Week 3 - Depression and Bipolar Disorder Flashcards
Uniploar depression or MDD clinical background
- mood swings in the SAME diraction (always downwards)
- stress can trigger
- 25% genetic
Bipolar depression clinical background
- swings of mania and depression
- hereditary
MDD clinical symptoms and classfications
term used to decrive the degree of depression that interferes with daily functioning
- symptoms last at least 2 weeks
lethargy
depressed mood
loss of interest
weight loss, appetite loss
insomnia
feelings of unworthlessness
suicidial ideation
MDD Pathophysiology
Neuronal connectivity is altered in brain regions affecting mood and activity
- imbalance between BDNF and glutaminergic activity
- alterations in melatonin and cortisol –> reduced size of hippocampus which dictates mood
MDD threatment
Should ALWAYS include:
- LIFESTYLE: reducing stress, healthy diet and exercise
- CBT: cognitive behavioural therapy
- ceasing illicit drugs and alcohol
very INDIVIDUALISED
- history of sucess/failure with treatments
- concurrent illness
- other medications
- likelihood of deliberate overdoes
- tolerability of ADRs
MDD Pharmacotherapy
TCAS
SSRIs
SNRIs
Non-selective MAO-Is
MDD : TCAs
tricylic antidepressents:
block presynaptic reuptake of 5HT, NA and DA,
block receptors in periphery, leading to unwanted effects:
- dry mouth
- blurred vision
- constipation
- confusion
- reduced seizure threshold
- weight gain
toxic and fatal in overdose (not given if high risk of suicide)
DRUGS: amitriptyline, imipramine, nortiptyline
MDD: SSRIs
Selective serotonin reuptake inhibitors
- selectively block presynaptic reupatake of 5HT
- hyponatremia can occur, esp in elderly
- can be toxic in overdose but not as bad as TCAs
DRUGS: citalopram, fluoxtenine and sertraline
MDD: SNRIs
Serotonin and noradrenaline reuptake inhibitors
- block the presynaptic reuptake of both 5HT and NA
- due to blocking NA has more cardiac ADRs
- not associated with weight gain
DRUGS: venlafaxine, desvenlafaxine and duloxetineN
MDD: Non-selective MAO-Is
NON-SELECTIVE and IRREVERSIBLE: block MAO-A and MAO-B from breaking down 5HT, NA, adrenaline and DA
- last line
- not to be used in: diabetes, heart disease, epilepsy
- interacts with many drugs
- weight gain, sleep disturbance, impotence are all common
DRUGS: phenelzine, tranylcypromine
How long does drugs for MDD take to work
- 2-3 weeks to start seeing any difference
- 6+ to see full effect
things seem worse before they get better - suicidal ideation often INCREASES in first weeks (support and non-drug therapy is so important)
patients cannot stop them as soon as they feel better - relapses
Biploar clinical symptoms
expansive and irritable mood
inflated self esteem
decreased need for sleep
rapid, loud sleep
rapid, loud speech
impulsive thoughts/inability to concenrate
agression/violence
peak onset is in early adulthood
caused by drug therapy
Bipolar treatment
most treated with antidepressants with the same 1st line options as for MDD - must be monitored very closely
- CBT and ECT are also very efficacious
QUETIAPINE - first line, blocks DA transmission in the brain, controls both depression AND mania
Prophylaxis
patients who have had 2 or more episodes or whose first episode was severe
narrow therapeutic window and MUST be Monitored
not for patients with thryoid issues, psoriasis, renal impariment
wight gain
skin problems
memory impairment
