Treatment of Mood Disorders

Question 1

how can you measure if a treatment is working

Answer 1

Scales - self report and objective

Quick inventory of depressive symptomatology - self reported

hospital anxiety and depression scale

montomary-asberg rating scale - observer rates scale, v sensitive to change

Question 2

what are the top 4 antidepressants

Answer 2

Escitalopram - best SSRI

Sertaline

Mirtazapine - promotes sleep and weight gain

Venlafaxine - associated with higher rate of adverse effects - good dose response relationship

Question 3

what are some reasons why antidepressants won’t work

Answer 3

not taking them 
wrong diagnosis 
substance misuse 
physical illness 
address any predisposing, precipitating and prolonging factors

Question 4

what should you do if antidepressants don’t seem to be working

Answer 4

Increase Dose
Swap to another one
Combine - most common SSRI/SNRI plutons mirtazapine
Augment - antipsychotic or lithium first

Question 5

how do you prevent a depression relapse for someone already on antidepressants

Answer 5

if 1st episode - continue antidepressants for at least 6 months after recovery without reducing dose

2nd episode or more - continue antidepressant for at least 1-2 years after full recover without reducing dose

consider psychological therapies
discuss lifestyle factors
discuss lack of addictive nature

Question 6

what should you do before starting antidepressants

Answer 6

get rating of depressive symptoms before and after each trial

warn patients of possible effects and probability that they will be transient

review after 1-2 weeks

ensure adequate dose for adequate time

Question 7

how to treat acute mania

Answer 7

Maximise antimanic medication dose
Stop antidepressants
Give antipsychotic
-ilanzapine, quetiapine or risperidone

Question 8

how to treat acute bipolar depression

Answer 8

Antidepressants should not be prescribed without an antimanic drug

Avoid antidepressants in those with a recent manic/hypomanic episode or history of rapid cycling

SSRIs preferable to other classes

Question 9

what is first line for bipolar depression prescribing

Answer 9

Antipsychotic - 1st line
Antidepressant - used with antipsychotic
ECT
Lithium

Question 10

what is the guidance for prescribing antidepressants

Answer 10

Try SSRI (first line) 
if doesn't work try different SSRI 
if doesn't work switch calls

Question 11

what are the 3 main classes of antidepressants

Answer 11

SSRIs
Tricyclics
MAIOs

Question 12

What’s an example of some good SSRIs

Answer 12

Escitalopram

Sertraline

Question 13

wha’s an example of some tricyclics

Answer 13

Amitriptyline
Imipramine
clomipramine

Question 14

what’s an example of some MAIOs

Answer 14

isocarboxazid

tranycypromine

Question 15

what is the first line mood stabiliser used for bipolar disorder

Answer 15

Lithium

Question 16

what are common side effects of lithium

Answer 16

dry mouth 
dizziness 
hypotension 
polyuria 
weight gain 
hypothyroid 
goitre 
loads of others

Question 17

what are the signs of lithium toxicity

Answer 17

Vomiting
Diarrhoea
Drowsiness
Coma

Question 18

what needs to be monitored when on lithium therapy

Answer 18

lithium levels
kidney function
thyroid function
calcium levels

Question 19

what drug should be given if lithium is ineffective or not tolerated

Answer 19

Sodium Valporate

Give carbamazepine instead if young women (not teratogenic)

Question 20

what is ECT

Answer 20

electroconvulsive therapy

Question 21

when is ECT used

Answer 21

As a last resort in severe depression and bipolar (and others)

gives an electric shock to the brain to induce seizure activity lasting 15-20 seconds

there is a quick recovery

Question 22

how does ECT effect the brain

Answer 22

Modulates monoamines
Potent anticonvulsant effect
Reduces hyper connectivity in frontal and limbic circuits
Bolsters neuronal survival
Promotes production of new neuronal processes in areas involving cognitive and emotional function