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Mood Disorders Flashcards

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1
Q

Define Mood

A

Overall state of emotion at a given time which is influenced by internal and external factors

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2
Q

What is a mood disorder?

A

A condition that affects a person’s everyday emotional state/mood (prevalence 1 in 4 adults)

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3
Q

What neurotransmitters effect mood? Where are they made?

A

Serotonin (Raphe nuclei)
Norepinephrine (Locus coeruleus)
Dopamine (Substantia nigra)

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4
Q

What are the types of mood disorders?

A

Depressive and bipolar

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5
Q

What criteria is required for ALL psychiatric conditions?

A
  1. Cannot be caused by a drug or external exposure
  2. Cannot be caused by a medical condition
  3. Must have significant impairment of social and/or occupational functioning
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6
Q

What is the prevalence of major depressive disorder?

A

21% in lifetime, 10% per year

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7
Q

Who is major depressive disorder most common for?

A

Women
Age ~30 years
Native Americans (lowest is asians)
Low socioeconomic status

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8
Q

What is the inheritability of major depressive disorder?

A

35-40%

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9
Q

What is the cause biologically of major depressive disorder?

A

Changes in neurotransmitter expression and sensitivity (serotonin, norepinephrine, glutamate, GABA, dopamine)

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10
Q

What medications can contribute to major depressive disorder?

A

Glucocorticoids, interferons

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11
Q

What is the diagnostic criteria for major depressive disorder?

A

A depressed mood or anhedonia for at least 2 weeks and at least 4 of the following:
-sleep changes
-feelings of worthlessness/guilt
- fatigue
- decreased concentration
- significant appetite or weight change
- activity changes
- recurrent thoughts about death or suicide

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12
Q

What is the mnemonic for major depressive disorder?

A

S - sleep
I - interest decrease
G - guilt

E - energy down

C - concentration down
A - appetite down
P - psychomotor agitation or retardation
S - suicidal ideation

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13
Q

What are the subtypes of major depressive disorder?

A

Anxiety - high levels of accompanying anxiety
Atypical - reactivity to pleasurable stimuli, hyperphagia, hypersomnia
Catatonic - major psychomotor disturbances
Melancholic - anhedonia, psychomotor changes, insomnia, decreased appetitie
Mixed - symptoms of mania
Peripartum - while pregnant or within 4 weeks or birth
Psychotic - with accompanying psychosis
Seasonal - associated with a particular season

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14
Q

What is the average time to resolution of a major depressive disorder episode?

A

20 weeks

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15
Q

When is the highest risk of recurrence of major depressive disorder?

A

Within the first few months following a episode’s resolution

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16
Q

What is the rate of recurrence of major depressive disorder?

A

40% in a year and 85% in a lifetime

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17
Q

What are the screening exams for major depressive disorder?

A

Quick initial -> Two question screen PHQ-2
Evaluate severity -> Patient Health Questionnaire-9 PHQ-9
Rating of sx -> Zung Self-Rated Depression Scale

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18
Q

What is the preferred approach to treating major depressive disorder?

A

A combination of pharmacotherapy and psychotherapy

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19
Q

What is the most common approach to treating major depressive disorder?

A

Pharmacotherapy only

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20
Q

What is electroconvulsive therapy?

A

Use of a small electric current to induce a cerebral seizure while patient is under general anesthesia

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21
Q

What is the indication for electroconvulsive therapy?

A

Severe, refractory depression
Esp if cannot tolerate other therapies (like pregnancy)

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22
Q

What are the adverse events for electroconvulsive therapy?

A

Cardiopulmonary, HA, nausea, transient cognitive impairment, muscle aches

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23
Q

What is vagal nerve stimulation?

A

A device is implanted in the chest wall and connected to one (left) vagus nerve

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24
Q

What is the indication for vagal nerve stimulation?

A

Typically used for refractory epilepsy but can be used for refractory depression

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25
What is transcranial magnetic stimulation?
A metal coil with magnetic field is placed against scalp to induce depolarization of neurons in a focal area
26
What is the indication for transcranial magnetic stimulation?
Treatment-refractory depression
27
What are the CI for transcranial magnetic stimulation?
High seizure risk, incompatible implants (bc magnetic)
28
What are the SE for transcranial magnetic stimulation?
Seizures, HA, scalp pain, transient hearing loss
29
What supplements can be used in major depressive disorder?
S-Adenosylmethionine: raises dopamine levels but can trigger manic episodes, preg safe 5-hydroxytryptophan: precuror to serotonin Omega- 3 Fatty Acids: antiinflammatory effects
30
What are herbals that can be used in major depressive disorder?
St. John's Wort: increases serotonin, maybe increases NE and dopamine Saffron: MOA unclear Ginkgo Biloba: Improved mood in memory loss patients, increases sensitivity to serotonin
31
How long should a patient be on an oral antidepressant before evaluation?
At least 4 weeks
32
How long should a patient be on an oral antidepressant?
At least 6 months after s/s improvement
33
What are the SSRI drugs?
Sertraline Citalopram Escitalopram Fluoxetine Paroxetine Fluvoxamine
34
What is the MOA or SSRI?
Selectively decreases the action of 5-HT reuptake pump, leading to increased serotonin levels in the synapse
35
What are the common CI in all SSRIs?
Allergy, use of an MAOI within 2 weeks
36
What are the common SE of SSRIs?
GI upset Sleep changes Neuro (HA, dizziness) Sexual dysfunction Psych Prolonged QT, weight gain, bleeding, orthostatic hypotension, serotonin syndrome
37
What is serotonin syndrome?
Diarrhea, increased bowel sounds, agitiation, hyperreflexia, dry mucus membranes, autonomic instability, hyperthermia, HTN, tremor, clonus, seizure, death Caused by increase in serotonergic activity
38
What is the treatment for serotonin syndrome?
Supportive care D/c serotonergic medications Sedation with benzos
39
What is unique about sertraline?
More GI upset Less QT prolongation Higher insomnia
40
What is unique about citalopram and escitalopram?
Most QT prolongation Minimal SE Least hepatic cytochrome enzymes
41
What is unique about fluvoxamine?
Shortest half life Most somnolence Many DDI due to cytochrome inhibition Good use with OCD
42
What is unique about fluoxetine?
Longest half-life Higher insomnia SE of anxiety Cannot take tamoxifen
43
What is unique about paroxetine?
Anticholinergic SE Increased weight gain, sexual disfunction DDI 2/2 cytochrome inhibitor Cannot take tamoxifen
44
What is the MOA for SNRIs?
blocks reuptake of 5-HT and norepinephrine, increasing their levels in the synapse
45
Which SNRIs have a greater effect on norepinephrine?
Savella/Fetzima
46
What are the SNRI drugs?
Venlafaxine Desvenlafaxine Duloxetine Milnacipran Levomilnacipran
47
What are the common CI for SNRIs?
Allergy MAOI in 2 weeks Serotonergic drugs Angle closure glaucoma
48
What are the common SE of SNRIs?
GI upset esp constipation Sleep changes Neuro (HA, dizziness) Sexual dysfunction (less than SSRI) Psych Diaphoresis, hypertension, serotonin syndrome Note: less weight gain side effects
49
What is unique about venlafaxine?
More SE esp N/V Most elevated BP
50
What is unique about desvenlafaxine?
Synthetic of venlafacixine's major metabolite Less SE than venlafaxine esp BP
51
What is unique about duloxetine?
Most likely to have DDI Least elevated BP Used for chronic pain relief
52
What is unique about milnacipran and levomilnacipran?
Anticholinergic SE Milnacipran/Savella is more for fibromyalgia
53
What is the MOA of Bupropion?
Dopamine-norepinephrin reuptake inhibitor and antagonizes nicotonic receptors
54
What is the MOA of mirtazapine?
Antagonizes alpha-2 adrenergic receptors and 5-HT2 and 5-HT3 receptors, which causes increased release of serotonin and norepinephrine
55
What are the SE of bupropion?
Dry mouth, insomnia, nausea, increased risk of seizures No weight gain or sexual dysfunction Think energy boost and sex
56
What are the CI for bupropion?
allergy, seizure disorder, anorexia/bulimia, within 2 weeks of MAOI
57
What are the SE of mirtazapine?
Drowsiness and weight gain, sexual dysfunction
58
What are the CI of mirtazapine?
Allergy, within 2 weeks of MAOI
59
What is the MOA of serotonin modulators?
Block reuptake of 5-HT
60
What are the serotonin modulators?
Nefazodone Trazodone Vilazodone Vortioxetine
61
What is the MOA of nefazodone and trazodone?
antagonize 5-HT receptors causing increased release of serotonin
62
What is the MOA of vilazodone and vortioxetine?
Partial agonist of 5-HT receptors mimicking serotonergic effects
63
What are CI to serotonin modulators?
allergy, within 2 weeks of MAOI
64
What are SE of serotonin modulators?
HA, diarrhea, nausea SI risk Serotonin syndrome risk
65
What is unique about nefazodone?
Most DDI risk BBW for hepatotoxicity, name brand pulled from market SE: less GI and weight gain, no sexual side effects
66
What is unique about trazodone?
SE: sedation, nausea, dry mouth, fatigue, constipation, sexual dysfuction (incl priapism) Doesn't cause weight change and less sexual dysfunction
67
What is unique about vilazodone?
Faster onset of treatment Less sexual dysfunction
68
What is unique about vortioxetine?
Faster onset of treatment Less sexual dysfunction
69
What is the indication for Ketamine/Esketamine?
Patients who fail or do not respond to ECT
70
What is the effect of Ketamine/Esketamine?
A rapid robust improvement in depression that fades in about 2 weeks
71
What are the SE of ketamine/esketamine?
Abuse potential Neurotoxicity Psychotomimetic effects (induces psychosis)
72
What is the MOA of ketamine/esketamine?
Opioid and AMPA agonist, NMDA antagonist
73
What are the CI to ketamine/esketamine?
Allergy, aneurysmal disease or AV malformation, h/o ICH, inability to tolerate increase in BP
74
What are DDI for ketamine/esketamine?
CNS depressants (including opiates), other nasal sprays
75
What is the MOA of MAOa?
Breaks down serotonin and norepinephrine
76
What is the MOA of MAOb?
Works with MAOa to break down dopamine
77
What is the indication for MAOIs?
Treatment-resistant or atypical depression
78
What is an indication for selegiline?
Low dose used for Parkinson's
79
What are the MAOI drugs?
Tranylcypromine Phenelzine Isocarboxazid Selegiline
80
What are the CI for MAOI drugs?
Allergy, CV disease, pheochromocytoma, hepatic or renal impairment, 2 weeks of other serotonergic drugs
81
What are the DDI for MAOIs?
Many. Too many
82
What are the SE of MAOIs?
Hypotension, GI upset, urinary hesitancy, headache, myoclonic jerks, edema, SI Hypertensive crisis when eating aged foods (tyramine)
83
What is the indication for TCAs?
Second line for depression 2/2 side effects
84
What is the MOA for TCAs?
Inhibits reuptake of 5-HT and norepinephrine
85
What are the tertiary amine TCAs?
Amitriptyline and Doxepin prevent 5-HT>NE reuptake
86
What are the secondary amine TCAs?
Nortriptyline and desipramine Prevent NE>5-HT reuptake Higher tolerability
87
What are the CI to TCAs?
Allergy 2 Weeks of MAOI Soon after MI
88
What are the SE to TCAs?
Anticholinergic Drowsiness Sexual dysfunction Diaphoresis Tremor Weight gain/increased appetite SI Prolonged QT
89
What is the indication for TeCAs?
Refractory of atypical depression
90
What are the TeCAs?
Maprotiline (blocks reuptake of NE and 5-HT) Amoxapine (blocks reuptake of NE, blocks dopamine receptors)
91
What are the TeCA side effects?
Similar to TCA, less anticholinergic but more antihistamine
92
What is lithium used for?
Typically bipolar, but can be unipolar depression Many SE and high toxicity risk
93
What is persistent depressive disorder?
A patient with ongoing depressive sx most of the time for >2 years with no longer than 2 months w/o sx and at least 2 of the following: -appetite changes -sleep changes -fatigue - Diminished ability (mental) - Low self-esteem -Feelings of hopelessness Cannot have mania! Feeling SAD For Life
94
What is the prevalence of persistent depressive disorder?
1.5% in the past 12 months
95
What is the treatment for persistent depressive disorder?
1st: SSRIs 2nd: TCAs and MAOIs (2nd bc side effects)

Behavioral Dynamics (5 decks)

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