Treatments for Mood Disorders: So-Called 'Antidepressants' and 'Mood Stabilizers'

Question 1

DSM-5 Criteria for MDD (unipolar depression)

Answer 1

5 or more of the following symptoms (including at least 1 depressed mood and loss of interest or pleasure) in the same 2-week period; each of these represents a change from previous functioning:
-Depressed mood (subjective or observed)
-Loss of interest or pleasure
-Change in weight or appetite
-Insomnia or hypersomnia
-Psychomotor retardation or agitation (observed)
-Loss of energy or fatigue
-Worthless or guilt
-Impaired concentration or indecisiveness
-Thoughts of death or suicidal ideation or suicide attempt

Question 2

DSM-5 Criteria for Persistent Depressive Disorder (PDD)

Answer 2

Depressed mood for most of the day, for more days than not, for 2 years or longer
Presence of 2 or more of the following during the same period:
-Poor appetite or overeating
-Insomnia or hypersomnia
-Low energy or fatigue
-Low self-esteem
-Impaired concentration or indecisiveness
-Hopelessness
Never without symptoms for more than 2 months

Question 3

Pharmacological treatment in depression. Response? Remission? Relapse?

Answer 3

Response: for patients with a disorder who receive treatment and improve to the level of 50% reduction of symptoms (previously the goal of treatment)
Remission: no symptoms for first several months and no relapse shortly after remission (current goal of treatment)
Relapse: when depression returns before there is a full remission of symptoms or within the first several months following remission of symptoms

Question 4

Major Depressive Disorder SIGECAPS

Answer 4

Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor Agitation/Retardation
Suicide
5 or more of the above symptoms must be present within a 2 week time period to diagnose.
Symptoms MUST interfere with social, occupational, OR interpersonal functioning.
Cannot be accounted for by another psychiatric disorder.
No past manic or hypomanic episodes
(Mania = at least 7 days; Hypomania = at least 4 days)

Question 5

Underlying Bipolar? DIGFAST

Answer 5

Distractibility
Indiscretion
Grandiosity
Flight of Ideas
Activities Increase
Sleep Deficit
Talkativeness
-If having these ^ symptoms in response to antidepressant treatment (or in general), may indicate underlying bipolar disorder

Question 6

SSRIs (list drugs)

Answer 6

Citalopram
Escitalopram
Paroxetine
Sertraline
Fluoxetine
Fluvoxamine

Question 7

Sertraline (prescriber notes)

Answer 7

Brand name: Zoloft
Best tolerated, best choice for pregnancy
SSRI

Question 8

Escitalopram (prescriber notes)

Answer 8

Brand name: Lexapro
Fewest adverse effects
SSRI

Question 9

Fluoxetine (prescriber notes)

Answer 9

Brand name: Prozac
Best for children 8+ and adolescents; longest half-life; can give weak dose (90mg once weekly after starting on daily dose); good for forgetful/noncompliant patients
SSRI

Question 10

Citalopram (prescriber notes)

Answer 10

Brand name: Celexa
Adverse effects = prolonging QT interval (–>abnormal heart rhythms; sudden cardiac death); AVOID IF CARDIAC HISTORY; limit dose to 40mg daily, in patients 60+ limit to 20mg daily
SSRI

Question 11

Paroxetine (prescriber notes)

Answer 11

Brand name: Paxil
Highest amount of adverse effects in SSRI class; worst sexual side effects; can treat premature ejaculation
SSRI
(Add wellbutrin (low and slow!) to reduce sexual side effects, can increase risk for serotonin toxicitiy)

Question 12

Fluvoxamine (prescriber notes)

Answer 12

Brand name: Luvox
used mostly for OCD
SSRI

Question 13

Serotonin Syndrome (Serotonin Toxicity)

Answer 13

Start with and escalates to :
1)Diarrhea/restlessness
2)Mydriasis (dilated pupils), Diaphoresis, HTN, tachycardia
3)Extreme agitation, tremor, rigidity, increased reflexes
4)Autonomic instability, hyperthermia, delirium, seizures
5)coma, respiratory failure, renal failure, death
Educate patient on early signs and when to call office

Question 14

First line treatments for MDD

Answer 14

SSRIs, SNRIs, Bupropion (Wellbutrin), Mirtazapine (Remeron)

Question 15

SNRIs (list drugs)

Answer 15

Duloxetine (Cymbalta)
Venlafaxine (Effexor)
Desvenlafaxine (Pristiq)
-Inhibit reuptake of both 5HT and NE
-AVOID IN PATIENTS WITH ALCOHOLISM/LIVER DISEASE
-Monitor BP before starting treatment and throughout treatment

Question 16

SNRIs (prescriber notes)

Answer 16

-AVOID IN PATIENTS WITH ALCOHOLISM/LIVER DISEASE
-Monitor BP before starting treatment and throughout treatment
-If one SNRI results in sexual dysfunction –> all SNRIs will
-Transient adverse effects = nausea, bowel changes, dizziness, dry mouth, fatigue, and agitation