Mood disorders Flashcards
What is the function of norepinephrine?
-concentration
-energy
What is the function of dopamine?
-“feel good” NT, pleasure
-motivation
What is the function of 5-HT?
-mood, happiness and well-being
-sleep, digestion
What is the pathogenesis of depression?
-changes in brain structure (unknown if cause or effect)
-neurotransmitter disturbances
-endocrine disturbances
-alterations in circadian rhythms
What is the monoamine deficiency theory?
a decrease in NE, serotonin and dopamine cause symptoms of depression, but we’re not really sure why
What is the mnemonic for depression?
SIG ED CAPS
sleep
interest
guilt
energy
depressed mood
concentration
appetite
psychomotor
suicidal ideation
How do antidepressants work?
they block enzymatic breakdown and slow reuptake of NE, 5-HT, and DA
What are the new 1st line drugs (second generation of drugs) for antidepressants?
Selective serotonin reuptake inhibitors (SSRIs) and Atyical antidepressants (SNRIs and NDRIs)
What are the first generation (2nd line) antidepressants?
monoamine oxidase inhibitors (MAOIs) and Tricyclic antidepressants (TCAs)
What happens when a NT causes a reaction?
it will bind to another receptor site, be re-absorbed, be broken down by enzymes
What is discontinuation syndrome?
like withdrawal for meds that effect your neurotransmitters
What is the acronym FINISH for?
for discontinuation syndrome
It stands for:
What is serotonin syndrome (SS)?
-too much serotonin in your body
-often related to 2 serotonergic drug interactions
What are the manifestations of Serotonin Syndrome?
Cognitive changes: confusion anxiety, restlessness
Autonomic changes: increased HR and BP and diaphoresis
Neuromuscular changes: hyperreflexia, tremors, increased temp
What is the management for Serotonin Syndrome?
-aggressive cooling measures
-sedation: benzos
-O2 for sat >94%
-short acting beta blocker: esmolol
-vasodilator: nitroprusside
-antidote: cyproheptadine (Periactin)
When does hypertensive crisis occur?
when taking a MAOI and eating food that contains tyramine
-the cheese effect (cheese, red wine, beer, chocolate, caffeine)
Manifestations:
hypertension, tachycardia, arrhythmias, hyperthermia, agitation
Treatment: supportive (fluids and cooling) and short-acting vasodilator like IV nitro
What are the pt and family teaching points for antidepressants?
-take several weeks to reach therapeutic effect
-watch for evidence of suicidality
-avoid hazardous activity and take at bedtime if sedation occurs
-avoid CNS depressants (ex. ETOH)
-do not discontinue abruptly–> discontinuation syndrome
-treatment should involve non-drug therapy to augment medication
-notify healthcare provider if pregnant
-avoid St. John’s Wort (herbal supplement thought to increase serotonin, NE, and DA and should be avoided due to possible interactions)
Which NTs are involved in mood disorders?
dopamine (DA), serotonin (5-HT), and norepinephrine (NE)
What changes are there to the brain structure and function during depression?
particularly in the limbic system which regulated emotions
-decreased size/activity of prefrontal cortex in some individuals
-decreased functioning of frontal and temporal lobes (where the limbic system is located)– unclear if this is cause or effect
-excessive activity of the amygdala (part of limbic system)
What happens when there is a decrease in NE or 5HT?
depression
What happens when drugs increase NE or 5HT?
relief of depression
What happens with low DA?
depression
What happens with high DA?
mania (as seen in bipolar disorder)
What are some examples of endocrine disturbances that can cause depression?
-abnormal cortisol secretion patterns (too much or not at the right time)– high cortisol depletes serotonin
-decreased thyroid function– hypothyroidism = low levels of serotonin
-hormonal changes after childbirth– postpartum depression
