Management of Mood Disorders Flashcards
What are some rating scales used to assess mood?
IDS, QIDS, HADS, MADRS
What is the IDS?
Self report of 30 questions = very detailed, patient rates each question, subjective
What is the QIDS?
Shorter version of the IDS = only asks about sleep, sadness, appetite, eight, concentration, view of self, suicide, energy and general interest
What is the HADS?
14 item self rated scale = easy to complete and administer
What is the MADRS?
10 item observer rated scale = highly sensitive to change
What are mood diaries useful for?
Identifying peaks and troughs in mood
Tracking overall mood progression
What are some evidence in support of antidepressants?
Reduce odds of relapse by 70%
For every 5 patients treated, 1 will stay well
What are the top 4 antidepressants recommended?
Escitalopram = probably best all round SSRI
Sertraline = well established, good cardiac profile
Mirtazapine = promotes sleep and appetite
Venlafaxine
What should you do if an antidepressant doesn’t work?
Increase dose, swap for another antidepressant, combine drugs, augment
What should you do when starting a patient on an antidepressant?
Get ratings of depressive symptoms before and after each trial
Warn patient about side effects
Review after 1-2 weeks
How is the first episode of relapse managed?
Continue antidepressant for at least 6 months after full recovery without reducing dose
How are second and subsequent relapses managed?
Continue antidepressant for at least 1-2 years after full recovery without reducing dose
What medication should be stopped in a patient having an acute manic episode?
Stop antidepressants
What is the first line treatment for acute mania?
Antipsychotics = olanzapine, quetiapine, ripendone
What are some features of treating acute mania?
Other options = lithium, valproate, ECT, carbamazepine
Oral medication if possible = IM medication if needed
Benzodiazepines or Z-drugs can be used for symptom control
How is acute bipolar depression treated?
SSRIs, especially fluoxetine, are preferred
Antipsychotic first line = quetiapine, olanzapine
Lamotrigine can be used but not acutely = takes time to titrate
What must be done if you are giving an antidepressant to a patient suffering from acute bipolar depression?
Must give it with an antimanic
What are some features of bipolar disorder maintenance therapy?
Lithium is gold standard
Psychoeducation very important
Lamotrigine if primarily depression
Valproate if primarily manic
What are some features of prescribing for older people?
Tricyclics can cause cognitive impairment
Fall risk increases when starting medication or increasing dose = SSRIs reduce sodium causing falls
Try to give monotherapy and start on half dose
What common class of drug can lithium not be prescribed alongside?
ACE inhibitors
What is ECT most commonly given for?
Recurrent depressive disorder without psychosis
How is ECT given?
Twice weekly = most patients are inpatients, receive bitemporal ECT, always under general anaesthetic with muscle relaxant, seizures usually last 15-30s
How common are side effects from ECT?
CV and pulmonary complications are most likely cause of death
66% complain of at least 1 side effect = headache is most common
64% experience some form of memory problems = usually autobiographical memory loss
What are the main effects of ECT on the CNS?
Modulation of monoamines Potent anticonvulsant effects 2nd messenger system effect Bolsters neuronal survival Reduces hyperconnectivity in frontal and limbic circuits
