Mood disorder Flashcards
test with high sensitivity test is the ability of the test to identify the dx
is the ability of the test to identify the dx
SSRI’s
inhibit transporter making more Neurotransmitter available in the synaptic cleft
depression associated symptoms
SIG E Caps
-S sleep issue (too much or less)
-I interest
-G guilt or worthlessness
-E energy
-C concentration difficulty
-A appetite
-P psychomotor agitation or irritation
- S suicidal
exercise
enhances neurotransmitter
depression screening
PH-Q9
serotonin, Gaba
well-being
calmness
impulsivity
aggression
sleep
sex drive
appetite
Indication for Labs
1st episode
precipitation unclear
severe depression
older age
specificity
ability to test to rule out the problem
Norepinephrine and dopamine
enhance
concentration, ambition. productivity
stress
reduce neurotransmitter
sensitivity
test highly sensitive
ability to test to identify the problem you are screening for depression
Bipolar disorder
patient should always screen for BD before starting an SSRI because SSRI can precipitate a maniac episode in pt with BD
BD symptom
insomnia
delusions
multiple social problems
hyperactive
mood swings
anxious. Irritable.
impulse control problem
paranoid
low energy
unable to focus
substance abuse
alcohol abuse
legal problem
relationship issue
Mild to moderate depression treatment
psychotherapy
medication
combination most effective
Depression treatment
1st line-SSRI
Increased risk of CYP450 liver enzyme effects
caution with elders, drug to drug interaction. benzo
-fluoxetine (prozac)
-paroxetine
-fluvoxamine
Greatest weigh loss but GI side effect
Less risk of CYP 450 liver enzyme effects
Safer in elders, fewer side effects
-sertraline (zoloft)
-citalopram (celexa)
-Escitalopram (Lexapro)
Pregnancy and breastfeeding_ SSRI
pregnancy
Highest risk
-fluoxetine and paroxetine
Lowest risk -
-Escitalopram
Breastfeeding
Highest risk citalopram
NB
Any woman at childbearing age should always be screened for pregnancy before starting a medication for depression
Most common SSRI side effects
GI tract
Diarrhea
n/v
sexual dysfunction
somnolence
weight gain
how to minimize side effect
start low and go slow
depression treatment and older adult
Citalopram, escitalopram and sertraline
Why are TCA’s risky in older adult
arrhythmias, cognitive changes, overdose risk as little as 1 week supply
What antidepressant class is on the beers list
TCA’s
avoid paroxetine (anticholinergic effect like TCA’s) and fluoxetine (prolonged side effects and long half-life) in elders
Abruptly stop SSRI symptoms
Anxiety
Dizziness
flulike symptoms
withdrawal symptom all psych med
6+ taking med
if stopped or rapidly reduced
consider fluoxetine low dose because has longest half-life to minimize withdrawal symptoms
serotonin syndrome
caused by excess serotonin
symptom
rapid HR, confusion, restlessness, agitation, and headache. nausea. vomiting.tremors,shivering
severe symptoms
seizure, high fever, syncope, irregular HR
send to ER
consider cyproheptadine to block the serotine production
name and anti-anxiety medication listed in the beers criteria
Benzodiazepine
alprazolam (Xanax®)
lorzepam (Ativan®),
diazepam (Valium®)
Clonazepam (Klonopin®)
TCA
tricyclic antidepressants
Amitriptyline.
Amoxapine.
Desipramine (Norpramin)
Doxepin.
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Protriptyline.
Trimipramine.
