Module 14b - Part 2 Flashcards
For a diagnosis, at least _____ of some massive list must occur for at least __ weeks.
5 symptoms
2 weeks
Depression is classified into two major types, what are they?
Exogenous
Endogenous
_________ depression is triggered by external stimuli, whereas _________ depression may or may not be related to external events
Exogenous
Endogenous
Prolonged grieving coupled with excessive guilt.
Pathological grief
What treatment modality is more effective to treat pathological grief?
Psychotherapy > drugs
Prolonged depression following failure or rejection. Common symptoms include hypersomnia and hyperphagia.
Adjustment disorder
What is the most effective treatment modality for treating adjustment disorder?
Psychotherapy > drugs
What are the two depression types within exogenous depression?
What treatment modality is best for exogenous depression?
Pathological grief
Adjustment disorder
Psychotherapy
What are the different depressive types within endogenous depression?
Major depression Severe depression Atypical depression Dysthymia Seasonal Affective Disorder Postpartum depression Bipolar disorder
Common symptoms include anhedonia and lack of response to positive stimuli. Symptoms are usually worse in the morning, and insomnia and weight loss are also typical.
Major depression
Similar symptoms to major depression with the addition of severe suicidal ideation and psychoses
Severe depression
The patient’s mood is regularly low but symptoms are not as severe as major depression.
Dysthymia
Mild or moderate symptoms of depression related to the lack of sunlight. Usually only affects people in the winter months.
Seasonal affective disorder
Alternating periods of elevated or irritable mood and periods of depression
Bipolar disorder
Moderate to severe depression in women after they given birth. Usually occurs within ___ months of delivery but may occur __ year after birth.
Postpartum depression
w/in 3 months - 1 year
Similar symptoms to major depression but patients also have the atypical symptoms of hypersomnia and hyperphagia. Patients are usually obese.
Atypical depression
This endogenous depressive type responds better to psychotherapy than drugs.
Dysthymia
Describe the major hypothesis for the biochemical basis of depression.
Monoamine hypothesis
States that altered monoamine release, receptor sensitivity, or postsynaptic function lead to symptoms of depression
Why is the efficacy of antidepressants difficult to assess?
Since it takes months for effects to occur
Results from placebo controlled CTs also suggests that as much as 40% of the effects of antidepressants may be due to the _______ ________.
placebo effect
Antidepressant drugs mediate their effects by one of two major mechanisms. What are they?
Inhibiting monoamine reuptake
Inhibiting monoamine metabolism
What are the four major classes of drugs used to treat depression?
TCAs
SSRIs
MAOIs
SSRIs/NSRIs
What is the mechanism of action of TCAs?
Prevent the reuptake of both serotonin and NE
What are the adverse effects of TCAs?
ASS WOD (Think TCA = techoic ass+ids [acids] —> ASS workout of the day)
Anticholinergic effects Sedation Orthostatic hypotension Decreased seizure threshold Cardiac toxicity Weight gain Sexual dysfunction
Describe the mechanism of action of SSRIs.
Block the reuptake of serotonin.
Why would SSRIs be used over TCAS if they only block serotonin, rather than serotonin and NE?
Thought to have similar efficacy to TCAs, but the incidence of side effects is lower
Most commonly used treatment of depression and most commonly used in major depression.
SSRIs
What are the adverse effects of SSRIs?
IWSS (i [don't] want Serotonin Syndrome) Insomnia Weight gain Sexual dysfunction Serotonin syndrome
Increased serotonin transmission can result in agitation, confusion, anxiety, hallucinations and incoordination.
Symptoms may occur within __ days of initial therapy and disappear when the drug is stopped.
Serotonin syndrome
3
Same mechanism of action as TCAs.
SNRIs - selective serotonin/NE reuptake inhibitors
What is the main advantage of SNRIs?
Faster onset of action
What are the adverse effects of SNRIs?
NDS (sNris –> Nintendo DS)
Nausea, diastolic HTN, sexual dysfunction
Enzyme that inactivates monoamine NTs.
Mononamine oxidase
What are the two major types of MAO, and what do each oxidize?
MAO-A - serotonin and NE
MOA-B - dopamine
MAO inhibitors inactivate which MAO subtype?
Both - non-selective
MAO inhihbitors are useful in the treatment of these depression types.
Atypical and Dysthymia (the weird ones)
MAO inhibitors mediate their effects by inhibiting the metabolism of monoamines in the __-_______ neuron.
pre-synaptic
What are the adverse effects of MAO inhibitors?
HI AOA (HI American Orthopedic Association)
Hypertensive crisis (tyramine containing foods)
Insomnia
Agitation
Orthostatic hypotension
Anxiety
Severe illness characterized by recurrent fluctuations between episodes of mania and depression
Bipolar disorder
What are the three major groups of drugs used to treat bipolar disorder?
Mood stabilizers
Antipsychotics
Antidepressants
What are the benefits of patients using mood stabilizers to treat bipolar disorder.
1 - Relieve symptoms during manic OR depressive episodes
2 - Prevent recurrence of manic or depressive episodes
3 - Do not worsen symptoms of mania or depression and do not alter the rate of cycling
The primary drugs used as mood stabilizers.
Lithium Valproic acid (anti-epileptic)
Although the mechanism of action of lithium is not clear, what do we believe it does?
Alter the uptake and release of glutamate
Block the binding of serotonin
Lithium has a ______ therapeutic range and plasma concentrations may be altered by _____.
narrow
sodium
Drugs that increase sodium loss from the body (i.e. ______) increase lithium concentrations and produce toxicity.
These toxic effects are?
diuretics
Gi upset, tremor, sedation, hypotension
GTSH
(Toxic - Thyroid stimulating hormone Gone)
Used in bipolar disorder acutely to control symptoms during manic episodes and long term to stabilize mood.
Antipsychotics
Why are antipsychotics even used to treat bipolar disorder, and which type is preferrable?
Show a benefit even in patient’s without psychotic symptoms
Atypical antipsychotics are preferred due to the lower incidence of EPS
Used to treat depressive episodes of bipolar disorder. Always used in conjunction with _____ _______.
antidepressants
mood stabilizers
Why are antidepressants not used alone in the treatment of bipolar disorder?
Thought that they may precipitate manic episodes
Which of the following is best in the treatment for bipolar disorder? A) TCAs B) SSRIs C) SNRIs D) All of the above
D - there is no evidence for which antidepressant works best
Patient is overwhelmed with uncontrollable worrying. The hallmark is an unrealistic or excessive worry about several activities that lasts 6 months or longer
GAD
An anxiety where the patient feels judged or a situational anxiety where escaping would be difficult or embarrassing.
Agoraphobia
Anxiety in social situations. Patients may not be able to talk (or stop talking), eat in front of others, or use public washrooms
Social anxiety disorder
Anxiety that occurs after experiencing a traumatic event. Symptoms may include re-experiencing the event and severe insomnia.
PTSD
Symptoms are related to a specific fear
Simple phobia
Patients have a sense of impending doom that is unrelated to stressors. They experience panic attacks, which are sudden in onset and may include symptoms like heart palpitations, chest pain, shortness of breath, dizziness
Panic disorder
Often confused for a heart attack.
Panic attack
What are the major classes of drugs used to treat anxiety?
Benzodiazepines
Buspirone
Antidepressants
First line therapy for anxiety.
Benzodiazepines
Act by potentiating the actions of GABA at the GABA receptor.
BDZs
Describe the mechanism of action of BDZs.
BDZs bind to a different site on the GABA receptor, than GABA.
This causes an increased binding of GABA to its receptor.
This leads to opening a chloride channel, and a subsequent influx of chloride
This causes CNS depression
Why are benzodiazepines safer than barbiturates?
Since they are not GABA agonists, there is a limit to how much CNS depression they may produce, unlike barbiturates
BDZs are useful in treating these 5 things.
Anxiety seizures insomnia Alcohol withdrawal Muscle spasm
A higher dose of BDZ is used to treat _______, and a lower for _______.
insomnia
anxiety
What are the adverse effects of BDZs?
CAR TTW (Benz = car, Try to win - think race) CNS depression Anterograde amnesia Respiratory depression Teratogenic Tolerance Withdrawal
Impaired memory of events that occur following dosing of BDZs.
Anterograde amnesia
Describe tolerance in BDZ treatment and how withdrawal symptoms are minimized.
Tolerance does not occur to anxiolytic or sedative effects, but occurs to seizure effects.
Withdrawal is minimized by tapering down the concentration of drug slowly.
BDZs are effective in treating these anxiety types.
GAD and SAD
Not a CNS depressant and acts to treat anxiety in a mechanism distinct from BDZs.
Buspirone
The likely mechanism of action of buspirone involves modulation of ________ and/or _________ neurotranmission.
serotinergic
Dopaminergic
Since buspirone is not a CNS depressant, it is useful in treating anxiety in patients who use _______.
alcohol (unlike Benzos, where respiratory depression may occur)
Buspirone:
- Shows no signs of _______ or physical ________
What is it’s major disadvantage?
tolerance, physical dependence
Major disadvantage is that its anxiolytic effects develop slowly - ineffective in treating symptoms that require immediate relief
Buspirone is effective in the treatment of ______ but appears to be ineffective in the treatment of other anxiety types
GAD
Although buspirone is well tolerated and non-sedating, what are some commonly reported side effects?
Dizziness, light-headedness, excitement
LED
Which antidepressants are most effective in treating GAD?
SNRIs, SSRIs, buspirone
Which antidepressants are most effective in treating Panic disorder/aographobia?
SSRIs, TCAs, MAOIs
SSRIs preferred
Which antidepressants are most effective in treating OCD?
SSRIs are the first line therapy
Which antidepressants are most effective in treating social anxiety disorder?
SSRIs are the first line of therapy
BDZs provide immediate relief
Which antidepressants are most effective in treating PTSD?
No evidence for efficacy of any drug in treatment
What must OCD patients also undergo with drug treatment?
Behavioural psychotherapy
Why are SSRIs preferred over MAOIs and TCAs in the treatment of panic disorder/agoraphobia?
Better tolerated
