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.