mood disorder Flashcards
1
Q
Criteria of MDD
A
- For at LEAST 2 WEEKS, Five or MORE of these SYMPTOMS, at least one of which is DEPRESSED MOOD or LOSS of INTEREST/PLEASURE
- depressed mood most of the time, most days
- loss of interest or pleasure in activites, most of the time, most days
- significant change in appetite or weight
- significant cahgne in sleeping habits
- psychomotor agitation or retardation
- fatigue or loss of energy, most of the time, most days
- feeling of worthlessness or excessive guild
- diminished ability to conc or make decisions
- recurrent thoughts of death and suicide
2
Q
Course of illness of MDD
A
- Women twice as likely to experience a depressive episode
- Average age of onset mid-20’s, but may begin at any age
- TEND TO BE EPISODIC
- Untreated episodes typically last at least four months, but will typically eventually remit spontaneously
3
Q
what to do before begining treatment
A
- Rule out medical causes for mood disturbances
- establish a diagnosis
- assess substances use
- assess for manic and psychotic symptoms
- determine patient preference and past treatment outcomes
- assess suicidality
4
Q
MAOI
A
- phenelzine and selegiline
- Not a first-line treatment due to signifcant risk with drug-food or drug-drug interations
- goods containing tyramine cause HTN crisis
5
Q
Tricyclic antidepressants
A
- imipramine, amitriptyline
- side effects: dry mouth, constipation, weight gain, orthostatic hypotensions, sexual dysfunction
- rarely used now for depression; too lethal in event of overdose (cardiac arrhythmias and seizures)
- still used for chronic pain
6
Q
SSRI
A
Most common FIRST-LINE TX
- citalopram, escitalopram, fluoxetine, fluvoxamine, paraxetine, sertraline
- less sedating, less likely to cause weight gain than tricyclics but equally likely to cause sexual dysfunction, GI upset, headache, sleep distrubance
- NON-lethal overdose
- require 2-7 weeks for patient to notice a response
7
Q
SNRI
A
- first-line treatment
- venlafaxine, desvenlafaxine, duloxetine, levomilnocipran
- side effects = elevated blood pressure and heart rate, weight gain, sexual dysfunction
8
Q
Bupropion
A
anti-depressant
- norepinephrine and dopamine reuptake inhibitor
- activating, increases energy, does not help with anxiety, unlike SSRI and SNRI
- Does NOT cause sexual dysfunction, or weight gain
- can be used for smoking cessation
9
Q
Mirtazopine
A
anti-depressants
- significant sedating and wieght gain effects; useful in patients where insomnia an dloss of appetite and prominent
10
Q
Bipolar disorder
A
- less prevalence (1%)
- highly recurrent course (90%)
- diagnosis requires the presence of a manic or mixed episodes; no depressive episode is required
- elevated risk of suicide
11
Q
manic episodes
A
- distinct period of abnormally elevated, expansive, or irritbale mood and abnormally and persistently increased goal-directed activity or energy lasting at least one week
- at least three of the following symptoms:
- inflated self-esteem or grandiosity
- decreased need for sleep
- increased talkativity or pressure to talk
- flight of ideas or racing thoughts
- distractivility
- increase in goal-diret acitivity
12
Q
hypomanic episode
A
- some symptoms as manic episode, but less severe, 4 days or more
- symptoms are a definite change from baseline, but do not markedly impair functioning
13
Q
TX of bipolar disorder
A
- MOOD STABILIZERS
- Lithium
- higher effect but difficult to tolerate
- narrow therapeutic window, can cause a variety of toxicities; requires ongoing close monitoring
- anti-convulsants (lamotrigine, divalproex)
- can also cause serious adverse evetns and require careful monitoring
- Lithium
- GOOD SLEEP HABITS are particularly important
14
Q
MDD
A
ONE or more major depressive episodes WITHOUT any manic, hypomanic, or mixed episodes
15
Q
Persistent depressive disorder
A
chronic, low-level depressed mood most days for at least 2 years
