11 Mood disorders and related drugs

Question 0

Depression dagnosis and treatment ratios

Answer 0

50% undagnosed
25% untreated
25% Treated

60- 80% improve if treated

Question 1

Mood disorder epidemiology etc

Answer 1

• 4th in disability adjusted life years
• same cost as heart disease
• Low recognition rate
• Highly treatable
• 5% prevalence for dysthymic disorder and MDD
• functional impairment exceeds: DM, HTN, Arthritis, Back problems, GI

Question 2

Depression presentation

Answer 2

Multiple Somatic complaints
Anxiety
"nerves, headaches" mex
"Weakness, imbalance"chinese
"heartbroken" hopi

Question 3

Symptom and psychiatric rates

Answer 3

Greater number of symptoms associated with prevalance of psychiatric disorders.

Question 4

Major depressive episode

Answer 4

5 symptoms at least two weeks with depressed moos or ahedonia

Question 5

Depression criteria

Answer 5

• 2 weeks or more
• SIGECAPS 5 of 9
• clinically significant distress
• Not substance or medical condition
• not bereavement

Question 6

PH9 scoring

Answer 6

several days-1pt
More than 1/2 - 2pt
Every day - 3pt

5-9 stable
10-14dysthymia or mild depression TX?
15-19 MDD TX
>20 SEVERE MDD- TX meds and psychotherapy

Question 7

Suicide red flags

Answer 7

ISPATHWARM

ideation
substance abuse
purposeless
anxiety 
trapped
hopelessness
Withdrawl
anger
recklessness
mood swings

Question 8

Bereavement stages

Answer 8

Stage 1: shock
*numbness, unreality - crying abdominal pang/empptiness, sighing, tightness in throat- thoughts of denial or disbelief

Stage 2: Preocupation
*guilt, anger, sadness- weakness, anorexia, insomnia, fatigue- dreams and thoughts of deceased- ahedonia and introversion

Stage 3:Resolution
*Thinks of past with pleasure- regains interest, new relationships formed

Question 9

TCAs

Answer 9

Imipramine, Amitryptyline, Desipramine, Nortryptyline, Doxepin, Clomipramine, Maprotilene, Amoxapine, protriptyline, trimipramine

Question 10

SSRIs

Answer 10

Fluoxetine, sertraline, paroxetine, citalopram, fluvoxamine, escitalopram

Question 11

SSRI SE

Answer 11

HA/dizziness
N,D,Constipation
Somnolence/insomnia
Sweating/tremor/dry mouth
Anxiety/restlessness
Sexual drive

Question 12

Atypical antidepressants

Answer 12

Buproprion, trazodone, nefazodone, venlaflaxine, mirtazapine, duloxetine, alprazolam

Question 13

MAOi

Answer 13

Phenelzine
Isocarboxazid
Tranylcypramine
selegiline 
RIMA

Question 14

Additional treatments

Answer 14

Lithium
Psychotherapy
ECT
Vagal nerve stimulation
Transcranial Magnetic stim
Deep brain stim
*St john's wort, Sam-E, Reboxetine

Question 15

Depression outcomes

Answer 15

Response
Remission
Relapse
Recovery
Recurrence

Question 16

Bipolar general info

Answer 16

2.6% 1 year prevalence
1% lifetime prevalence
4.4% lifetime rate in us
15% suicide rateq

Question 17

Manic episode

Answer 17

*Distinct period >1 week
*Elevated or expansive mood (abnormal and persistent)
*Irritable mood
*Severe
Traits:
*Grandiosity
*Decreased need for sleep
*Hyperverbal/pressured speech
*Flight of ideas
*distractability
*Psychomotor agitation and goal seeking actvity
*Pleasurable activity with painful consequences

Question 18

Mania Stage 1

Answer 18

• increased Psychomotor activity and increased rate of speech
• Labile mood/euphoria
• Grandiosity
• Tagential but coherant thoughts
• Sexual preocupation, religion, spending, letter writing,
• High but not out of control

Question 19

Mania Stage 2

Answer 19

• Pressured speech, ^ psychomotor activity
• Dysphoric mood/depression
• Hostility/anger
• Explosive/assultive behavior
• Flight of ideas
• Delusional preoccupations

Question 20

Stage3 mania

Answer 20

• Desperate/panic stricken
• Loose associations
• bizzare idiosyncratic delusions
• hallucinations
• disorientation
• ideas of reference

Question 21

NE pathways

Answer 21

Loccus ceruleans to cerebellum and around limbic system

Question 22

Serotonin pathways

Answer 22

Raphe nucleus to limbic, cingulate gyrus, basal ganglia, and neocortex

Question 23

Mirtazapine MOA

Answer 23

alpha 2, 5ht2, 5ht3 antagonist- antagonizes presynapic receptors

Question 24

SSRIs

Answer 24

* Fluoxetine, paroxetine, sertraline, citalopram, escitalopram, * Less acute tox than TCA MAOI * Similar in effectiveness to TCAs * nausea, insomnia, sexual dysfunction * Serotonin rxn if mixed with MAOIs - hyperthemia, muscle rigidity, CV collapse

Question 25

SSRI withdrawl

Answer 25

Dz/Lightheaded, Vertigo/faint, shock like, paresthesia, anxiety, diarrhea, fatigue, gait instability, HA, insomnia, irritability, NV, tremor, visual disturbances

Question 26

SSRI usage

Answer 26

``` MDD, OCD (high dose SAD PTSD GAD PMS Hot flashes ```

Question 27

Fluoxetine*

Answer 27

* Affects meetabolism * 7 day halflife on active metabolite * Sustained release formulation available

Question 28

Sertraline*

Answer 28

Shorter half life than fluoxetine Less metabolism interaction *OCD, PTSD, Panic attacks

Question 29

Paroxetine*

Answer 29

Same but hot flashes as well

Question 30

Fluvoxamine

Answer 30

OCD

Question 31

SNRIs

Answer 31

*Venlafaxine- Anxiety and depression *Duloxetine- MDD/anxiety, Fibromyalgia (care with liver DZ) Minacipran-fibromyalgia and MDD

Question 32

Buproprion***

Answer 32

Atypical * DNRI * Tobacco cessation, SAD * No weight gain or sexual dysfunction

Question 33

Mirtazapine***

Answer 33

Atypical Blocks presynaptic alpha2, 5ht2, 5HT3, H2 antagonist *increases appetite

Question 34

Trazodone

Answer 34

Atypical Weak SSRI *Sedating and used for insomnia *CV SE, TrazaBONE

Question 35

Vortioxetine

Answer 35

Atypical MDD SSRI-like + 5ht1 and 5HT3

Question 37

TCA effects

Answer 37

* Decreased REM and Stage 3/4 sleep * Prominant anticholinergic - dry mouth, blurred vision, urinary retention * sedation * orthostatic * cardiac abnormalities (increased NE---> palp, lengthened QRS, T wave abnormalities)

Question 38

TCA OD

Answer 38

``` Hyperpyrexia- exceptionally high fever BP changes Cardiac conduction abnormalities Seizures coma ``` Tx- Supportive with 3 days of observation (long t1/2)

Question 39

TCA Drug interactions

Answer 39

Guanethidine- blocks uptake Sympathomimetics Absorption and metabolism of other drugs

Question 40

TCA indications

Answer 40

MDD Enuresis in kids- imipramine Chronic pain-amitryptyline OCD-Clomipramine and SSRIs

Question 41

MAOi

Answer 41

Phenelzine***, Tranylcypromine - MDD, Narcolepsy * Improves depressed mood * Corrects depression sleep disorders * Stimulation in normals * Lowers BP- orthostasis * Tox--> Agitation, hallucinations, hyperpyrexia convusions, BP changes

Question 42

Tyramine

Answer 42

MAO inhibs stop breakdown | Causes NE release and hypertensive crisis

Question 43

Refractory depression

Answer 43

* Antipsychotic augmentation - Olanzapine - Aripriprazole - Quietapine * Ketamine-experimental * Physiological - ECT - TMS (transcranial magnetic) - DBS (deep brain stimulation)

Question 44

St. John's wort

Answer 44

MAOi Might help with mild depression 3A4 induction - inhibits Birth control, Aids drugs, cyclosporine

Question 57

TCA drugs and mechanisms.

Answer 57

Imipramine, Amitryptyline Block serotonin and NE reuptake