Mood disorders
-
Upload
linda-avila -
Category
Science
-
view
30 -
download
4
description
Transcript of Mood disorders
MOOD DISORDERS
Mood disorders
• Elevation/depression in mood over a period of time that affects the ability of a person to function.
• Can lead to suicides and impair social and occupational functioning.
2 common types
• Major depression
• Bipolar disorder
Major depression
• Mood disorder in which the patient has one/more episodes of major depression but has no history of mania episodes.
A. Epidemiology
• Occurs more frequently in women than men, women having a lifetime risk of 1.7-2.7 times higher than men
• Highest risk of depression occurs in adults ages 25-44, although depression may occur at any age
B. Pathophysiology
• GENETIC THEORIES
-people who have parent/sibling w/ history of depression have greater risk of having depression than the general population
B. Pathophysiology
• BIOGENIC AMINE THEORY
-depression is assoc. w/ decreased levels of norepinephrine, serotonin & dopamine in the brain.
• DYSREGULATION THEORY
-impaired homeostasis of NE, 5-HT, & DA in the brain is assoc. w/ depression rather than their absolute levels.
C. Diagnosis & clinical features
Upon major depressive episodes, patients should experience at least five/more persistent symptoms for at least 2 weeks.
C. Diagnosis & clinical features
C. Diagnosis & clinical features
Symptoms impair social and occupational functioning and should not related to a general medical condition/substance abuse.
Patients w/ excessive sedation, increased appetite, wt. gain, and agitation are classified as experiencing atypical depression.
D. Treatment options
• 2 common options(pharmacotherapy, psychotherapy)
• The choice should be patient specific & influenced by the severity of symptoms.
1. Pharmacotherapy options
• Aka antidepressants• Use for mild-severe major depression & produces a
response of 40-70% of patients• Have similar efficacies but, differ in adverse effects, MOA,
medication interactions & cost.
1. Pharmacotherapy options
• MAOIs• TCAs• SSRIs• SNRIs
• Bupropion• Mirtazapine• Trazodone• Nefazodone
Monoamine oxidase inhibitor
• Indications. Patients experiencing atypical depression.• MOA. MAOIs inhibit monoamine oxidase, w/c is
responsible for the breakdown of neurotransmitters s/a DA, 5-HT, NE.
• AE. hypertensive crises, serotonin syndrome, orthostatic hypotension, peripheral edema, wt. gain, & sexual dysfunction.
Tricyclic amines
• Indications. Not usually indicated first-line for the treatment of depression, should no be used in pt. w/ suicidal ideations, cardiovascular conditions, urinary retention and severe prostate hypertrophy.
• MOA. TCAs inhibit the reuptake of 5-HT & NE.• AE. anticholinergic effect, sedation, wt. gain, orthostatic
hypotension, tachycardia, & seizures.
Selective serotonin reuptake inhibitors
• Indications. Considered first line for treatment of depression, indicated for anxiety, panic disorder, post-traumatic stress disorder & obsessive compulsive disorder.
• MOA. SSRIs blocks the reuptake of serotonin.• AE. Nausea, vomiting, insomnia, somnolence, dry
mouth, sedation, sexual dysfunction, headache & tremor.
SSRI
Serotonin & norepinephrine reuptake inhibitors
• Indications. Use in treatment not only of depression but also of painful peripheral neuropathies.
• MOA. Inhibit reuptake of 5-HT & NE, increased their levels.
• AE. Similar to SSRIs assoc. w/
elevations of diastolic blood pressure.
Bupropion(Wellbutrin)
• Indications. Depression and for smoking cessation.• MOA. Inhibit reuptake of dopamine.• AE. Nausea, vomiting, & insomnia.
Mirtazapine (Remeron)
• MOA. Cause an increase in levels of 5-HT & NE.• AE. Sedation, wt. gain, increase appetite.
Trazodone (Desyrel)
• Indications. Indicated for treatment of depression but not frequently used because of sedation. Used in low doses for insomnia in depressed patients.
• MOA. Increase 5-HT.• AE. Sedation, nausea, & orthostatic hypotension.
Nefazodone (Serzone)
• MOA. Blocks reuptake of NE & 5-HT.• AE. Dry mouth, nausea, constipation, orthostatic
hypotension & sedation
E. Duration of treatment
3 Phases of Treatment
• Acute phase -begins w/ the initiation of therapy until remission is reached, last b/w 6-12 weeks.
• Continuation phase -begins after remission is reached, last b/w 6-9 months.
*Medication from the acute phase is continued during this phase to prevent relapse of depression.
E. Duration of treatment
• Maintenance phase –used in patients with high risk of recurrence of depression, s/a those w/ history of multiple episodes, suicidal thoughts & severe depression.
These patients should receive MT for 2-3 years & many may receive life-long therapy.
F. Administration & dosage
• Usually started at low doses & slowly titrated• If patients receive only a partial/no response, other
antidepressants may be consider.• When changing to another antidepressant agent, caution
should be used to prevent serotonin syndrome.
H. Suicide risk
• FDA has issued a Black box warning for all antidepressants that an increase in suicidal thoughts & actions may occur with therapy & that adolescents & children receiving therapy should be closely monitored.