week 4 mood disorders- depression Flashcards
what are the type of mood disorders?
- Major Depressive Disorder (MDD)
- Bipolar I Disorder
- Bipolar II Disorder
- Persistent Depressive Disorder (Dysthymia)
- Cyclothymic Disorder
- Premenstrual Dysphoric Disorder
mood disorders- neurobiology
-genes
-psychosocial adversity in childhood
-ongoing or recent psychosocial stress
-norephinephrine
-serotonin
-dopamine
Major Depressive Disorder: Diagnostic Criteria
Diagnostic Criteria: Major Depressive Disorder
The individual must be experiencing five or more symptoms during a 2 week period at at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure in the same 2-week period
❑ Depressed mood
❑ Loss of interest/pleasure
❑ Weight loss or gain
❑ Insomnia or hypersomnia
❑ Psychomotor agitation or retardation
❑ Fatigue
❑ Feeling worthless or excessive/inappropriate guilt ❑ Decreased concentration
❑ Thoughts of death/suicide
❑ Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
❑ Episode not attributable to physiological effects of a substance or another medical condition
❑ Episode not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other psychotic disorder
❑ No history of manic or hypomanic episode
Depression: Pharmacotherapeutic Interventions: Antidepressants
Increase activity of neurotransmitters in the brain which help to lessen the symptoms of depression
- Dopamine
- Norepinephrine * Seratonin
- Work best when combined with psychotherapy, social support and self care
- Two in three people with MDD eventually achieve lasting symptom remission with conventional antidepressants and therapy
Depression: Pharmacotherapeutic Interventions: Antidepressants
- Increase activity of neurotransmitters in the brain which help to lessen the symptoms of depression and anxiety
- Work best when combined with psychotherapy, social support and self care
dopamine
-influences decision making
-influences motivation
-influences arousal
-signals pleasure and reward
norepinephrine
-influences alertness
-influences motor function
-regulates blood pressure
-regulates heart rate
serotonin
-regulates mood
-regulates appetite
-regulates sleep
-regulates social behaviour
-regulates sexual desire
Side Effects of Antidepressant Medications by Class
SSRI
Nausea, vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation, decrease in sexual desire and response
Side Effects of Antidepressant Medications by Class
SNRI
Nausea, drowsiness, dizziness, nervousness, fatigue, loss of appetite, decrease in sexual desire and response, increase in blood pressure
Side Effects of Antidepressant Medications by Class
NON-SELECTIVE CYCLICS
Dry mouth, tremors, constipation, sedation, blurred vision, difficulty urinating, weight gain, dizziness,
Side Effects of Antidepressant Medications by Class
MAOI
Orthostatic hypotension, insomnia, swelling, weight gain
Side Effects of Antidepressant Medications by Class
NDRI
Jitteriness, insomnia
Side Effects of Antidepressant Medications by Class
NaSSA
Drowsiness, weight gain
Bipolar
2 TYPES
Type 1
* Manic Episodes
* Distinct period(s) elevated mood + energy
Type 2
* Depressive Episodes
* Hypo-Mania
Bipolar I Disorder: Diagnostic Criteria (DSM-5, APA)
❑ Distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day
❑ During the period of mood disturbance and increased energy or activity 3 or more of the following symptoms
❑ Inflated self-esteem or grandiosity
❑ Decreased need for sleep
❑ More talkative than usual or pressure to keep talking
❑ Flight of ideas or subjective experience that thoughts are racing
❑ Distractibility
❑ Increase in goal-directed activity
❑ Excessive involvement in activities that have a high potential for painful consequences
-The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features
❑ The episode is not attributable to the physiological effects of a substance
Bipolar II Disorder: Diagnostic Criteria (DSM-5, APA)
Criteria have been met for at least one hypomanic episode or at least one major depressive episode
❑ There has never been a manic episode
❑ The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorder
❑ The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomanic cause clinically significant distress or impairment in social, occupational or other important areas of functioning
Bipolar I and Bipolar II Disorders: Pharmacotherapeutic Interventions: Mood Stabilizers
naturally occurring
-Lithium
ANTICONVULSANTS
Carbamazepine (Tegretol)
Divalproex (Epival)
Lamotrigine Lamictal)
ADJUNCTIVE ANTICONVULSANTS
Gabapentin (Neurontin)
Topiramate (Topamax)
LITHIUM
*Common side effects include Increased thirst and urination, nausea, weight gain, fine trembling of the hands
*Less common side effects can include tiredness, vomiting and diarrhea, blurred vision, impaired memory, difficulty concentrating, skin changes, slight muscle weakness, thyroid and kidney function changes
DIVALPROEX/VALPROIC ACID/VALPROATE
*Common side effects include drowsiness, dizziness, nausea and blurred vision
*Lesson common side effects are vomiting, mild ramps, muscle tremor, mild hair loss, weight gain, bruising or bleeding, liver problems , changes in menstrual cycle in people who identify as women
CARBAMAZEPINE
*Common side effects include dizziness, drowsiness, blurred vision, confusion, muscle tremor, nausea, vomiting or mild cramps, increased sensitivity to sun, skin sensitivity and rashes and poor coordination
*A rare but dangerous side effect is reduced blood cell counts, soreness of the mouth, gums or throat, mouth ulcers or sores and fever or flu like symptoms can be a side of this effect
LAMOTRIGINE
Common side effects include fever, dizziness, drowsiness, blurred vision, nausea, vomiting or mild cramps, headache and skin rash
*A rare but dangerous side effect is a severe skin rash
Mood Disorders: Non-Pharmacological Interventions
Electroconvulsive Therapy (ECT)
An invasive treatment for severe mania, severe depression, treatment refractory depression, catatonia and treatment resistant schizophrenia
* Small electric currents are passed through the brain intentionally triggering a brief seizure while an individual is under anesthetic
* ECT brings about neurophysiological and neurochemical changes in the brain
* The procedure takes about 5 to 10 minutes, with added time for preparation and recovery
* The changes in brain chemistry can result in improvement after as few as 6 treatments
Mood Disorders: Non-Pharmacological Interventions
Electroconvulsive Therapy (ECT)
drawbacks and benefits
BENEFITS
* Mood stabilizing property is superior to pharmacotherapy for depressive episodes, manic episodes and mixed episodes in bipolar disorder
* Can return to usual activity a few hours after the procedure
* Can result in rapid symptom improvement
* Can be offered for inpatients and outpatients
DRAWBACKS
* Requires sedation with anesthesia in hospital
* May cause low mild transient side effects including confusion, retrograde amnesia, nausea, headache, jaw pain or muscle ache
* May cause medical complications associated with anesthesia
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