Lecture 60 - Mood Disorders and Antidepressants

Question 1

Major Depressive Disorder (MDD) diagnosis requires 5 symptoms to be present, 1 of which must be EITHER Depressed mood or Loss of interest in things you would normally enjoy (these feelings should be present most of the time on most days). The other four symptoms can be any combination of SIGECAPS. What does the mnemonic stand for?

How long do these symptoms need to be present for an MDD diagnosis?

Answer 1

S –> Suicidal thoughts

I –> Loss of interest (anhedonia)

G –> inappropriate Guilt (or feelings of worthlessness)

E –> Energy (lower than normal)

C –> Concentration (can’t focus much)

A –> Appetite (changes from norm)

P –> Psychomotor (lack of or increased)

S –> Sleep (more or less than usual)

2 weeks

Question 2

Atypical Depression is similar to MDD. The difference is with Atypical, patients will specifically want to _____ more, _____ more, and will show signs of Psychomotor changes. (Focus on APS of SIGECAPS).

Answer 2

Sleep more

Eat more

Question 3

Seasonal Affective Disorder (SAD) typically presents as _______ (Atypical or Typical?) Depression.

Answer 3

Atypical Depression

Question 4

MAOIs can be remembered with the mnemonic TIPS. What does it stand for?

Answer 4

T –> Tranylcypromine (Parnate)

I –> Isocarboxazid (Marplan)

P –> Phenelzine (Nardil)

S –> Seleginline (Emsan) –> Keep in mind this one is administered transdermally.

Question 5

Patients taking MAOIs need to restric their consumption of _______, which is a precursor of Norepi and is found in high concentrations in aged foods (e.g. cheese or pickles).

Answer 5

Tyramine

Question 6

______, bc it is admnistered transdermally, tends to have a greater inhibitory effect on MAO-B in the periphery than MAO-A in the gut. This decreases risk of severe hypersensitivity reaction with a diet NOT restricted in Tyramine intake.

Answer 6

Selegiline

Question 7

Tricyclic Amines (TCAs) affect Monoamine Concentration in what way?

Answer 7

They decrease the reuptake of Monoamines in the presynaptic terminal –> increases concentration in synapse.

Question 8

TCAs have a greater effect on the _____ than do MAOIs. What might they cause?

Answer 8

Heart

They can cause arrythmias or QT prolongation

Question 9

SSRIs are specific to _______, which means they’ll have fewer side effects than MAOIs and TCAs. Remember the suffixes (-etine; -opram; -aline)

Answer 9

Serotonin

Question 10

SSRIs can cause _____ discomfort, Sexual side effects, and Easy ______.

Also, rapid cessation of SSRIs can lead to SSRI discontinuation syndrome. How do these patients present?

Answer 10

GI discomfort

Easy Bruising

Patients with SSRI discontinuation syndrome will present with Flu-like symptoms.

Question 11

SNRIs are similar to SSRIs, but their side effects can include an increase in ______. Keep in mind SNRIs inhibit the reuptake of Serotonin AND ______. Keep in mind the suffixes -afaxine and -aciprin.

Answer 11

BP

Norepi

Question 12

_________ (one of the enantiomers of _______) was approved for treatment of Depression. It is administered intra_______, and works very quickly.

Answer 12

Esketamine

Ketamine

Intranasally