Mood Disorders Flashcards
Depression Dx
5/9 symptoms (1 must be anhedonia) for 2+ weeks :
Sleep changes, Interest↓ (anhedonia), Guild, Energy↓, Concentration problems, Appetite changes, Psychomotor retardation or agitation, Suicide
Dysthymia Dx
3/9 symptoms for 2+ years (cannot have gone more than 2mo w/o symptoms)
Physiologic cause of depression
↓NE, ↓serotonin, ↓DA d/t post-synaptic receptor problem
Mania Dx
euphoric mood for 1+ week + 3 DIGFAST symptoms (distractibility, irresponsibility, grandiosity, flight of ideas, activity↑/agitation, sleep↓, thoughtlessness/talkativeness)
Hypomania Dx
euphoric mood for 4days - less severe, no psychosis
Bipolar Type I Dx
1 manic episode (+/- MDD)
Bipolar Type II Dx
Hypomania + MDD
Cyclothymic Disorder
mild depression + mild hypomania that lasts 2+ years
NT associated w/ mania, psychosis, euphoria, etc
high DA & NE & low Serotonin
Atypical depression
mood reactivity + hypersomnia + over-eating/weight gain
Peripartum depression
onset w/in 4 weeks of delivery , lasts >10d (postpartum blues <10d)
Recurrent Depression
period of 2mo rest with NO depressive symptoms
Seasonal affective disorder
2+ years with 2 major depressive episodes showing temporal association & no non-seasonal depression
MDD Neuroanatomy
Left prefrontal cortex w/ decreased BF
Bipolar Neuroanatomy
Right prefrontal cortex w/ decreased BF
Neuroanatomy of MDD & Bipolar
high amygdala activity, low cingulate gyrus & hippocampus activity (high cortisol)
Cognitive distortions
all or nothing thinking, over-generalization, magnification, jumping to conclusions
Diathesis-Stress Model
Biological component (predisposition) + Stressor (environment shapes it)
Depression Tx
- SSRI (MDD w/ atypical)
- SNRI (MDD w/ melancholy, diabetic peripheral neuropathy)
- TCA (MDD w/ melancholy)
- MAO-I
Tri-C Syndrome
TCA S/E (convulsion, coma, cardiac arrhythmias)
TCA S/E
Tri-C Syndrome, Orthostatic hypotension, anticholinergic effects
Which TCA is very sedating
Amitriptyline
Which TCA is less sedative, but higher risk for seizures?
Desipramine
Which TCA is preferred by elderly?
Nortriptyline
Hypertensive crisis (w/ ingestion of tyramine)?
MAO-I - risk of stroke/MI/arrhythmia
tranylcypromine, phenelzine, isocarboxazid, slegiline
MAO-I
What drug can not be mixed with SSRIs & TCAs d/t excessive Serotonin risk?
MAO-I (2wk break b/w)
Non-responders for MDD Tx
SSRIs: + SSRI + lithium + thyroid + bupropion
MDD Tx length
6 months and then taper gradually over 1-2 weeks
Options for non-seponders
vagal n. stimulation, transcranial magnetic stimulation, ECT (last line)
Bipolar
- Lithium (acute & long-term)
- Anticonvulsants (rapid cyclers)
- Atypical antipsychotics (acute)
Lithium S/E
hypothyroidism, renal dysfunction, seizures, tremors, nephrogenic diabetes insipidus, teratogenic
Anticonvulsant Valproate S/E
hepatic failure, pancreatitis
Anticonvulsant Carbamazepine S/E
rash
Clozapine S/E
Agranulocytosis
Bipolar: Acute Manic Phase Tx
Lithium +
Oxcarbazepine or valproate +/- benzo
Bipolar: Acute Depressive Phase Tx
Lamotrigine +
Antidepressant + atypical antipsychotic
Bipolar Maintenance:
Lithium, Carbamazepine, Valproate, Lamotrigine
Suicide risk is most related to
degree of hopelessness
A depressive episode is not required in which of the following?
Bipolar Type I
Which antidepressant has a mechanism of action as an α2-receptor antagonist?
Mirtazapine
Which agent is best known to have SE of decreasing thyroid function?
Lithium
Drug with significant α1 receptor antagonism, causing orthostatic hypotension?
Imipramine
