Week 7: Mood and Affect

Question 1

What would a person’s day be like with depression?

Answer 1

Low motivation + interests = low energy

Question 1

Define Mood Disorders

Answer 1

Recurrent disturbances or alterations in mood that cause psychological stress and behavioural impairment

Question 2

What are the key diagnostic criteria for Major Depressive Disorder?

Answer 2

At least a 2 week history of 5 or more of the symptoms – Symptoms represent a change from baseline

1.Depressed mood most of the day, nearly every day**
2.Markedly diminished interest/pleasure in activities most of the day, nearly every day**
3.Significant weight loss or weight gain/decreased appetite
4.Difficulty sleeping (insomnia or hypersomnia)
5.Psychomotor agitation or retardation – slow
6.Fatigue/loss of energy
7.Feelings of worthlessness or inappropriate guilt
8.Inability to concentrate or indecisiveness
9.Recurrent thoughts of death/suicide

** At least 1 of either depressed mood or loss of interest/pleasure MUST BE PRESENT for diagnosis

Question 3

What are the depressive symptoms in youth/teen?

Answer 3

*Irritable or Angry Mood
*“Acting Out” behaviors
*Unexplained aches and pains
*Extreme sensitivity to criticism
*Withdrawing from some, but not all people

Question 4

What are the depressive symptoms in older adults?

Answer 4

Common:
- focuses on physical health symptoms
- weight loss
- poor appetite
- anhedonia – loss of pleasure
- social isolation

Less common:
- depressed mood/ sadness/crying
- weight gain

Question 5

What is the etiology of MDD?

Answer 5

Disruption in the balance of neurotransmitters
E.g., Serotonin, norepinephrine, monoamine oxidase

Genetic vulnerability – Twin studies consistently show that genetic factors play a role in the development of depressive disorders.

Cognitive Distortions:
- Irrational beliefs - irrational thoughts leading to a depressive, negative “worldview”
- Distorted Attitudes
- Learned helplessness

Psychosocial Factors:
- Life Events/Life Circumstances – It is believed that psychosocial stressors and interpersonal events trigger neurophysical and neurochemical changes in the brain.
- Acute & chronic strains
- Perceptions of helplessness, and powerlessness – A person who believes that an undesired event is his or her fault and that nothing can be done to change it is prone to depression.

Question 6

What are the medications for Depression?

Answer 6

• SSRI’s* (Selective Serotonin Reuptake Inhibitors)
• SNRI’s (Serotonin Norepinephrine Reuptake Inhibitors
• NRI’s (Norepinephrine Reuptake Inhibitors
• NDRI’s (Norepinephrine Dopamine Reuptake Inhibitors
• SNDI’s (Serotonin-Norepinephrine Disihibitors
• TCA’s (Tricyclic Antidepressants)
• MAOI’s* (Monoamine Oxidase Inhibitors)

Question 7

What are the characteristics of antidepressant medications?

Answer 7

– act on neurotransmitters depending on which ones are affected

• Typically, slow to work (may take 4-6 weeks before anti-depressant effect seen)
• May see improvement in some symptoms (e.g., insomnia) within 2 weeks

Question 8

What are the characteristics of IV Ketamine tx?

Answer 8

• For treatment-resistant depression (off label use)
• Not a comprehensive treatment but used to augment a treatment plan
• In most cases medications/”boosters” will be required to sustain the effects
• Administered as an inpatient or as an outpatient
• Course is 8 treatments (2-3x/week) – low dose

Question 9

What are the SE of IV Ketamine?

Answer 9

dissociative Sx up to 4h
hallucinations
vivid / distressing dreams
N/V
increased saliva
dizziness
blurred visions