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25 Cards in this Set

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what are affective disorders?

characterised by changes of mood - major depression and bipolar disorder



whats the diagnostic criteria for major depression?

at least FIVE symptoms for TWO weeks. depressed mood, loss of interest or pleasure in regular activities, significant weight loss or gain, insomnia or hypersomnia, fatigue, feelings of worthlessness or excessive guilt, impaired thinking or concentration, indecisiveness

what is the biological hallmark of major depression?

receptors are insensitive to monoamine synthesis, storage or release

whats bipolar disorder?

characterised by distinct moods of depression and mania - elevated mood, uncontrolled thought and speech, impulsive actions, accelerated speech, increased activity and reduced sleep, delusions of grandeur

what are the incidences of suicide like in Australia?

15%

whats the incidences of bipolar like?

1-2% of population, peaking in early adulthood

whats the biological reason for mania?

an excess of monoamine activity

how do SSRIs work?

they selectively inhibit reuptake of serotonin receptors . they are most commonly prescribed first-line. this is because even though they are not as effective in severe depression as TCAs, they have a favourable risk benefit ratio.

what are some SSRIs?

fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, escitalopram

do SSRIs have an effect on cardiac conduction?

no - they have very little antimuscarinic activity

how else do they compare to TCAs?

not as sedating, less nausea and diarrhoea, no food interactions, safer in overdose, low seizure incidence

what are some side effects of SSRIs?

increased aggression and suicidal thoughts in children and adolescents, tremor, hyperthermia, tachycardia, hypo/hypertension, disorientation, profuse sweating

what are MAOIs?

irreversible inhibitors. phenelzine, tranylcypromine, isocarboxazid. they are older, used as second line. they are related to amphetamines. they are usually used when SSRIs aren't effective.

what are some side effects of MAOIs?

insomnia, weight gain, peripheral oedema, dry mouth, blurred vision, constipation, loss of sex drive, failure to ejaculate, orthostatic hypotension, agitation. interact significantly with food containing tyramine - MAOIS block metabolism of tyramine in food causing massive adrenergic stimulation and a hypertensive crisis. Gravy, miso, liver, cured meat, tofu, caviar, cheese and dairy, figs, avocado, raisins, banana, broad beans, beer, red wine, sherry, vegemite, soy, peanuts.

what are TCAs?

imipramine, desipramine, amitryptiline, nortriptyline, clomipramine, doxepin, dothiepin. Inhibit uptake of NAd (nictonamide adenine dinucleotide) and serotonin - with little or no effect on dopamine.

what are TCAs used for?

unipolar endogenous depression (elevate mood, increase physical activity, alertness, appetite and sex drive). bipolar endogenous depression, anxiety disorders

what are some side effects of TCAs?

muscarinic blockade (dry mouth, blurred vision, constipation, glaucoma, urinary retention), alpha-receptor blockage (postural hypotension, sexual dysfunction, weight gain), histamine receptor blockage (sedating)

what are mixed reuptake inhibitors?

they block reuptake of both serotonin and NAd. venlafaxine, desvenlafaxine, duloxetine, milnacipran

what are some noradrenaline reuptake inhibitors?

bupropion, reboxetine, atomoxetine

how do we treat depression?

mild depression - no pharmacology. moderate to severe depression - SSRIs preferred. discontinue treatment gradually - short-acting SSRIs and TCAs produce a withdrawal reaction

what else are antidepressants used for?

neuropathic pain, anxiety disorders, fibromyalgia, bipolar, obesity, smoking cessation and attention-deficity hyperactivity disorder

how do we treat bipolar?

administer prophylactic meds to prevent mood swings, 3-4 weeks before benefits start. given in an acute attack meds can only work to reduce mania not depression (excepting lithium).

what are some mood stabilisers?

lithium and antiepileptics

what are some atypical antipsychotics?

olanzapine, risperidone, quetiapine, apripiprazole.

whats lithium?

its used as a prophylactic in bipolar, it takes 7-10 days to work. its excreted by the kidney.