Mood Disorders Flashcards
depressed mood, loss of interest, enjoyment, guilt, altered sleep and eating, suicidal thoguhts
- etiology: spontaneously, life events
- deficits in noradrenergic or sertotonergic neurotransmission
depression
- periods of depression alternating with periods of mania or hypomania
- increased activity, decreased need for sleep, racing thoughs, elevated mood or irritability, increased self esteem, grandiose ideation
- treat w/ mood stabilizing agents and antidepressants or antipsychotics as needed
bipolar disorder
- treatment of depressive symptoms resulting in euthymia
- should not elevate mood in non depressed people
- 4 classes: MAOIs, TCAs, SSRIs, miscellaneous
antidepressants
- increased synaptic availability of norepi and serotonin
- several wks of treatment required before max effects achieved
- ultimate effect due to secondary changes in receptors, increases in BDNF in hippocampus and its sequelae, cognitive changes
mechanism of antidepressants
phenelzine and tranylcypromine
MAOIs
increase synaptic availability of norepi and serotonin by blocking their catabolism, irreversibly inhibit a and b subtypes, used primarily in individuals not adequately treated by other antidepressants
MAOIs (phenelzine, tranycypromine)
- postural hypotension, weight gain, agitation, sexual dysfunction
- overdose can cause seizures, shock, delirium, hyperthermia, but not fatal
- potentiate the action of other sedatives such as alcohol
- drugs interactions, serotonin syndrome esp w/ SSRIs
- food interactions –> hypertensive crisis
- precautions for 2 wks because of irreversible inactivation
MAOIs overdose, side effects
amitriptyline, nortriptyline, clomipramine
tricyclic antidepressants
- inhibit the reuptake of norepi and serotonin at the NE and 5-HT transporters
- potent agonist of cholinergic, histaminergic and alpha adrenergic receptors
Tricyclic antidepressants
- sleepiness
- sympathomimetic (tremor, insomnia)
- anticholinergic
- orthostatic hypotension
- arrhythmias
- seizures, weight gain
- sexual dysfunction
- discontinuation syndrome
TCAs side effects
- suicide risk
- coma, respiratory depression, delirium
- arrhythmias
- seizures
- hyperpyrexia
- bowel and bladder dysfunction
- cardiac defects
- adverse interactions with MAOIs
TCAs
fluoxetine, sertraline, paroxetine, citalopram, escitalopram
SSRIs
inhibit serotonin reuptake, can inhibit reuptake of norepi at higher doses
SSRIs
- anxiety, insomnia
- sleepiness, fatigue
- tremor, GI symptoms
- rashes, weight loss or gain
- decreased libido
- sexual dysfunction
SSRIS
- low risk of fatal overdose
- discontinuation syndrome (with short half lives and antimuscarinic)
- adverse drug rxns with MAOIs –> serotonin syndrome
- CYP2D6 and 3A4 inhibitors
- active metabolites inhibit 2D6 and 3A4
- in pregnancy pulm HTN in newborn, enters breast milk
SSRIs
duloxetine, venlafaxine, desvenlafaxine, levomilnacipran
NE and 5-HT uptake inhibitors
maprotiline
NE uptake inhibitor
- serotonin uptake inhibitor
- 5HT1a partial agonist
- side effects: nausea, vomiting, constipation, insomnia
vilazodone
- serotonin uptake inhibitor
- 5HT3 antagonist and 5HT1a agonist
- n/v,constipation
vortioxetine
- increases 5HT and NE release by blocking alpha 2 receptors on nerve terminals
- sedating
mirtazepine
- inhibits dopamine reuptake as well as effects on 5HT and NE
- CNS stimulation, anxiety, agitation, insomnia, dizziness, sweating, aggravation of psychosis
- lower incidence of sexual dysfunction than with SSRIs
buproprion
- inhibits reuptake of5HT and NE
- dopamine antagonist, antipsychotic activity
- side effects similar to TCAs, but also EPAs and tardive dyskinesia
amoxapine
- sedating at subantidepressant doses
- 5HT2a antagonist
- weak inhibitor of NET and SERT
- very short half life
- used as hypnotic and pre-anesthetic
- PRIAPISM
trazodone
black box warning on antidepressants?
increase risk of suicidal thinking and behavior in children, adolescents, and young adults with MDD
may affect ion transport, serotonin system, PI cascade, arachidonic acid signaling
lithium
- absorbed rapidly but accumulates slowly in the brain
- therapeutic levels reached in 6-10 days
- > 95% excreted in urine
lithium
- low therapeutic index
- tremor most common (Treat with propanolol)
- thyroid enlargement
- polydipsia and polyuria –> nephrogenic diabetes insipidus
- EEG alterations
- leukocytosis
- edema, acne
lithium side effects
- overdose: tremor, nausea, vomiting, diarrhea, sedation
- severe: ataxia, confusion, coma, arrhythmias, hypotension, albuminuria, death
- contraindicated in renal or cardiovascular disease, teratogenic
lithium
