Management of Mood Disorders Flashcards
What scales are commonly used to assess mood disorders?
- Inventory of depressive symptomatology
- Quick inventory of depressive symptomatology
- Hospital anxiety and depression scale
- Montgomery-Asberg Rating Scale - for ECT
Name the top four antidepressants
- escitalopram
- sertraline (easy dose titration)
- mirtazapine (promotes sleep and appetite with less SSRI effects)
- venlafaxine (higher rate of adverse effects)
How are depressive relapses prevented?
Continue medication for at least 6 months after full recovery - if a second episode occurs must continue for at least 1-2 years after
What is the treatment for a bipolar patient who presents with acute mania/hypomania?
Discontinue antidepressant
Antimanic - risperidone, quetiapine, olanzapine
What other drugs can be given in mania?
Lithium, valproate, carbamazepine, ECT
How should medications be administered in mania?
Oral or IM if cannot tolerate
What drugs can be used short term for symptomatic relief?
Benzodiazepines - agitation and insomnia
When should antidepressants be avoided?
Recent manic/hypomanic episode
History of rapid cycling bipolar
What is the first line treatment in bipolar depression?
Antipsychotic - quetiapine, olanzapine
If bipolar is primarily depressive what can be given?
Lamotrigine
If bipolar is primarily manic what can be given?
Valproate
What is the gold standard drug in bipolar?
Lithium
What is the most common use of ECT?
Recurrent depressive disorder without psychosis
Describe ECT
Usually given twice weekly, 6-12 treatments over 3-6 weeks, bilateral temporal bone - under general anaesthetic and muscle relaxant. Seizure lasts 15-30secs
What causes death in ECT?
Cardiovascular and pulmonary complications
