Week 5.4: Psychiatric Perspectives Flashcards
Drugs that help alleviate symptoms of depression.
Antidepressants
Medications used alongside antidepressants to enhance their effect.
Augmenting Drugs
Bright Light Therapy: Effective for Seasonal Affective Disorder (SAD) and non-seasonal affective disorders.
Phototherapy
What are examples of neurostimulation approaches to mood disorders?
Electroconvulsive Therapy (ECT): Uses electrical currents to treat severe depression.
Deep Brain Stimulation (DBS): Involves implanting electrodes in the brain.
Vagal Nerve Stimulation (VNS): Originally for epilepsy, now used for depression.
Repetitive Transcranial Magnetic Stimulation (rTMS): Uses magnetic fields to stimulate brain areas.
Derived from other medical areas (e.g., tuberculosis drugs, epilepsy treatments).
Antidepressants, anticonvulsants, and antipsychotics
Reduction of symptoms below a certain level.
Rating Scales:
HAM-D (Hamilton Depression Rating Scale)
MADRS (Montgomery-Asberg Depression Rating Scale)
QIDS-SR (Quick Inventory of Depressive Symptomatology - Self-Report)
Remission
What is the goal of depression?
Remission
Low levels of symptoms remaining after treatment.
Can predict poorer treatment outcomes and higher relapse rates.
Residual Symptoms
Found that even mild residual symptoms after treatment can lead to early relapse.
Professor Judd’s Study
A landmark study led by Professor John Rush in the early 2000s in the U.S.
Purpose: To find the best treatment strategies for depression through a multi-level approach.
STAR*D Study (Sequence Treatment Alternatives to Relieve Depression)
What are the Treatment Levels in STAR*D?
Level 1: Initial treatment with the SSRI citalopram.
Level 2: Options to switch to other antidepressants, cognitive therapy, or augment with other treatments.
Level 2A: Alternative for those receiving cognitive therapy in Level 2, with the possibility of switching antidepressants.
Level 3: Further treatments, including lithium or triiodothyronine.
Level 4: Includes tranylcypromine or mirtazapine combined with venlafaxine.
What are the recommendations if Remission is not achieved?
Revisit Diagnosis: Ensure the diagnosis is accurate.
Examine Adherence: Check if the patient is following the treatment plan.
Medication Adjustments:
Increase dosage.
Change treatment.
Augment with other medications.
What is the relationship between remission and relapse?
If a patient does not achieve full remission, they are at a higher risk of relapse.
Conversely, achieving full remission reduces the risk of relapse.
The presence of residual symptoms (symptoms that remain even after treatment) can make a patient more vulnerable to relapse. These lingering symptoms can indicate that the underlying issues of depression are not fully resolved, making it easier for the depression to return.
What are the next-step drug treatment options?
Dose Increase
Switching Antidepressants
Augmenting Treatment
Combination Treatment
What are the considerations in switching antidepressants?
When to Consider: If there are troublesome side effects or no improvement.
Process: Can be done quickly unless there are potential drug interactions or discontinuation effects.
Within or Between Classes: Initially, switch within the same class; after multiple failures, switch to a different class (e.g., from SSRIs to SNRIs).
When should dose increase be considered?
Should be considered if there are minimal side effects and some improvement on the current antidepressant.
When should you consider augmenting treatment?
If there is partial or insufficient response but good tolerability.
May not always be more effective; individual responses vary.
Combination Treatment
Examples: Quetiapine, aripiprazole, risperidone, olanzapine.
Purpose: Added to antidepressants to enhance their effect.
Atypical Antipsychotics
Type: Monovalent cation.
Evidence: Strong evidence supporting its use for augmentation.
Lithium
What are the considerations with Lithium to augment antidepressants?
When lithium is used to augment antidepressants, its effectiveness depends on maintaining the right amount of lithium in the blood.
Normal Range: The “normal range” for lithium in the blood is at least 0.6 millimoles per litre.
What are Physical Treatment Options for Multiply Treatment-Resistant Patients?
Electroconvulsive Therapy (ECT)
Transcranial Direct Current Stimulation (tDCS)
Repetitive Transcranial Magnetic Stimulation (rTMS)
Vagus Nerve Stimulation (VNS)
Deep-Brain Stimulation (DBS)
Ablative Neurosurgery
