Mood Disorders Flashcards
Treatment for Atypical Depression
MAOIs are particularly useful
SSRIs may also be effective
Atypical Depression is marked by:
hypersomnia hyperphagia reactive mood leaden paralysis hhypersensitivity to interpersonal rejection
Seasonal Affective Disorder
At least 2 consecutive years of 2 MDD episodes during the same season in both years
*Winter is the most common Season
Triad for Seasonal Affective Disorder
Irritability
Carbohydrate Craving
Hypersomnia
Treatment for Seasonal Affective Disorder
Light Therapy
Standard Antidepressants
Preventative Therapy with Extended Release Bupropion
Rapid Cycling Specifier for mood disorders
Have had at least 4 major episodes of MD, manic, hypomanic or mixed episodes during the past 12 months
What kinds of drugs worsen depression?
Reserpine: depletes monoamines
Used as antihypertensive and antipsychotic by blocking NE to decrease BP or agitation
Tachyphylaxis
Used to describe a patient as Treatment refractory for depression
Selegiline
MAOI that inhibits MAO-B, unlike other MAOIs that inhibit MAO-A
At low doses or with transdermal patch, patient does not need to have diet restrictions to tyramine
Important Reaction with MAOI use
Tyramine Crisis: from consumption of cheese, wines, smoked meats, liver
Leads to hypertensive crisis, stroke, and death
Treatment for tyramine hypertensive crisis
IV phentolamine (5mg) alpha blockers
**PTs with difficult access to care should carry 10mg tablets of nifedipine (alpha blocking properties to decrease BP)
What medication should be discontinued prior to ECT?
Benzodiazepines
In ECT seizure should last
30-90 seconds
In ECT, if seizure lasts longer than 2 minutes what should be done?
Terminate seizure with IV Lorazepam (1-2mg)
Most troublesome long term side effect of ECT
Memory Impairment: Anterograde and Retrograde Amnesia
PTs with mixed episodes of mania have a poorer response to ________ so consider using _______
Poorer response to Lithium
Consider anticonvulsants
What population of patients are at very high risk for developing depression?
Stroke Patients
Pancreatic Cancer also has a high association with depression
The Elderly
What are the two most common kinds of sleep disturbances associated with depression?
Initial insomnia: difficulty falling asleep
Terminal insomnia: early morning awkenings
What childhood factor is associated with the later development of depression?
Loss of a parent before the age of 11
How long does it take for antidepressants to start working?
Usually 4-8 weeks, this should be the trial period
What is Serotonin Syndrome?
Marked by autonomic instability, hyperthermia, and seizures
Can progress to rhabdomyolysis, renal failure, coma and death
*Risk factor is combo of MAOI and SSRI, or not allowing sufficient tapering time between switching from SSRI to MAOI and vice versa
MDD with melancholic features
Anhedonia Early morning wakening psychomotor disturbance excessive guilt aonrexia
*40-60% of hospitlized MDD patients
MDD with Catatonic features
Catalepsy Purposeless motor activity Extreme negativism or mutism Bizarre postures Echolalia
MDD with psychotic features
Characterized by presence of delusions or hallucinations
May be mood congruent or incongruent
*10-25 % of hospitalized MDD patients
