Prevalent enough
that some state
agencies mandate
all new mothers
receive info about
mood shifts
Seasonal
effective
disorder
Enhanced release
of melatonin r/t
lower lvls of
natural light.
May be relieved
w/light therapy
Psychotic
depression
Expression of
intense mood
shifts and unusual
behaviors.
Depressive signs,
loss of contact with
reality,
hallucinations,
delusions, and
disorganized
speech.
Assessment & treatment
Corticosteroids, levodopa,
and oral contraceptives can
cause similar symptoms to
depression
Rule out this
possibility in health
exam
Medical and neurologic
disorders can also
cause depressive
symptoms.
This too
Ask about alcohol
& drug use, family
history.
Therapy:
Interpersonal:
Focuses on
pt/ disturbed
relationships
Cognitive-behavioral
therapy:
Help pt, change
negative styles of
thought &
behavior.
Psychodynamic:
Focus on
resolving pt.
internal conflict.
Postponed until
symptoms are
significantly
improved
Electroconvulsive therapy
is useful when therapy
fails.
Over 70% show
improvement
Transcranial magnetic
stimulation may be an
effective somatic treatment.
Surgical implant that
does not effect memory,
require general
anesthetic, and is helpful
w/o overt risk of
generalized seizures
Antidepressants
Depression & anxiety
are caused by similar
neurotransmitter
dysfunction.
Can also treat some
pain
Closely monitor for
warning signs of
suicide, especially at
beginning of
treatment.
Children to young
adults are at greater
risk.
Also monitor for
anxiety, panic
attacks, agitation,
irritability, insomnia,
impulsivity, hostility,
and mania.
Exerts effects
through action on
norepinephrine,
serotonin, and
dopamine.
Will either block
breakdown of
norepinephrine
or slow reuptake
of serotonin and
norepinephrine
Selective serotonin
repuptake inhibitors
(SSRIs)
Same efficacy as
MAOIs and TCAs
Advantage: greater
safety profile, less
sympathomimetic and
anticholinergic effects,
no cardiotoxicity.
Makes presynaptic
neurons less sensitive to
serotonin, but
postsynaptic more
sensitive
All drugs have equal efficacy
and similar side effects.
Most common side effect is
impotence.
Serotonin syndrome
can result when
combining an SSRi w/
an MAOI, a TCA,
lithium, or any number
of drugs
Signs include confusion,
anxiety, restlesness,
hypertension, tremors,
sweating, hyperpyrexia, or
ataxia.
Serotonin is found in high
concentrations in
hypothalamus, limbic system ,
medulla, and spinal cord
Functions in cycling btwn REM and
NREM sleep, pain perception &
emotion
Inadequate amounts cause
depression
Atypical
antidepressants
Serotonin-norepinephrine
reuptake
inhibitors:
Includes duloxetine
(Cymbalta) and
venlafaxine
(Effexor)
In many cases
dopamine is also
affected.
Duloxetine is also
approved for GAD and
neuropathic pain
Venlafaxine is also
approved for GAD.
Bupropion
(Wellbutrin)
Reuptakes
serotonin and
affects activity of
norepinephrine
and dopamine
Contraindicated
in pt. w/seizure
disorder
Mirtazapine
(Remeron)
Blocks
presynaptic
serotonin and
norepinephrine
receptors
Nefazodone
Similar to
mirtazapine
Causes minimal CV
effects, fewer
anticholinergic
effects, less sedation,
and less sexual
dysfunction, but does
cause hepatotoxicity
Trazodone
(Oleptro)
Used to treat
insomnia b/c high
levels are needed
for depression, and
that causes
sedation
Tricyclic
antidepressnats
Inhibits presynaptic
reuptake of
norepinephrine and
serotonin
Safer than MAOIs, but
side effects still include
orthostatic
hypotension, cardiac
dysrhythmia, dry
mouth, constipation,
blurred vision, and
tachycardia.
Most have a long
half life, increasing
side effect risk.
Significant
interactions w/ CNS
depressants,
sympathomimetics,
anticolinergics, and
MAOIs.
Clomipramine
(Anafranil) is used
for OCD
Doexpin (Sinequan)
is for GAD,
neuropathic pain,
and fibromyalgia
Some are used off label
for panic disorder and
social anxiety. Can be
used for childhood bed
wetting too.
Monoamine
oxidase
inhibitors
Decreases
effectiveness of
MAO, thus
limiting
breakdown of
norepinephrine,
epinephrine,
dopamine, and
serotonin
B/c of interactions ,
hepatotoxicity, and
safer meds, these are
reserved for pt.
unresponsive to
conventional
treatment.
Common side effects
are orthostatic
hypotension,
headache, insomnia,
and diarrhea.
Hypertensive crisis can
occur w/antidepressants
and sympathomimetic
drugs.
Serotonin syndrome
can occur when
combined w/SSRIs
Severe
hypotension when
combined
w/antihypertensives
Potentiates
hypoglycemic effects of
insulin &oral
antidiabetic drugs
When taken
w/meperidine,
dextromethorphan, or
TCAs, hyperpyrexia
can occur
Hypertensive crisis
can occur when
combined w/foods
containing tyramine.
Tyramine is degraded
by MAO in intestines,
but if MAO is
inhibited, it enters the
bloodstream in high
concentrations and
displaces
norepinephrine within
presynaptic nerve
terminals.
Results in sudden
release of
norepinephrine.
Occipital headache,
stiff neck, flushing,
palpations,
diaphoresis, and
nausea are
symptoms.
Mi and stroke can
happen.
Calcium
channel
blockers can be
given as an
antidote.