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A comprehensive overview of various mood disorders, including bipolar disorder, cyclothymia, dysthymia, and major depressive disorder. It covers the diagnostic criteria, symptoms, and treatment options for these conditions, with a focus on pharmacological interventions. The use of mood stabilizers, antidepressants, and other medications, as well as the importance of monitoring laboratory values and potential side effects. It also touches on non-pharmacological approaches, such as psychotherapy and electroconvulsive therapy. The information presented in this document can be valuable for healthcare professionals, students, and individuals interested in understanding and managing mood disorders.
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Patient comes in with symptoms of mania followed by periods of depression; what is it? - ✔✔bipolar 1 patient comes in with hypomania/regular mood (euthymic) followed by periods of depression, what is it? - ✔✔bipolar 2 how many symptoms of mania must you have to have "full" mania? - ✔✔seven of thirteen what is the difference between mania and hypomania? - ✔✔hypomania has less severe symptoms; 3 symptoms over shorter period of time (hypomania) Cyclothymia - ✔✔a disorder that consists of mood swings from moderate depression to hypomania and lasts two years or more moods are always irregular- not ever to a full extreme Dysthymia - ✔✔a form of depression that is not severe enough to be diagnosed as major depression "eeyore" always kind of down and depressed SIADH - ✔✔syndrome of inappropriate antidiuretic hormone will retain water hyponatremia will be observed what is something you should watch out for if a patient is on multiple antidepressants? - ✔✔SIADH
what medical problems mimic mood disorders? - ✔✔hypothyroid- depression hyperthyroid- mania involuntary admission - ✔✔hurt yourself hurt someone else inability to care for self Carbamazepine (Tegretol) - ✔✔mood stabilizer indication: bipolar disorder major side effects: CYP 450: (inducer- speeds up metabolism of other drugs) patient education: what 3 medications must have blood draws associated with them? - ✔✔carbamazepine, lithium, valproic acid Mood Disorder Questionnaire - ✔✔Screens for Bipolar Disorder 7+ is a positive screening 4 - 5 might be hypomania how is the PHQ-9 scored - ✔✔ 1 - 4 minimal depression 5 - 9 mild depression
What is vagus nerve stimulation? - ✔✔--For Tx of treatment-resistant MDD implantation of a device that causes intermittent electrical stimulation of vagus nerve What is TMS (transcranial magnetic stimulation)? - ✔✔noninvasive procedure for treatment resistant depression, uses magnetic pulses what is ECT used for? - ✔✔severe depression mania catatonia severe agitation in dementia How is ECT performed? - ✔✔premedication with atropine, followed by general anesthesia and administration of a muscle relaxant. a generalized seizure is then induced by passing a current of electricity across the brain. seizure lasts <1min
Steady state generally achieved in 5 days Check lithium dosing 8-12 hours after previous dose Signs of toxicity: T wave flattening, renal toxicity, hyperreflexia, coarse tremor, nystagmus, delirium Treat toxicity: HEMODIALYSIS Valproic Acid (Depakote) - ✔✔Antiseizure med. Precautions/interactions: contraindicated in liver disease, pregnancy. Side effects: hepatotoxicity, teratogenic effects, pancreatitis. Therapeutic window: 50- 100 Peak plasma concentration: 1-4hours Collect trough level just before the next dose (24 hours) Collecting at the 12-hour mark can lead to false high trough level Signs of Depakote toxicity: Cerebral edema, hyperammonemia, hepatotoxicity, electrolyte abnormalities · Supportive therapy for toxicity
What is rapid cycling bipolar disorder? - ✔✔-four or more distinct mood episodes within a 12 month period
Escitalopram (Lexapro) - ✔✔Antidepressant, SSRI: 10-20 mg qd can cause QT prolongation (especially in doses >20mg) minimal drug-drug interactions what medications can cause SIADH? - ✔✔carbamazepine SSRIs amitriptyline morphine how is SIADH reflected in lab values? - ✔✔decreased serum osmolality (increased serum volume) increased urine osmolality (decreased urine volume) what two medications are most likely to cause discontinuation syndrome? - ✔✔paroxetine (paxil) and venlafaxine (effexor) -- short half lives which SSRIs have no sexual side effects - ✔✔mirtazapine, nefazadone, buproprion which antidepressants are more activating? - ✔✔bupropion, venlafaxine, fluoxetine which antidepressants are more sedating? - ✔✔trazodone, TCAs, paroxetine, mirtazapine which antidepressants are more associated with weight gain? - ✔✔Mirtazapine Paroxetine
TCA's which antidepressants might be associated with weight loss? - ✔✔bupropion what antidepressant is useful for nicotine cessation? - ✔✔bupropion what antidepressant might help with methamphetamine withdrawal? - ✔✔mirtazapine what antidepressants might be useful with ADHD? - ✔✔bupropion, venlafaxine which antidepressants might be useful with pain disorders? - ✔✔•Duloxetine •Venlafaxine Amitriptyline which antidepressant might be useful with headaches? - ✔✔amitriptyline which preexisting condition should be avoided in the prescription of bupropion? - ✔✔seizure disorder how does paroxetine interact at the 2d6 site? - ✔✔it is a potent inhibitor and substrate (tons of medication interactions) how could the long half life of fluoxetine been of benefit and risk? - ✔✔benefit: decrease withdrawal/discontinuation symptoms negative: if patient has side effects, long time to get out of system what are the biggest risks in TCAs? - ✔✔cardiotoxic very dangerous in overdose (NO SUICIDAL PATIENTS!)
what antidepressants are more sedating? - ✔✔Paxil, Remeron, TCAs which antidepressants increase appetite? - ✔✔Paxil, Remeron, TCAs, Nardil which antidepressants decrease appetite? - ✔✔Wellbutrin, Prozac, Effexor, Pristiq, Fetzima, Parnate what strategies should be considered for augmentation? - ✔✔•Lithium •Atypical Antipsychotics •Thyroid Hormone •Buspirone •Pindolol •Omega-3 Fatty Acids (Lovaza) •SAMe (S-adenosyl-l-methionine) •L-methylfolate (Deplin) •Modafinil •Stimulants •Light Therapy behavioral therapy - ✔✔focuses on changing behavior by identifying problem behaviors, replacing them with appropriate behaviors, and using rewards or other consequences to make the changes •Behavioural therapy is based on the concept that a deficit of 'reinforcers', such as pleasant activities and positive interpersonal contacts, leaves patients vulnerable to depression •Sample interventions: increase activity level, structured goal setting, interpersonal skills training interpersonal therapy - ✔✔treatment that strengthens social skills and targets interpersonal problems, conflicts, and life transitions
•patients who have experienced a previous positive response to ECT, and patients who prefer ECT for a specific reason. what are the recommendations for VNS? - ✔✔•VNS may be an option in patients with depression with insufficient response to trials of pharmacotherapy. what is the recommendation for TMS? - ✔✔there is currently insufficient evidence to recommend the clinical efficacy of TMS in the standard clinical setting. Further research is needed What is Carbamazepine used for? - ✔✔-Especially useful in Txing mixed episodes and rapid-cycling bipolar DO, less effective for depressed phase what blood tests should be done when taking carbamazepine? - ✔✔kidney, liver, TSH, and CBC what major side effects can be associated with carbamazepine? - ✔✔SIADH aplastic anemia leukocytosis what is the dosage range of carbamazepine? - ✔✔ 400 - 1200mg/day what is the starting dose of carbamazepine? - ✔✔200mg BID (titrate up by 200mg each week) what is the CYP 450 of carbamazepine? - ✔✔3a4: substrate and inducer (induces self- requiring higher dosing) renally excreted what birth defects might be associated with carbamazepine? - ✔✔neural tube defects What is escitalopram used for? - ✔✔GAD , depression
what are the most common side effects of escitalopram? - ✔✔GI upset, sexual dysfunction what is the standard dosing range of escitalopram? - ✔✔ 10 - 20mg/day what is the starting dose of escitalopram? - ✔✔10mg/day what is the CYP 450 of escitalopram? - ✔✔minimal; minimal drug interactions What is fluoxetine used for? - ✔✔depression, PMDD, OCD GAD/panic disorder (possibly) is fluoxetine activating or sedating? - ✔✔activating; good for patient who has a hard time getting out of bed what is the dosage range of fluoxetine? - ✔✔ 20 - 80mg/day what is the starting dose of fluoxetine? - ✔✔20mg in the AM how long is the half life of fluoxetine? - ✔✔long- approx 10-14 days what is the CYP 450 of fluoxetine? - ✔✔inhibits 2d6 and 3a when can an MAOI be started after fluoxetine use? - ✔✔5 weeks who would you consider for fluoxetine use? - ✔✔atypical depression (hypersomnia, hyperphagia, low energy, mood reactivity)
what is the dosage range for sertraline? - ✔✔ 50 - 200mg/day what is the starting dose of sertraline? - ✔✔50mg/day how does sertraline affect CYP 450? - ✔✔minimally (2d6, 3A4) who might sertraline be good for? - ✔✔atypical depression What is lamotrigine used for? - ✔✔MOOD STABILIZER
bipolar disorder good for mania what tests should be used in lithium? - ✔✔TSH and kidney function what should the plasma level of lithium be? - ✔✔0.6-1.2 mEq/L what are the most common side effects of lithium? - ✔✔weight gain, sedation