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Psychiatry week 1 > Management of mood disorders > Flashcards

Management of mood disorders Flashcards

1
Q

What is usually the 1st line drug for the treatment of depression ?

A

SSRI - but not always need to take into consideration the patients co-morbidities etc

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2
Q

What is a good question to always ask when deciding anti-depressant treatment for the patient ?

A

What they used last time and if it worked ?

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3
Q

How long do anti-depressants take to work ?

A

Usually 2-6weeks

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4
Q

When would you consider ECT in treatment of depression ?

A

If needing a quicker response e.g. suicide risk etc

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5
Q

What are some of the other treatment options in depression besides anti-depressants ?

A
  • ECT
  • CBT
  • IPT
  • CBASP
  • lifestyle changes
  • meaningful activity
  • stress reduction
  • routine (especially sleep)
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6
Q

In psychotic depression what drugs can be combined to treat this ?

Which drug should be continued ?

A
  • Anti-depressants and anti-psychotics
  • The anti-depressant is the drug which should then be continued long-term
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7
Q

What is a rare risk of the use of anti-depressant drugs in young people ?

A

Can rarely cause agitation and lead to suicide in young people

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8
Q

What is none response to an anti-depressant defined as ?

A

No response or inadequate response after six weeks at the maximum BNF dose or highest tolerated dose

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9
Q

How long should anti-depressant medication be continued for in the treatment of depression?

A
  1. Continue treatment for 6-12 months after full resolution of symptoms
  2. after a first episode, 12-24 months for a recurrence,
  3. after third episode should continue indefinitely if willing
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10
Q

What is the mainstay of treatment of bipolar disorder ?

A

lithium, anticonvulsants (lamotrigine and carbamazepine), antipsychotics

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11
Q

Why are anti-depressants not usually used in the treatment of bipolar (considering they often get depressive episodes)?

A

Antidepressants can cause switching to mania/hypomania or mood instability. Even if they don’t cause elevated mood they are not as effective as mood stabilisers for bipolar depression.

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12
Q

What drug is good for the treatment of bipolar depression?

A

Lamotrigine

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13
Q

What drug is good for the treatment of mania/hypomania ?

A

Volproate semisodium

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14
Q

What drugs are good for the treatment of both elevated and depressed states in bipolar disorder ?

A

Lithium and anti-psychotics

Note lithium is more the maintenance therapy and is the 1st line treatment for that

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15
Q

What can be given to a patient with bipolar disorder if compliance is poor or they are unwilling to take oral medication?

A

IM antipsychotics can be given every 2-4 weeks

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16
Q

Anti-depressants are not usually used in the treatment of depressive episodes of bipolar but when would they be considered and what anti-depressant would you use 1st line?

A

severe depressive episodes

1st line = SSRI’s

17
Q

What are the different types of SSRI’s available?

A

Fluoxetine, sertraline, citalopram, escitalopram, paroxetine

18
Q

What are the main side effects someone may experience when taking an SSRI?

A
  • GI upset (diarrhoea & vomiting)
  • anxiety (worsened)
  • agitation
  • insomnia
  • sexual dysfunction - delayed orgasm
  • Hyponatremia in older patients.
  • Transient increase in self-harm / suicidal ideation in <25 years (mainly teenagers)
19
Q

When should SSRI’s be taken to reduce the risk of insomnia caused by them?

A

In the morning

20
Q

What are some of the symptoms people may experience when discontinuing trearment with SSRI’s and which SSRI is associated worse symptoms ?

A
  • GI upset, anxiety, agitation, insomnia, myoclonus
  • So taper the dose over a few weeks
  • Paroxetine is associated with the worse symptoms so is rarely used
21
Q

When taking with what class of drug is there an increased risk of GI bleeds when on an SSRI?

22
Q

If someone has cardiac problems and needs to be put on an SSRI which SSRI is safest ?

A

Sertraline

23
Q

Which SSRI is safest to use in epilepsy ?

A

Citalopram

24
Q

Which SSRI is associated with long QT syndrome ?

A

Citalopram

25
Q

Which is the most effective SSRI?

A

Fluoxetine

26
Q

Give some examples of tricyclic anti-depressants

A

Amitriptyline, clomipramine, imipramine, lofepramine, dosulepin.

27
Q

What are the common side effects of tricyclic anti-depressants and what is the important one you need to be wary about ?

A
  • sedation
  • weight gain
  • confusion
  • anticholinergic effects - blurred vision, dry mouth, constipation, urinary retention
  • sexual dysfunction
  • postural hypotension, tachycardia

Rarely cardiac arrhythmias

28
Q

Who are tricyclics avoided in ?

A
  • Cardiac problems,
  • Older people
  • Suicidal intent (cardiac toxicity in OD - overdose)
29
Q

What is the main Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)?

A

Mirtazapine

30
Q

When is mirtazapine usually used ?

A

Often used when SSRI hasn’t worked (2nd line)

31
Q

When may mirtazipine be used 1st line over an SSRI?

A
  • if patient has insomnia and/or poor appetite, it also has a good effect in reducing anxiety
  • SSRI would make their insomnia worse
  • Has a higher sedative effect at a lower dose compared to higher (weird)
32
Q

What can mirtazapine often be used inconjuction with ?

A

SSRI or venlafaxine (SNRI)

33
Q

What are the side effects of mirtazapine ?

A
  • Main ones are - Sedating, causes hunger/weight gain (both may be advantage or disadvantage) - could be good if someone with anorexia needs an anti-depressant
  • Other side effects: constipation, dizziness, falls, dry mouth, unusual/vivid dreams. Rarely blood dyscrasias (haematological problems e.g. lower platelets), seizures.
34
Q

What situations must you be careful with mirtazapine use ?

A
  • It causes GI upset with alcohol so need to avoid alcohol when on it
  • and be careful when combining with other sedating agents
35
Q

What is serotonin syndrome ?

A

It is a potentially fatal condition triggered by too much nerve cell activity.

36
Q

List the causes of serotonin syndrome

A
  • monoamine oxidase inhibitors
  • SSRIs
  • ecstasy
  • amphetamines
  • st johns wart
37
Q

What are the clinical features of serotonin syndrome ?

A
  • Neuromuscular excitation (e.g. hyperreflexia, myoclonus, rigidity)
  • Autonomic nervous system excitation (e.g. hyperthermia)
  • Altered mental state - confusion ==> coma ==> death

May initially appear like someone youd exepect to be on ectasy e.g. buzzing etc

38
Q

What is the management of serotonin syndrome ?

A
  • supportive including IV fluids
  • benzodiazepines
  • more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

Psychiatry week 1 (12 decks)

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