Mood Disorders II Flashcards
Depressive episode diagnostic criteria
Associations w/ development of depression
- Depression may follow CVA (post-stroke depression)
- Depression may follow MI (post-MI depression)
- Cancer patients at >3-4x risk for depression
Screening for depression
PHQ-2 and PHQ-9 are used to screen patients
Summary of depression pharmacology
Persistent Depressive Disorder (including Dysthymia)
Manic episode diagnostic criteria
Hyponamnic episode diagnostic criteria
Differential for mania
Types of bipolar
Peak age of onset for bipolar disorder
Age of Onset: peak late teens 15-19, retrospective report of significant childhood depression is common
Second peak between age 35-45
Before perscribing any antidepressant, you must ALWAYS . . .
. . . screen for a history of mania
You don’t want to make mania worse by treating depression with the wrong antidepressant
You should ask about:
- An uncharacteristic episode of increased energy or elevated/irritable mood
- Decreased need for sleep is most specific symptom
- FHx bipolar disorder
Summary of bipolar pharmacology
Premenstrual Dysphoric Disorder (PMDD) Summary
Substance/Medication-Induced Mood Disorder Summary
Mood Disorder due to Another Medical Condition Summary
Appetite disturbances in childhood may be marked by. . .
. . . failure to demonstrate expected weight gain, rather than weight loss
Another use for growth curves!
Disruptive Mood Dysregulation Disorder
Current state of the monoamine theory of depression
It is now believed that it is the downstream adaptation of the neuron to the increased levels of monoamines over time which results in the efficacy of SSRIs, SNRIs, MAOis, etc, not JUST the increase in levels of monoamines.
This argument is based on the notion that synaptic monoamine levels increase rapidly after taking these drugs, however they take weeks to months to have any effect, suggesting that the true therapeutic mechanism lies downstream of increasing monoamine levels.
Neuroplasticity hypothesis
That it is a lack of neural connection in the prefrontal cortex which causes depression, likely caused by excessive neural pruning.
Neuroendocrine hypothesis
Theory that depression represents a dysregulated response to psychosocial stress.
The HPA axis’s feedback is impaired, increasing cortisol levels and having downstream effects on limbic circuits.
Inflammation hypothesis
Considered an adendem to the neuroendocrine hypothesis.
Some patients w/ depression have elevated CRP even in the absence of illness. Depression patients with this elevated CRP have depression that responds to anti-inflammatories.
This may represent a subset of patients.
Role of 5HT1A receptor downregulation in the mechanism of action of SSRIs
When this receptor is stimulated it inhibits firing of serotonergic neurons, this means that it works as an autoreceptor that inhibits serotonergic activity.
As a response to serotonin stimulation, the serotonergic neuron downregulates 5HT1A receptors. This occurs over weeks, and has been proposed as the explanation of delayed monoamine antidepressant effects.
Thus, the neurons are disinhibited to release more serotonin in the synaptic space and to fire more frequently.
SERT
The serotonin transporter (SERT) is a monoamine transporter protein. This is a membrane protein that transports serotonin from synaptic spaces into presynaptic neurons.
It is the target of inhibition of SSRIs
BDNF
The neurotrophic hypothesis of depression proposes that depression is associated with reduced brain BDNF levels in the hippocampus. So, antidepressant treatments alleviate depressive symptoms and increase BDNF levels.
BDNF, in turn, upregulates neuronal mTOR, which then promotes the expression many other proteins, including glutamate receptors in the synaptic cleft.
Adjustment disorder
Not a psychiatric condition necessarily! This is often on the ddx for depression.
The DSM V got rid of the ___ with regards to MDD diagnosis, which places more emphasis on ___ when diagnosing depression.
The DSM V got rid of the bereavement exception with regards to MDD diagnosis, which places more emphasis on functional impairment when diagnosing depression.
Imortant side effects of lithium
- Tremors (HUGELY important for certain occupations)
- Nephrogenic diabetes insipidus
