Week 8: Mood disorders Flashcards
What is a mood disorder?
A mental health problem that primarily affects a person’s emotional state. A person may experience long periods of extreme happiness, extreme sadness or both
How long do symptoms need to be present for a person to be diagnosed with depression?
2 weeks
How many symptoms from the DSM5 do you need to be diagnosed with depression?
5 or more
What 4 things have to be occurring to be diagnosed with depression?
- Symptoms are causing clinically significant distress or impairment in social, occupational or other functioning
- Episode not caused by physiological effects, substances or medical condition
- Episode should not be explained by schizophrenia or psychotic disorders
- No history of manic or hyper manic episodes
Mild depression?
Some difficulty in concentrating in ordinary work and social activities but will not cease to function completely
Severe depression?
Unlikely that they will be able to continue with social, work or domestic activities
Explain the adverse life events and depression cycle
People who have gone through adverse life events are more likely to develop depression.
Can lead to more stress and dysfunction and make the life events worse, worsening depression
Depression and physical health?
There are interrelationships between depression and physical health
E.g CVD can lead to depression
What preventions have been used in elderly for depression?
Exercise programs
Postpartum depression?
Occurs during pregnancy or after delivery
Persistent depressive disorder (dysthymia)?
Chronic form lasting for at least 2 years
May occasionally lessen and worsen in severity during this time
Seasonal affective disorder (SAD)?
Occurs during certain seasons of the year.
Typically late autumn early winter until spring or summer
Psychotic depression?
Severe.
Often combined with psychotic episodes such as hallucinations or delusions
Episodes may be upsetting, disturbing and often have a theme
Depression may also be related to….
A medical condition, medication or substance abuse
Recurrent depressive disorder?
Repeated depressive episodes
Depressed moods, loss of interest and enjoyment, reduced energy and lethargy for at least 2 weeks
Psychological treatments for depression?
CBT
Interpersonal Psychotherapy
Can be individualised or group form
What other treatments (other than psychological) are available for depression?
SSRIs - selective serotonin reuptake inhibitors
SNRIs - serotonin and noradrenaline reuptake inhibitors
TCAs - tricyclic antidepressants
MAOIs - monoamine oxidase inhibitors
ECT - electroconvulsvie therapy
Ketamine therapy
SSRI examples?
Prozac
Paxil
Celexa
Zoloft
SSNI examples?
Cymbalta (duloxetine)
Effexor (venlafaxine)
Meridian (subutramine)
What are tricyclic antidepressants?
They have 3 rings in their chemical structure hence the name
Mode of action is to block the reuptake of serotonin, noradrenaline, histamines and acetylcholine
Tricyclic antidepressants are considered a dirty drug. What does this mean?
Less specific in what they target. This may lead to some side effects
What are monoamine oxidise inhbitiors?
Mode of action: monoamine oxidizers are involved in the reuptake and breaking down of neurotransmitters
By inhibiting this there is less breakdown and more neurotransmitter available
Acts on noradrenaline and serotonin
What is ECT?
Being put under anesthetic and having a current applied to the brain that induces a seizure
Rapidly relieves depressive symptoms
What severity of depression is ECT recommended for?
Severe. Only when they are resistant to drug and psychotherapy
What else is ECT effective in treating?
Mania and schizophrenia
What is ketamine therapy?
Pain-relieving medication that can induce a seizure
Low doses relieve symptoms rapidly
Is ketamine therapy permanent?
No. You need maintenance doses.
How does ketamine therapy work?
Works on NMDA receptors - promotes more glutamate, more excitation and less depressive symptoms
How many people worldwide are affected by depression?
264+ million
What is bipolar disorder?
Defined by mood swings from periods of depression to periods of mania
What are the 4 types of bipolar?
Bipolar I, II, Cyclothymia disorder and other or unspecified
Bipolar I?
Most severe form with episodes lasting at least 7 days
may recquire hospitilisation
Depressive episodes last up to 2 weeks
Depression and mania can be present at the same time
Bipolar II?
Cycles of depression, however, experience hypomania. These are less severe episodes of mania that aren’t as intense or disruptive
Can usually handle daily responsibilities and does not require hospitalisation
Cyclothymia bipolar disorder?
Milder form
Continuous regular mood swings from mild to moderate highs and lows for extended periods of time
Changes in mood occur quickly and at any time
Can have short periods of normal mood
How long do cyclothymia symptoms need to be experienced before diagnosis?
Adults: at least 2 years
Children: 1 year
Other or unspecified bipolar?
The symptoms do not meet criteria for diagnosis but there are still significant, abnormal changes in mood
What treatments are available for bipolar?
Lithium
Valpronic acid
How does lithium work?
Dissolves in the bloodstream and interacts with GABA, dopamine and glutamate - GABA dampens activity, with less excitation from glutamate
Down side to lithium treatment?
Can be toxic!
Need to be monitored and a balance found
What is valpronic acid?
Typically used for epilepsy
Acts on glutamate to reduce and dampen activity
What is bipolar affective disorder?
Type of depression that typically consists of both manic and depressive episodes separated by periods of normal mood.
Elevated or irritable mood, overactivity, pressure of speech, inflated sense of self and decreased need for sleep
How many people in middle and low income countries receive no treatment for their disorder?
76-86%
What are some barriers to receiving treatment?
Lack of resources
Lack of trained health care providers
Social stigma
Inaccurate assessment
