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Flashcards in Depression Lecture Deck (37):
1

Define depression

an illness that involves the body, mood and thoughts
- Affects the way a person eats and sleeps, the way one fees about oneself and teh way one thinks about things

2

At least one of the following symptoms have been present during the same 2 week period?

Depressed mood
Loss of interest of pleasure (anhedonia)

3

What are other symptoms that at least 3 have to be present?

Change in weight/appetite
Altered sleep patterns
Psychomotor agitation or retardation
Fatigue/lack of energy
Feelings of worthlessness or excessive/inappropriate guilt
Difficulty concentrating and making decisions
Suicidal thoughts or plans

4

What is the biogenic amine hypothesis?

Depression caused by decreased brain levels of neurotransmitters
- NE (regulates vigilance, motivation, energy, anxiety, irritability)
- Serotonin/5-HT (anxiety , irritability, impulsivity, appetite, aggression
- DA (appetite, aggression)

5

What is the goals of depression treatment?

Response rate to meds are only up to 50%
Some argue effectiveness is overstated
Lots of side effects
Alternative therapies are warranted for treatment (CAMs)

6

Define anxiety

unpleasant state of tension, apprehension, or uneasiness
- Not just nervousness or anxiousness
-Persistent, unremitting, debilitating and beyond control

7

What are clinical presentations of anxiety?

Anxious
Physical (tachycardia, sweating, trembling, digestive issues, shortness of breath)
Anxiety disorders (generalized, panic disorder, social anxiety disorder, phobias)
OVER 6 MONTHS

8

What are treatment targets for anxiety?

Noradrenergic model
GABA model

Increase GABA = less excitability of neurons
5-HT, NE, DA
Symptom controling

9

Define noradrenergic model

Autonomic nervous system is hypersensitive and overreacts to stimuli

10

Define GABA model

Major inhibitory neurtransmitter of CNS
Regulatory effect on 5-HT, NE, DA

11

What is Complementary and Alternative Medicine

Not conventional medicine
- Natural products
- Mind-body medicine (cognitive and behavioral therapy)
- Manipulative and body-based practice (acupunture

12

What are natural products for depression?

St. John's Wort
SAMe
5-HTP
L-tryptophan

13

Folic acid deficiencies?

Requierd for synthesis of DA, NE, and 5-HT
- Patients are 6X less likely to respond to anti-depressants

14

Omega-3 FA deficiencies?

DHA & EPA are primary
Depression is less in place with high fish diets
Levels decreased in pregnancy

15

What are natural products for anxiety?

Kava
Valerian
St. John's Wort
SAMe
5-HTP
L-tryptophan

16

St. John's Wort MOA and use?

- ONLY DEPRESSION
Increases CNS neurotransmitter levels
- Nonselective reuptake inhibition
- Decrease degradation of neurochemical
- Might inhibit uptake of GABA and L-glutamate

17

St. John's Wort active ingredients?

Xanthones
Hypericins
Hyperforin

18

St John's Wort clinical effects?

Improves mood, reducing insomnia and somatic symptoms of depression
More effective than placebo
Not recommended for anxiety
Mixed in OCD

19

St. John's Wort Adverse Effects?

Headache, nauseam dry mouth, photosensitivity
Serotonin syndrome (agitation, confusion, diarrhea, hyperthermia, rapid heartbeat, bp changes)

20

St. John's Wort Precautions?

History of bipolar disorder or schizophrenia
Drug interactions (induces CYP450 3A4 and PGP due to hyperforin)

21

St John's Wort drug interactions?

Immunosuppressants
Antiretrovirals
Chemotherapeutic agents
Warfarin
Oral contraceptives
SSRI's, TCA's, MOA-I

22

St John's Wort counseling?

Seek medical advice before use
Not for use in severe depression

23

SAMe uses and MOA?

Depression + osteoarthritis
Gives methyl groups to neurotransmitters and catecholamines

24

SAMe adverse effects and precautions?

Well tolerated (some nausea, diarrhea, heartburn, dry mouth, headache, insomnia, etc)
- May convert bipolar into mania
- Drug interactions with agents affecting 5-HT
- Caution in patients with diabetes
- Poor product quality
- High cost

25

L-tryptophan or 5-HTP uses and MOA

Anxiety, depression, alleviate stress, induce sleep
- Precursor to serotonin
- Increases serotonin in CNS

26

L-tryptophan and EMS?

1989, banned.
Development of EMS
Deaths reported

27

Clinical effects and adverse effects of 5-HTP?

Unknown if effective at antidepressants
- Heartburn, stomach pain, belching, flatulence, diarrhea, anorexia

28

Valerian uses?

Sedative-hypnotic
Anxiety

29

Valerian MOA?

Inhibits metabolism of GABA

30

Valerian clinical and adverse effects?

May decrease social anxiety and generalized anxiety disorder
- Hepatotoxicity, headache, excitability

31

Valerian counseling points?

Restlessness
30 minutes before bedtime
More effective as a routine
Do not abruptly discontinue
Use caution that require alertness

32

Kava Kava uses and MOA?

Stress relief, anxiety, tension, insomnia
- May increase GABA binding site
- No effects on benzodiazepine receptors

33

Kava Kava active ingredients?

Kavalactones and kavapyrones

34

Kava Kava clinical effects?

Positive on anxiety
Women and younger patients
Significant anxiolytic reduction

35

Kava Kava adverse effects

Dizziness and drowsiness
Hepatotocity
Mouth ulcers and numbness
Skin reaction

36

Kava Kava precautions

Interaction siwth other CNS depressants
Interaction of anticoagulants
CYP2E1, 2C9, 3A, 2D6 inhibitor

37

Kava counseling points?

Not in patients with liver problems or concomitant hepatotoxic medications, or alcohol consumer
- Short term