Mood Disorders Flashcards
Major Depressive Episode
5+ sx in same week and change in functioning
Persistent Depressive Disorder
Depressed mood + 2 sx >1 year
Bipolar Disorder/Manic Depression
3+ sx greater or equal to 1 week
MAO hypothesis
Low monoamines DA, NE, SR
Dysregulation hypothesis
Dysregulation of postsynaptic receptors due to abnormal neurotransmitter concentrations
Neuroendocrine hypothesis
Hypothyroidism and dysfunctional HPA axis (high cortisol levels but limited stress response to dex challenge)
Key components of antidepressant pharmacology
Alleviate depressive sx, not CNS stimulant
Neurostransmitter levels increase rapidly, but sx not reduced for weeks
Sudden d/c = rapid withdrawal sx
Measuring Response/Onset of Effects
Week 1: appetite, sleep,
Weeks 2-3: drive and concentration
Weeks 4-6: mood and hopelessness
Best indicator of clinical response?
Fatigue
How long is an adequate trial of antidepressants?
8 weeks
TCAs Side Effects
Hypotension/increased HR - alpha
Wt gain - His
Lower seizure theshold - GABA
AntiAch - m
TCAs MOA
Block reuptake of NE and SR
MAOi MOA
Block degradation of NE, SR and DA
Selective vs Non-Selective MAOis
MAOa and MAOb
Selegiline - MAOb only - less dietary restrictions
MAOi Drug Interaction
Tyramine! - HTN crisis
Serotonin Syndrome
Abdominal pain High HR and BP Changes in MS Tremor Diarrhea
SSRI Side Effects
GI upset
Stimulant (paxil - sedation)
Weight loss
Low libido
SSRI Withdrawal
Flu like syndrome
TAPER
NDRI
Wellbutrin
DA > NE»_space;»»»> SR reuptake blockers
SNRI
SR NE Reuptake Inhibitor
SARI
SR antagonist and reuptake inhibitor!
Trazodone
NSSA
Noradrenergic Specific Serotonin Antidepressant
Mirtazapine
Increases neurotransmitter levels
Anti-histamine activity = sedation and weight gain
Drugs use to augment antidepressants
Lithium Pindolol Stimulants Atypical Antipsychotics Synthroid Anticonvulsants
