Wk9 Mood Disorders

Question 1

What is the classification of Mood Disorders and what are their diagnostic criteria?

Answer 1

Classification:
Bipolar Disorders
- Primary: bipolar I, bipolar II
- Secondary: substance-induced MD

Depressive Disorders
- Primary: disruptive DD, persistent DD, major DD

> Primary Mood Disorder由药物引起
Secondary Mood Disorder（Pre-Existing Condition）

Diagnostic criteria: either one of the S/S

• depressed mood
• diminished interest
• significant weight loss
• insomnia or hypersomnia
• feeling worthlessness
• fatigue, diminished concentration

Hamilton Scale & Beck Scale
> 5, means depression

Question 2

What are the risk factors for depression?

Answer 2

• Genetic/family history
• brain chemistry reasons, ie ↓ serotonin level
• ageing
• personality, ie negative emotionality
• long-term pressure, ie bully, work stress
• traumatic events

Question 3

What are the major classes of antidepressant drugs?

Answer 3

SSRIs: selective serotonin reuptake inhibitors
Indications:
- anxiety, depression, eating disorders, obsessive-compulsive disorders
- 1st line, better tolerated than SNRIs, TCAs, MAOIs
Drugs: citalopram, sertraline, fluoxetine
MOA: ↑ extracellular serotonin levels
AEs: N&O, dry mouth, headache, constipation, sweating
NP:
- SSRIs for OCD is often higher than for anxiety/depression
- begin half dose for anxiety disorder
- check Na+ for hyponatraemia
- tapering over a few weeks before withdrawal

SNRIs: selective noradrenaline reuptake inhibitors
Drugs: venlafaxine
MOA: inhibits serotonin & noradrenaline reuptake, ↑ the extracellular concentration
AEs: N&O, dry mouth, headache, constipation, sweating, increased BP
NP:
- check BP
- monitor for ↑ suicidal thoughts
- tapering when withdrawal

TCAs: Tricyclic antidepressants
Drugs: amitriptyline
MOA: block reuptake of Serotonin & Noradrenaline
> used for resistant depression
AEs: N&O, dry mouth, headache, constipation, sweating, postural hypotension
NP:
- check BP, supine + standing
- be cautious with overdose (2 wks delayed effect), be cautious with suicidal behaviours
- tapering before withdrawal

MAOIs: monoamine oxidase inhibitors
(Phenelzine, Tranylcypromine)
MOA: ↓ monoamine oxidation (depression is due to deficiency of monoamine neurotransmitters)
> 3rd line
AEs: N&O, dry mouth, headache, headache, drowsiness, weakness
NP: avoid fermented/pickled food, each fresh

Question 4

What are the nursing practice points of using antidepressants?

Answer 4

• Educate PT of drug choices and non-pharmacological treatments
• Educate PT of likely outcomes, ie gradual relief from anxiety/depression
• For a single episode, continue treatment for 6~9 months after resolution of symptoms
• Withdraw antidepressants gradually to avoid withdrawal effects

Question 5

What are the withdrawal effects and nursing considerations for switching between antidepressant medicines?

Answer 5

NP:

• gradual withdrawal, to prevent withdrawal S/S, ie restlessness, insomnia, tremor, N&O, sweating
• May have to wait for reasonable ‘antidepressant-free intervals’ before engaging next med choice
• Consider hospitalisation during washout if severely depressed

Withdrawal effects:
SSRIs/SNRIs: N&O, tremor, sweating, restlessness
TCAs: hypersalivation, abdominal cramping, anxiety, insomnia
MAOIs: N&O, restlessness, insomnia