Mood Disorders and Antidepressants

Question 1

What are mood disorders?

Answer 1

Abnormal elevation or lowering of mood, including conditions like depression and mania.

Question 2

What is the lifetime prevalence of Major Depressive Disorder (MDD)?

Answer 2

5%, affecting ~1 in 38 adults in the UK at any one time.

Question 3

What are the core symptoms of MDD according to DSM-5?

Answer 3

Depressed mood or anhedonia (loss of interest/pleasure)

Question 4

Name additional DSM-5 symptoms required for an MDD diagnosis (at least 4).

Answer 4

• Weight/appetite changes.
• Insomnia/hypersomnia.
• Fatigue or loss of energy.
• Worthlessness or guilt.
• Difficulty concentrating.
• Thoughts of death or suicide.

Question 5

What is Persistent Depressive Disorder (Dysthymia)?

Answer 5

Chronic depression with depressed mood lasting at least 2 years and 2 additional symptoms (e.g., fatigue, low self esteem).

Question 6

What are the types of bipolar disorder?

Answer 6

Bipolar I: At least one manic or mixed episode.

Bipolar II: Major depressive episode + hypomania.

Cyclothymia: Chronic mood swings for ≥2 years.

Question 7

What is the monoamine hypothesis of depression?

Answer 7

Depression in caused by a functional deficit of serotonin (5HT), noradrenaline (NA), and/or dopamine (DA) in the brain.

Question 8

Name 3 key neurotransmitters implicated in mood disorders.

Answer 8

Serotonin (5HT), noradrenaline (NA), and dopamine (DA).

Question 9

What are the proposed mechanisms causing mood disorders?

Answer 9

• Genetic factors
• Endocrine disruption (HPA axis).
• Neuroinflammation.
• Monoamine imbalances.

Question 10

What are Monoamine Oxidase Inhibitors (MAOIs), and how do they work?

Answer 10

Antidepressants that inhibit monoamine breakdown by blocking MAO-A (5HT) and MAO-B (DA).

Question 11

What is the “cheese reaction” with MAOIs?

Answer 11

A hypertensive crisis triggered by consuming tyramine-rich foods (e.g., aged cheese) while on MAOIs

Question 12

What are Tricylic Antidepressants (TCAs), and how do they work?

Answer 12

Antidepressants that block the reuptake of serotonin (5HT) and noradrenaline (NA), increasing their levels.

Question 13

Name common side effects of TCAs

Answer 13

• Sedation
• Antimuscarinic effects (e.g., dry mouth).
• Cardia arrhythmias

Question 14

What are SSRIs, and why are they commonly used?

Answer 14

Selective Serotonin Reuptake Inhibitors that increase serotonin levels. They are safer and better tolerated than older antidepressants.

Question 15

Name example of SSRIs

Answer 15

Fluoxetine (Prozac), Paroxetine, Citalopram

Question 16

What is Ketamine’s role in depression treatment?

Answer 16

An NMDA receptor antagonist used for rapid relied in treatment-resistant depression.

Question 17

What is the gold standard treatment for bipolar disorder?

Answer 17

Lithium, used prophylactically to prevent depressive and manic episodes.

Question 18

What are the side effects of Lithium?

Answer 18

• Polyuria, weight gain, tremor, nausea.
• Nephrotoxicity and hypothyroidism

Question 19

Name anticonvulsants used as mood stabilisers in bipolar disorder.

Answer 19

Valproate, Lamotrigine.

Question 20

What is Electroconvulsive Therapy (ECT), and when is it use?

Answer 20

ECT induces seizures to treat severe depression, especially in treatment-resistant cases or depression with psychotic features.

Question 21

Name limitations of antidepressants

Answer 21

• Delayed onset (4-6 weeks)
• <40% remission rates.
• Side effects: e.g., emotional blunting with SSRIs

Question 22

What are atypical antidepressants?

Answer 22

• Mirtazapine: Blocks α2 and 5HT receptors.
• Bupropion: Blocks NA/DA reuptake.

Question 23

What are common non-pharmacological treatments for depression?

Answer 23

Cognitive Behavioural Therapy (CBT).

Mindfulness-Based Cognitive Therapy (MBCT)

Question 24

What is the therapeutic range for lithium?

Answer 24

0.4 mmol/L to 1.0mmol/L