mood disorders Flashcards
biological factors/NT of depression
DECREASED NOREPINEPHRINE o Fewer β-adrenergic activity DECREASED SEROTONIN o Fewer 5HT activity DECREASED DOPAMINE o Fewer D1 activity
Biological Factors: Neurotransmitters- Mania
INCREASED DOPAMINE psychosis, hyperactivity
INCREASED NOREPINEPHRINE euphoria, grandiosity
DECREASED SEROTONIN
depression-mania mood swing (due to activation of other NT that are normally inhibited )
atypical paralysis
“leadened paralysis”
eating and sleeping MORE
can use buproprion
both buproprion and mirtazapine do not have ??
anti-libido side effects
mirtazapine
a2 antagonist
a2 limits NE release
SSRIs
Fluoxetine Paroxetine
Sertraline Citalopram
5-HT-specibic reuptake inhibitor
SSRIs SE
GI & Sex dysfunction Better tolerated than TCA or MAOIs
SNRIs
Venlafaxine
Duloxetine
TCAs have ??? effect
bad for who ??
anticholinergic effects
hallucinations, can worsen alzheimers, cognitive impairment, constipation, Tachycardia Urinary retention Dry mouth
Amitriptyline is the most
TCAs
3oAmitriptyline 3oImipramine 3oClomipramine
3oDoxepin 2oNortriptyline 2oDesipramine`
avoid foods rich in ?? when taking MAO-i
tyramine
not breaking down, can cause hypertensive crisis
risk of ?? with MAO-i and other antideps.
serotonin syndrome: 5HT syndrome with any drug that ↑ 5HT: hyperthermia, confusion, myoclonus, cardiovascular, diarrhea, seizures
can treat with antihistamine:
Cyproheptadine (5HT2 receptor antagonist)
bipolar tx: lithium
mood stabilizer
may supplement with anti-psych, benzo, etc
-interferes w. ibuprofen clearance
lithium SEs
Tremor, diabetes insipidus, Hypothyroidism, congenital abnormality Gastric distress, renal dysfunction
may want to use anticonvulsants instead
carbamazepine
bipolar (mood stabilizer)
diabetic neuropathy
trigeminal neuralgia
anti-epileptic
atypical antipsychotics
??
drugs that cause agranulocytosis
carbamazepine
clozapine
bipolar tx
need mood stabilizer along with antidepressant even when in depressed phase
-just antidep. may trigger manic episode
-some compound:
Symbyax is a bixed combination of
bluoxetine + olanzapine [antidepressant + atypical antipsychotic]
bipolar maintenance (greatest challenge)
-Lithium, carbamazepine, valproic acid
▫ (lithium in particular reduce suicide risk and relapse)
▫ Thyroid supplementation necessary for long-term
-lamotrigine: prophylactic antidepressant & mood stabilizing
treatment response
f. u 4-6 wks, 50% require modification
- fair-good: keep same dose
- partial: augment (SSRI (lithium + thyroid + buproprion + mirtazapine)
- no response: switch to a different class
- if not responsive to 2+ tx: “treatment-resistant”
what agent poor choice for old man due to a1 antagonism-->higher risk of falls? lithium bupropion excitalopram imipramine
imipramine
a 3 month supply of ??? could be lethal
TCA (i.e. amitriptyline)
-1 month is normal dose
it takes longer than ??? for SSRIs to start working
4–8 weeks
on highest dose SSRI (sertraline) and having weight gain, insomnia
add buproprion
for atypical depressant symptoms
pt on fluoxetine, lost 8 lbs, seeing some improvement
keep on tx, reevaluate in 1 month
bipolar pt taking 0.7 mEq/L lithium (0.6-1.2 mEq/L) and having continuing mania symptoms
increase lithium dose
-still on low end of range
-benzos can be added if agitation/anxiety if haven’t optimized lithium yet
hospitalized pt on max dose lithium, sleeping 2-3 hrs, making rude sexual coments, pacing, pressured speech
augment lithium w. antipsychotic
next best option: switch to carbamazepine
pt. with periods of intense sadness and anhedonia w. alternate periods of extreme mood elevation and energy bursts
should be on ??
fluoxetine and olanzapine
pt depressed for 6 mos and having trouble sleeping, good tx?
paroxetine
-is sedating
fluoxetine has opposite effect
pt. has mood swings and reckless behavior
has elevated BUN/Cr
has N/V etc
on lithium
taking citalopram and MAO-i at same time
serotonin syndrome
pt w. MDD but doesn’t want sexual dysfunction, should take
buproprion
pt slow moving and flat affect put on fluoxetine, showing greatly increased activity levels, flight of ideas, pressured sleep
medication precipitated a manic episode
pt w. biplar disorder, started on lithium, should order what tests before??
thyroid function, creatinine, pregnancy test
pulmonary function not affected
