is MDD more common in men or women?
Women
What ethnicity is MDD most common and least common in?
MC in native americans
LC in asians/pacific islanders.
What are some genetic factors that may predispose someone to MDD?
FMHx of depression or alcoholism.
What medications fall under risk factors for MDD?
Glucocorticoids
Interferons
What is the diagnostic criteria for MDD according to the DSM 5?
Depressed mood or An-hedonia for >= 2 weeks
PLUS
at least 4 of the following:
Sleep Changes
Guilt
Fatigue
Decreased Concentration
Significant appetite/weight change
Activity changes
Recurrent thoughts of suicide/death
Note:
Symptoms must cause distress and cannot be due to other causes.
What is the MDD mnemonic?
SIG E CAPS
Sleep Disturbances
Interested Decreased (Anhedonia)
Guilt/Worthlessness
Energy Decreased
Concentration problems
Appetite/Weight change
Psychmotor agitation/retardation
Suicidal Ideation
What are the 8 subtypes of MDD episodes?
Anxiety
Atypical
Catatonic
Melancholic
Mixed
Peripartum
Psychotic
Seasonal
CAMPP SAM
What is the minimum for someone to have MDD in terms of episodes?
1 major depressive episode at minimum
When is the highest risk for a recurrent major depressive episode?
Within the first few months following the resolution of the previous.
Is bereavement a differential for MDD?
No
What are some of the screening methods we use for MDD?
PHQ-2 (2 question screen asking for depressed mood and anhedonia)
PHQ-9 (9 question screen to follow up on the PHQ-2)
Zung Self-Rated Depression Scale (in-depth rating of current depressive symptoms)
What are the non-pharmacological options for treating MDD?
Psychotherapy
ECT
Vagal nerve stimulation
Transcranial magnetic stimulation (TMS)
What is the preferred approach to MDD treatment? What is the MC?
Most preferred is a combination.
MC is just pharmacotherapy
What are the goals of MDD treatment?
Provide education
Maintain patient safety
Achieve full remission of symptoms
Return patient to baseline function
How do we decide IP vs OP treatment of MDD?
Mild/Moderate can be treated OP, generally no SI/HI and still able to take care of themselves.
What is ECT?
Use of small electric current to induce cerebral seizure UNDER general anesthesia.
When is ECT indicated?
First-line therapy for any severe SI/psychosis/catatonia/malnutrition d/t food refusal 2/2 to depressive illness.
*More efficacious than any other treatment for severe MDD.
What are the CIs of ECT?
No absolute CI.
Caution in cardio, neuro, or AC use.
What are the MC adverse effects from ECT?
Cardiopulmonary, HA, Nausea, transient cognitive impairment, and muscle aches.
What is vagal nerve stimulation?
Usually a device implanted in chest wall, connected to a vagus nerve. (usually left).
When is vagal nerve stimulation mainly used?
Refractory epilepsy.
Can be helpful for refractory depression.
What is TMS?
Metal coil with magnetic field placed against scalp.
Induces depolarization of neurons in a focal area WITHOUT any sedation or anesthesia.
When is TMS indicated?
Refractory depression.
What are the CIs of TMS?
High seizure risk, incompatible implants
*Less efficacious than ECT.
What supplements can one take for MDD?
S-Adenosylmethionine (SAMe)
5-Hydroxytryptophan (5-HTP)
Omega-3 FAs
What is SAMe?
Naturally occurring substance in the body that may raise dopamine levels.
Used as an adjunctive option for mild to moderate depression in pregnant patients.
*May trigger manic episodes
What is 5-HTP?
Natural precursor to serotonin, but risk of GI upset, serotonin syndrome, and eosinophilic myalgia syndrome.
When are omega-3 FAs best used for MDD? What are they cautionary in?
Work better with antidepressants.
Caution in anyone on AC, bc increases bleed risk.
What herbals are often used for MDD?
St. John’s Wort
Saffron
Gingko biloba
What does St. John’s Wort do?
Increases serotonin, and possibly NE and Dopamine levels as well.
Risk of GI upset, serotonin syndrome, and photosensitivity.
Many drug drug interactions (DDIs, such as warfarin)
What does saffron do?
Could help with depression.
Risk of GI upset, mania, bleeding, and is fatal at high doses.
What does gingko biloba do?
Improved mood in pts being treated for memory loss; may increase sensitivity to serotonin
May increase risk of bleeding.
*Commonly used by older people for memory loss.
What are some general guidelines for antidepressant use?
Start low and go slow, titrating over 7-10 days.
Trial for at least FOUR WEEKS MINIMUM!!!!!!!!!!!!
Rx should be continued for SIX MONTHS IF IMPROVING.
GRADUAL DOWN TITRATION if you want to dc the antidepressant.
What SSRIs have slightly increased efficacy according to some studies?
Paroxetine, escitalopram.
What SNRI has slightly increased efficacy according to some studies?
Venlafaxine
What serotonin modulators have slightly increased efficacy according to some studies?
Mirtazapine
Vortioxetine
Mirtazapine/Remeron is a TeCA
What TCA has slightly increased efficacy according to some studies?
Amitriptyline
What are the big SEs of SSRIs?
Weight gain and sexual dysfunction.
What drug classes comprise first gen antidepressants?
MAOIs
TCA
TeCAs