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54 Cards in this Set
- Front
- Back
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Two types of depressive disorders
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Major Depressive Disorder
Dysthymia |
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Major depressive disorder (MDD)
criteria |
1.represents change in previous functions
2.Symptoms cause clinically significant distress or impair socail occupational, or other important areas of functioning. 3. Five or more depressed mood most of day nearly every day Anhedonia Weight loss or gain Insomnia/hypersomnia Increased or decreased motor activity Anergia Feelings of worthlessness or inappropriate guilt Decreased concentration or indecisiveness Thoughts of death or suicide |
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Dysthymia
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1.occurs or 2yr period adult 1 yr child
2.Symptoms cause clinically significant distress or impair social occupational, or other important areas of functioning. 3. Two or more decreased or increased appetite Insomnia/hypersomnia Low energy chronic fatigue Decreased self-esteem Poor concentration or indecisiveness Feelings of hopelessness or despair |
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anergia
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reduction in or lack or energy
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anhedonia
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inability to find meaning or pleasure in existence
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Physical changes with depression include
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lethargy/ fatigue
changes in eating patterns Changes in sleep patterns Change in bowel habits Interest in sex declines pain |
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Cognition changes with depression
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thinking is slow
memory and concentration affected dwell on or exaggerate perceived faults and failures unable to focus on successes ability to solve problems and think clearly impacted |
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Milieu Therapy
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therapy that focuses on manipulation of the environment (both physical and social) to effect positive change
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ECT
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Electro convulsive therapy
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First line drug treatments for Depression
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TCAs Cyclic antipressants
SSRIs Newer atypical antidepressants |
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Second line drug treatments for depression
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MAOIs
Monamine oxidase inhibitors |
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What do
TCAs (tricyclic antidepressants) do? |
inhibit reuptake of norepinephrine and serotonin by presynaptic neurons in the CNS. Their levels increase in the brain and elevate mood
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TCAs (tricyclic antidepressants) have the following adverse reactions
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Sedation, weight gain, sexual dysfunction, Anticholergenic side effects (dry mouth, blurred vision, constipation, urinary retention, tachycardia possible confusion) Orthostasis, dysrythmias, heart failure, ECG changes.
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TCAs (tricyclic antidepressants)
drug names |
Amitriptyline (Elavil, Endep)
Amoxapine (Asendin) Desipramine (Norpramin, Pertofrane) Doxepin (Adapin, Sinequan) Imipramine (Tofranil) Nortriptyline (Pamelor, Aventyl) Protriptyline (Vivactil) Trimipramine (Surmontil) Maprotiline (Ludiomil) |
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What do Selective serotonin reuptake inhibitor (SSRI) do?
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selectively block the neuronal uptake of serotoninleving more serotonin available for the synaptic site.
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SSRIs compared to TCAs
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SSRIs have less anticholinergic side effects, less cardiotoxicity, and faster onset than TCA's. Less dangerous when taken in iverdose
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Serotonin syndrome symptoms
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ab pain. diarrhea,
Hyperexia/fever tachycardia/ cardiovascular shock Elevated BP Altered mental status/ delirium Myoclonus/muscle spasms, tonic rigidity Irrational/mood swings seizures/ status epilepticus Apnea/death |
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Selective serotonin reuptake inhibitor (SSRI) Drug names
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citalopram (Celexa)
escitalopram (Lexapro) fluoxetine (Prozac), fluvoxamine (Luvox) paroxetine (Paxil) sertraline (Zoloft) |
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Selective serotonin reuptake inhibitor (SSRI) adverse reactions
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Sedation minimal, sexual dysfunction,. Initially nausea, loose bowell movements, headache, insomnia
Toxic rare: serotonin syndrome |
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Treatment for Serotonin Syndrome
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Discontinue offending agent
Initiate symptomatic treatment *serotonin receptor blockade: cyproheptadine, methysergide, propranolol *coolling blankets, chlorpromazine for hypothermia *Dantrolene, diazepam muscle rigidity *Anticonvulsants *Artificial ventilation/ Paralysis |
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Names of Novel antidepressants
(newer atypical) |
Trazodone (Desyrel)
Bupropion (Wellbutrin/Zyban) Venlafaxine (Effexor) Mirtazapine (Remeron) Duloxetine (Cymbalta) |
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Bupropion (Wellbutrin/Zyban) is used to treat
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ADHD
Chronic fatigue syndrome rapid cycling bipolar II disorder Sexual side effects form other antidepressants Anxiety disorders PTSD |
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Duloxetine (Cymbalta)
is used to treat |
Major depression
Geriatric Depression |
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Venlafaxine (Effexor) is used to treat
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treatment resistant depression
Chronic depression Bipolar depression depression with ADHD Medical illness with depression anxiety geriatric depression |
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is used to treat
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sleep disturbance
poor appetite pain Medical illness with depression Anxiety SSRI induced sexual dysfunction |
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Trazodone (Desyrel)
is used to treat |
Older adults
SSRI induced insomnia |
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Bupropion (Wellbutrin) side effects
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seizures if more than 300 mg taken
Seisure risk high in some individuals Some naseau |
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Trazodone (Desyrel) side effcts
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Possible priapism
Postural hypotension Weight gain memory disfunction |
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Venlafaxine (Effexor) side effects
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Risk of sustained hypertension
Somnolence dry mouth dizziness Rapid discontinuation leads to withdrawals symptoms |
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Mirtazapine (Remeron) side effects
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strong sedating effect
possible increase weight, appetite, cholesterol |
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Duloxetine (Cymbalta) side effects
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Naseau
Somnolence dry mouth constipation decreased appetite increased sweating Fatigue twice a day dosing |
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Monoamine oxidase inhibitor (MAOIs) drug names
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Phenelzine (Nardil)
Selegiline (EMSAM) Tranylcypromine (Parnate) |
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Monoamine oxidase inhibitor (MAOIs) adverse reactions
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Hypotension (critical older adults)
Sedation weakness, fatigue Insomnia Changes cardiac rhythm Muscle cramps Anorgasmia/ sexual impotence Urinary hesitancy/ constipation weight gain |
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Monoamine oxidase inhibitor (MAOIs) interact with the following drugs
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Over the counter meds for colds/ allergies /congestion
TCAs Narcotics Antihypertensives Amine precursors Sedatives (ETOH, barbituates/benzos) General Anesthetics Stimulants (ampethamines, cocaine) |
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Monoamine oxidase inhibitor (MAOIs) interact with the following foods
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Foods high in Tyramine
avacados fermented bean curd, fermented soybeans figs bananas large quantity fermented/ smoked/aged meats liver bologna, peperoni, salami pickled/smoked/cured fish almost all cheeses yeast extract Some imported beers, Chianti soups shrimp paste soy sauce Chocolate large amounts Fava beans Ginseng Caffienated beverages |
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Monoamine oxidase inhibitor (MAOIs) toxic effects
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Hypertensive crisis
Severe headache stiff sore neck flushing cold clammy skin tachycardia severe nose bleed dilated pupils chest pains stroke coma death N/V |
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ECT is an effective treat particularly for
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major depression and bipolar depressive with psychotic features or those with refractory to other treatments
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Vagus nerve stimulation
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an adjunct for pt with treatment resistant depression (TRD) Must have failed 4 antidepressant trials. Device surgically implanted in brain sends pulse to left vagus nerve at regular intervals.
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Transcranial Magnetic Stimulation
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using electromagnets to deliver an electrical field to the cerebral cortices
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Subtypes seen in Major Depressive Disorder
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Psychotic features
Catatonic features Melancholic features Postpartum Seasonal Features Atypical: weight/appetite changes, hypersomnia, high anxiety, sesitive to perceived interpersonal rejection. |
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Bipolar I disorder
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at least one episode of mania alternating with major depression. Psychosis may accompany the manic episode
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Bipolar II disorder
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Hypomanic episodes alternating with major depression. Psychosis is not present. hypomania tends to be euphoric and the depression tends to put people at risk for suicide
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Cyclothymia
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Hypomanic episodes alternating with minor depressive episodes at least 2 years in duration. Tend to have irritable hypomanic episodes
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rapid cycling
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4 or more mood episodes in a 12 month period. Used to indicate more severe symptoms such as poorer global functioning, high recurrence risk and resistance to treatment.
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hypomania
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episode associated with unequivocal change in functioning that is uncharacteristic of person when not symptomatic. Disturbance/change observed by others. Hospitalization not required. Symptom not due to effects of substance (drug abuse, meds other condition)
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Mania
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severe enough to cause marked impairment in occupational/ social activities. Necessitates hospitalization to prevent harm to self or others or there are psychotic features. Symptom not due to effects of substance (drug abuse, meds other condition)
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Lithium maintenance blood levels are
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between 0.4 and 1.3 mEq/L
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Lithium Carbonate is effective for
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the acute treatment of mania and depressive episodes and the prevention of recurrent mania and depressive episodes. Often first choice of treatments.
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Lithium effective in reducing
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Elation grandiosity
Flight of ideas Irritability / manipualtiveness anxiety |
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lithium to a lesser extent controls
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insomnia
psychomotor aggitation threatening assaultive behavior Distractibility Hypersexuality Paranoia |
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Lithium adverse reactions
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small increment exists between therapeutic and toxic dosage
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Expected Lithium side effects
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fine hand tremor
polyuria mild thirst mild naseau generl discomfort weight gain |
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Early signs of toxicity
medication should be withheld blood levels measure dosage reevaluated |
naseau/ vomitting
diarrhea thirst polyuria slurred speech muscle weakness |
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Advanced signs Lithium toxicity
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coarse hand tremor
perssistant gastrointestinal upset mental confussion muscle hyperirritability |
