Mood disorders

Question 1

What is the function of norepinephrine?

Answer 1

-concentration
-energy

Question 2

What is the function of dopamine?

Answer 2

-“feel good” NT, pleasure
-motivation

Question 3

What is the function of 5-HT?

Answer 3

-mood, happiness and well-being
-sleep, digestion

Question 4

What is the pathogenesis of depression?

Answer 4

-changes in brain structure (unknown if cause or effect)
-neurotransmitter disturbances
-endocrine disturbances
-alterations in circadian rhythms

Question 5

What is the monoamine deficiency theory?

Answer 5

a decrease in NE, serotonin and dopamine cause symptoms of depression, but we’re not really sure why

Question 6

What is the mnemonic for depression?

Answer 6

SIG ED CAPS

sleep
interest
guilt
energy
depressed mood
concentration
appetite
psychomotor
suicidal ideation

Question 7

How do antidepressants work?

Answer 7

they block enzymatic breakdown and slow reuptake of NE, 5-HT, and DA

Question 8

What are the new 1st line drugs (second generation of drugs) for antidepressants?

Answer 8

Selective serotonin reuptake inhibitors (SSRIs) and Atyical antidepressants (SNRIs and NDRIs)

Question 9

What are the first generation (2nd line) antidepressants?

Answer 9

monoamine oxidase inhibitors (MAOIs) and Tricyclic antidepressants (TCAs)

Question 10

What happens when a NT causes a reaction?

Answer 10

it will bind to another receptor site, be re-absorbed, be broken down by enzymes

Question 11

What is discontinuation syndrome?

Answer 11

like withdrawal for meds that effect your neurotransmitters

Question 12

What is the acronym FINISH for?

Answer 12

for discontinuation syndrome

It stands for:

Question 13

What is serotonin syndrome (SS)?

Answer 13

-too much serotonin in your body
-often related to 2 serotonergic drug interactions

Question 14

What are the manifestations of Serotonin Syndrome?

Answer 14

Cognitive changes: confusion anxiety, restlessness

Autonomic changes: increased HR and BP and diaphoresis

Neuromuscular changes: hyperreflexia, tremors, increased temp

Question 15

What is the management for Serotonin Syndrome?

Answer 15

-aggressive cooling measures
-sedation: benzos
-O2 for sat >94%
-short acting beta blocker: esmolol
-vasodilator: nitroprusside
-antidote: cyproheptadine (Periactin)

Question 16

When does hypertensive crisis occur?

Answer 16

when taking a MAOI and eating food that contains tyramine
-the cheese effect (cheese, red wine, beer, chocolate, caffeine)

Manifestations:
hypertension, tachycardia, arrhythmias, hyperthermia, agitation

Treatment: supportive (fluids and cooling) and short-acting vasodilator like IV nitro

Question 17

What are the pt and family teaching points for antidepressants?

Answer 17

-take several weeks to reach therapeutic effect
-watch for evidence of suicidality
-avoid hazardous activity and take at bedtime if sedation occurs
-avoid CNS depressants (ex. ETOH)
-do not discontinue abruptly–> discontinuation syndrome
-treatment should involve non-drug therapy to augment medication
-notify healthcare provider if pregnant
-avoid St. John’s Wort (herbal supplement thought to increase serotonin, NE, and DA and should be avoided due to possible interactions)

Question 18

Which NTs are involved in mood disorders?

Answer 18

dopamine (DA), serotonin (5-HT), and norepinephrine (NE)

Question 19

What changes are there to the brain structure and function during depression?

Answer 19

particularly in the limbic system which regulated emotions

-decreased size/activity of prefrontal cortex in some individuals
-decreased functioning of frontal and temporal lobes (where the limbic system is located)– unclear if this is cause or effect
-excessive activity of the amygdala (part of limbic system)

Question 20

What happens when there is a decrease in NE or 5HT?

Answer 20

depression

Question 21

What happens when drugs increase NE or 5HT?

Answer 21

relief of depression

Question 22

What happens with low DA?

Answer 22

depression

Question 23

What happens with high DA?

Answer 23

mania (as seen in bipolar disorder)

Question 24

What are some examples of endocrine disturbances that can cause depression?

Answer 24

-abnormal cortisol secretion patterns (too much or not at the right time)– high cortisol depletes serotonin
-decreased thyroid function– hypothyroidism = low levels of serotonin
-hormonal changes after childbirth– postpartum depression

Question 25

What happens with low levels of melatonin?

Answer 25

depression

Question 26

What are the 4 classes of antidepressants?

Answer 26

1st line:
-selective serotonin reuptake inhibitors (SSRIs)
-atypical antidepressants (SNRIs and NDRIs)

2nd line (1st gen):
-monoamine oxidase inhibitors (MAOIs)
-tricyclic antidepressants (TCAs)

Question 27

What is Bipolar Disorder?

Answer 27

-etiology unknown
-affects 1% of the population
-high suicide risk
-likely due to neurotransmitter disturbances (Glu, NE, GABA)
-excess excitation
-inflated self-esteem, grandiosity, decreased need for sleep/food, distractible, increased talking, delusions, paranoia, hallucinations
-treatment is mood stabilizers and anti-seizure meds