Treatment of Mood Disorders

Question 1

How long do antidepressants usually take to work?

Answer 1

2-6 weeks

Question 2

What should be considered when a patient needs a quicker response than antidepressants can offer?

Answer 2

ECT

Question 3

What is non-response to an anti-depressant?

Answer 3

No/inadequate response after 6 weeks at maximum dose

Question 4

What drug is useful in bipolar depression?

Answer 4

Lamotrigine

Question 5

What drug is useful in mania/hypomania?

Answer 5

Valproate

Question 6

When can antidepressants be used in bipolar disorder?

Answer 6

Short term - severe depressive episode

Question 7

What can be done if the patient is unwilling to take oral medication for bipolar disorder?

Answer 7

Depot IM antipsychotics every 2-4 weeks

Question 8

Which drug class is the first line antidepressant?

Answer 8

SSRIs

Question 9

Give some examples of SSRIs

Answer 9

Fluoxetine
Sertraline
Citalopram
Escitalopram
Paroxetine

Question 10

Give some side effects of SSRIs

Answer 10

GI upset
Anxiety
Agitation
Insomnia
Sexual dysfunction
Hyponatraemia (older patients)

Question 11

Which SSRI is safest in cardiac problems?

Answer 11

Sertraline

Question 12

Which SSRI is safest in epilepsy?

Answer 12

Citalopram

Question 13

Give some examples of TCAs

Answer 13

Amitriptyline
Clomipramine
Imipramine

Question 14

Why are TCAs not first line for depression?

Answer 14

Cardiac side effects

Danger in OD

Question 15

Give some side effects of TCAs

Answer 15

Sedation
Confusion
Dizziness
Antimuscurinic effects 
Sexual dysfunction
Cardiac arrhythmias

Question 16

What type of drug is mirtazapine?

Answer 16

Noradrenergic and specific serotonergic antidepressant

Question 17

When is mirtazapine used?

Answer 17

First line in insomnia/poor appetite

Question 18

Give some side effects of mirtazapine

Answer 18

Constipation
Dizziness
Falls

Question 19

Give some examples of SNRIs

Answer 19

Venlafaxine

Duloxetine

Question 20

When are SNRIs generally used?

Answer 20

When SSRIs/mirtazapine have not worked

Question 21

Give some examples of MAO inhibitors

Answer 21

Irreversible - phelezine

Reversible - moclobemide

Question 22

When are MAO inhibitors used?

Answer 22

Treatment resistant depression

Question 23

What is the big risk of MAO inhibitors?

Answer 23

Hypertensive crisis

Question 24

Which foods must be avoided in patients taking MAO inhibitors?

Answer 24

Cheese
Alcoholic drinks
Dried meats
Gravy based food

Question 25

What is the most effective treatment for bipolar disorder?

Answer 25

Lithium carbonate

Question 26

Give some side effects of lithium

Answer 26

``` GI upset Dry mouth Sedation Weight gain Tremor Arrhythmia Renal impairment ```

Question 27

What tests must be done prior to giving lithium?

Answer 27

U+Es TFTs ECG

Question 28

What is tested every 3 months in lithium monitoring?

Answer 28

Lithium level | U+Es

Question 29

What is tested every 6 months in lithium monitoring?

Answer 29

TFTs

Question 30

Give some signs of lithium toxicity

Answer 30

``` GI upset Blurred vision Coarse tremor Confusion Seizures Coma ```