[ Psychiatric ] Mood disorders 3

Imipramine – indication

Nocturnal enuresis.

TCA side effects – by receptor

Antihistaminic (sedation, weight gain), anticholinergic (dry mouth, tachycardia), and α1-blocking (orthostatic hypotension).

TCA overdose – features

Convulsions, coma, cardiotoxicity, hyperthermia, and hypotension.

TCA overdose – treatment

Sodium bicarbonate.

Bupropion – mechanism and extra use

Inhibits NE and DA reuptake, also used for smoking cessation.

Bupropion – sexual side effects

Low risk (sexually happy).

Bupropion – side effects

Stimulant effects, headache, weight loss, and seizures (lowers seizure threshold).

Bupropion – patients at seizure risk

Bulimia and anorexia nervosa patients.

Mirtazapine – mechanism

α2 antagonist (increases NE and 5-HT release).

Mirtazapine – side effects

Sedation and increased appetite with weight gain.

Trazodone – main use

Insomnia.

Trazodone – side effects

Sedation, nausea, and priapism.

ECT – indications

Refractory cases or life-threatening symptoms (suicidality), in depression, bipolar mania, and psychotic disorders.

ECT – side effects

Reversible amnesia (retrograde and anterograde) and tension headache.

Bipolar disorder – genetics

1st degree relatives have 10 times the risk, monozygotic twin concordance 40 to 70%.

Bipolar 1 vs bipolar 2

Bipolar 1 needs at least 1 manic episode, bipolar 2 has hypomanic and depressive episodes with no manic episode.

Bipolar disorder – treatment

Mood stabilizers (lithium, 1st line) and atypical antipsychotics, avoid antidepressants alone as they can cause mania.

Cyclothymic disorder – duration

2 years or more.

Lithium – role

1st line (gold standard) mood stabilizer, used for acute mania.

Lithium – mechanism

Decreases excitatory and increases inhibitory neurotransmission.