Mood Disorders Flashcards
MDD symptoms: SIGECAPS
S: sleep (insomnia or hypersomnia)
I: interest (decreased)
G: guilt (feelings of worthlessness or guilt)
E: energy loss of fatigue
C: concentration (diminished ability to think, indecisiveness)
A: appetite (changes with significant weight gain or loss)
P: psychomotor agitation or retardation
S: suicidality or recurrent thoughts of death
Major depressive episode criteria
5 or more symptoms > 2 weeks
Change from previous episode
Causing significant distress or impairment in social or work function
Depressed mood and/or loss of interest or pleasure has to be at least 1 of the symptoms
MDD criteria
1 or more MDEs
No mania or hypomania
Recurrent episodes requires > 2 months symptoms remission
Persistent Depressive Disorder
Depressed mood, most of the day, most days (dysthymia)
For at least 2 years
During this period, symptoms ceased for less than 2 months
While depressed, 2 or more symptoms (poor appetite/over eating, insomnia or hypersomnia, low energy or fatigue, low self esteem, poor concentration and indecisive, feelings of hopelessness)
Longer, milder and higher functioning than MDD
4 steps in the cognitive depression cycle
Negative stressful events
Pessimistic explanatory style
Hopelessness depressed state
Cognitive and behavioural changes
Factors to consider in selecting an antidepressant
Efficacy Tolerability Drug interactions and safety Simplicity of use Previous meds and response Comorbidity Patient preference Cost
Common and less serious side effects of antidepressants
Headache Nausea Constipation and diarrhea Insomnia or sedation Anxiety/agitation (Sexual side effects, dry mouth)
Uncommon and more serious side effects of antidepressants
Hyponatremia
Falls and fractures
Risk GI bleed
Suicidality
How long should you stay on anti depressants after symptom remission?
9 months
Bipolar type 1
Manic episode
Depression not required
Marked or severe impairment in functioning
Not due to drugs or substances
Bipolar type 2
Hypomanic episode (>4 days)
Major depressive episode
Not marked or severe impairment in functioning
Not due to drugs or substances
Manic episode definition
A distinct period of abnormally and persistently elevated, expansive, or irritable mood
And abnormally and persistently increased goal-directed activity or energy lasting at least 1 week (or any duration if hospitalization is needed)
And 3+ symptoms (inflated self esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, increased risky behaviours)
Psychosis may be present
Bipolar 2 definition
At least 1 hypomanic episode
And at least 1 major depressive episode
There has never been a manic episode
Distress or impairment is not marked or severe
Lithium
Mood stabilizer
Anti-suicidal effects
Li side effects
Polyuria, polydipsia Tremor Diarrhea, nausea Hypothyroidism Renal dysfunction Leukocytosis Acne, rash, alopecia Edema Sedation Ataxia Dysarthria Delirium
