Mood Disorders Flashcards
Norepinephrine, dopamine
Enhances:
▪ Concentration
▪ Ambition
▪ Productivity
most common psych disorder
depression
why do life events precipitate depression
stress reduces neurotransmitters
Sensitivity:
SNOUT
sensitivityrules out
Specificity:
Specific positive
rule IN disease
SPIN
indications for labs with depression
First episode of depression
Precipitant unclear
Severe depression
Older age
Depression- labs to check
CBC, CMP, TSH, B12/folate, pregnancy test, UDS
Major Depressive Disorder
> 5 symptoms present, most of the day, nearly every day, >2 weeks
One symptom must be depressed mood or loss of interest/pleasure
Bipolar Disorder: 15 Symptoms
- Depression
- Hyperactivity
- Insomnia!!!
- Mood swings
- Anxiety
- Irritability
- Impulse control problems
- Delusions
- Paranoia
- Low energy
- Inability to focus
- Substance abuse
- Alcohol abuse
- Legal problems
- Relationship issues
1st line depression meds
SSRIs
SSRI highest risk pregnancy
prozac, paxil
lowest SSRI risk pregnancy
escitalopram
SSRI side effects
diarrhea, N/v, sexual dysfunction, somnolence, weight gain
Prescribing antidepressants in older adults
SSRI- first choice- citalopram, escitalopram, sertraline
antidepressant on BEERS list
TCAs
Avoid paroxetine, fluoxetinea
Discontinuing SSRIs
taper slowly over 1-2 months
serotonin syndrome
Symptoms: rapid heart rate, changes in blood pressure and temperature, confusion, restlessness, agitation,
headache, nausea, vomiting, tremors, shivering
* Severe symptoms: Call 911; refer to emergency department
Seizures, high fever, syncope, irregular heart rate
* Management: stop the SSRI, SNRI, other meds
* Consider: cyproheptadine (Periactin) to block serotonin production
SNRI that does not raise BP
duloxetine
SNRI indications
Depression unresponsive to SSRIs
Anxiety disorders
Chronic pain, especially neuropathic pain
Menopausal VMS (hot flashe
NDRI
buproprion
Indications:
Depression, ADHD (Why?)
Cigarette smoking cessation, weight loss
No sexual side effects, no weight gain
NDRI contra
seizures
hypertension
highest suicide rates among
older men
Suicidal Risk Factors
- Presence of psych disorders
- Hopelessness
- Impulsivity
- History of attempts
- Marital status: highest to lowest risk shown below
Never married > Widowed > Separated > Divorced > Married without children > Married with children
if positive depression screening, next should be
labs
