Depressive disorders

• What are the most common symptoms of depression?

• Sad

• Empty

• Irritable mood

• Is depression more common in men or women?

• Women

• What are the manifestations of depression and how many do you have to have and how many weeks do you need signs?

• Depressed mood

• 5 of following symptoms (at least 2 wks)

  • Sleep to little/much

  • No energy

  • Abnormal eating patterns

  • Vague physical symptoms

  • Inability to concentrate

  • Feelings of despair

  • Obsessed with death

  • Avoiding interpersonal interactions

  • Lack of interest in appearance or sex

  • Delusions or hallucinations

• What is the cause of depression?

• Monoamine hypothesis

• HPA axis dysregulation

• Immunological issues

• Genetic and environmental factors

• What is the Monoamine hypothesis?

• Imbalance of norepinerine, serotonin and dopamine

• What is treatment for depression?

• Therapy

• Pharmacologic treatment

• Electroconvulsive therapy (ECT)

• What are the antipressent classes?

• Selective serotonin reuptake inhibitors (SSRIs)

• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

• Atypical antidepressants

• Tricyclic antidepressants (TCAs)

• Monoamine oxidase inhibitors (MAOIs)

• What is some general information about antidepressants?

• Taken daily to establish therapeutic blood level

• Can take 2-6 weeks for full effect

• During 6 week period client has higher risk of suicidal ideation

• What to be cautious of in use of antidepressants?

• Elderly

• Cardia

• Liver

• Kidney

• Alcohol problems

• Herbs

• Multiple meds

• What drug is an SSRI?

• Escitalopram (lexapro)

• Sertraline (Zoloft)

• Fluoxetine (Prozac)

• What is the action of SSRI?

• Blocks the reabsorption of serotonin in synaptic cleft and increases availability of serotonin

• What are SSRI used for?

• Depression

• Anxiety disorders

• Migraines

• What are the side effects of SSRI?

• CNS stimulation

  • Headache

  • Insomnia

  • Agitation

  • Restlessness

  • Tremors 

  • Seizures

• Weight loss (early) Weight gain (later)

• Sexual dysfunction

• GI irritation/bleeding

• Drowsiness

• Lightheadedness

• Suicidal ideation

• What is Serotonin syndrome?

• Life threatening reaction to excess of serotonin

• What are the mild symptoms of serotonin syndrome?

• Mydriasis (dilation of the pupil of the eye)

• Shivering

• Sweating

• Tachycardia

• What are the moderate symptoms of serotonin syndrome?

• Altered mental status

• Autonomic hyperactivity

• Neuromuscular abnormalities

• What are the life threatening symptoms of serotonin syndrome?

• Delrium

• Hypertension

• Hyperthermia

• Muscle rigidity

• Tachycardia

• What are the contraindications of SSRI?

• Concurrent use of MAOIs and TCAs

• What are the precautions of SSRI?

• Cardiac

• Liver

• Kidney

• Disease

• Seizure

• Gi bleeding

• What are the interactions of SSRI?

• MAOIs

• TCA

• Lithium

• St Johns wart

• Warfarin

• NSAIDS

• What drug is an SNRI?

• Venlafaxine (Effesor)

• Duloxetine (Cymbalta)

• What is SNRI action?

• Blocks reuptake of of norepinephrine and serotonin

• What is SNRI use?

• Depression

• Anxiety disorders

• Neuropathic pain conditions

• Fibromyalgia

• Chronic back pain

• Diabetic neuropathy

• What are the side effects of SNRI?

• CNS Stimulation

  • Headache

  • Insomnia

  • Agitation

  • Restlessness

  • Tremors 

  • Seizures

• Sexual dysfunction

• Nausea

• Weight loss

• Hypertension

• Tachcardia

• Serotonin syndrome

• What drugs are TCAs?

• Amitryptaline (Elavil)

• Doxepin (Sinequan)

• What is the action of TCAs?

• Blocks reuptake of serotonin and norepinephrine 

• But also blocks

  • H1

  • SNS

  • PNS

• What are the uses of TCAs?

• Depression

• Depression in bipolar

• Anxiety

• OCD

• ADHD

• Neuropathic pain

• Fibromyalgia

• Migraine prevention

• What are the side effects of TCAs?

• Orthostatic hypotension

• Antichlorinic effects

  • Dry

  • Tured 

  • Tachcardia

• Sedation

• Blood dyscrasias

• Cardiac toxicity

• Dysthrymias

• Confusion

• Agitation

• Coma death

• What are the contraindications of TCAs?

• Seizure disorder

• Recent MI

• MAOIs

• What are the precautions of TCAs?

• Those who are sensitive to anticholinergic effects

• Cardia

• Respiratory

• Glaucoma

• Urinary retention

• What is the interaction of TCAs?

• Serotonin blockers

• Anticholinergics

• Antihistamines

• CNS depressants

• Epinephrine and dopamine drugs

• What drugs are Monoamine oxidase inhibitors (MAOIs)?

• Phenelzine (Nardil)

• Isocarboxazid(Marplan)

• What is the action of MAOIs?

Monoamine oxidase enzyme inactivates and breaks down norepinephrine, dopamine, epinephrine and serotonin. And the medication inhibits breaking down of these enzymes leading to higher levels of these neurotransmitters

• What are MAOIs used for?

• Depression

• Anxiety disorders

• Not used frequently cause causes a lot of problems

• What are the side effects of MAOIs?

• CNS Stimulation

  • Headache

  • Insomnia

  • Agitation

  • Restlessness

  • Tremors 

  • Seizures

• Orthostatic hypotension

• Hypertensisive crisis

  • Headache

  • Nausea

  • Tachycardia

• What are the contraindications of  MAOIs?

• Cardiac disease

• Adrenal tumors

• Renal insufficiency

• SSRI and other antidepressants

• What are the interactions of  MAOIs?

• Food high in tyramine

• Medication that require MAO for breakdown

• How to tell effectiveness of antidepressants/

• Client verbalizes relief of depressive symptoms

• Increased participation in ADL

• Interest in social participation

• Improved sleeping and eating habits