Euphoria - High, Elevated,

Expansive Euthymia - Neutral

Dysphoria - Depressed, Blue, Sad

Manic episode with psychotic features

Manic episode

Hypomanic episode

Depressive episode

Major depressive episode with psychotic features

• Mood disorders don’t necessarily involve a rapid decline in functioning

• Treatment for both major depressive disorder and bipolar disorder involve medications and (usually) psychotherapy

• Untreated mood disorders have the potential to result in vastly diminished level of function along with accompanying crummy life circumstances

- Leading cause of disability ages (15-44)

- 14.8 million or 6.8%

- Median age is 32 - more prevalent in women

Symptoms: (Chronic, mild depression)

Persist for at least two years in adults and one year for children

1.5% of the population age 18 or over (3.3 Million)

Median Age is 31

Two or more of the following – Decreased appetite – Insomnia – Low energy – Low self esteem – Decreased concentration – Feelings of hopelessness

5 or more symptoms present in a 2-week period & are a change from previous functioning; at least 1 of the symptoms is depressed mood or loss of interest or pleasure.

• (S) Insomnia or hypersomnia nearly every day. (Sleep)

• (I) Markedly diminished Interest or pleasure in all or almost all, activities

• (G) feelings of worthlessness or excessive or inappropriate Guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

• (E) fatigue or loss of energy nearly every day (Energy)

• (C) diminished ability to think or Concentrate or indecisiveness, nearly every day (eithe by subjective account or observation by others

• (A) significant weight loss when not dieting or weight gain (Appetite)

• (P) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down.)

• (S) recurrent thoughts of death (not just fear of dying), recurrent Suicidal ideation without a specific plan or a suicide attempt or a specific plan for committing suicide.

AND, the symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning

Depressed Mode SIGECAPS

S- Sleep I- Interest G- Guilt E- Energy C- Concentrate

A- Appetite P- Psychomotor - restlessness or slowed down S- Suicidal

• Same as major depressive disorder but includes delusions and/or hallucinations

• Delusions and hallucinations are mood congruent (i.e., the content of the delusions and hallucinations matches the depressed mood)

Manic Episode

DigFast

lasting at least a week Abnormally, persistently elevated, expansive or irritable mood

– (D) Distractibility

– (I)  Decreased need for sleep (Insomnia)

– (G) Grandiosity

– (F) Flight of ideas

– (A) Increased goal directed Activity

– (S) Pressured Speech

– (T) Excessive involvement in pleasurable activities with potential for painful consequences (Thoughtlessness)

Hypomanic Episode

DIGFAST

A distinct period of persistently elevated expensive or irritable mood lasting throughout at least 4 days that is clearly different from the usual not depressed mood

• during the period of mood disturbance 3 or more of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree 1. (D) distractibility 2. (I) decreased need for sleep 3. (G) Inflated self esteem or grandiosity 4. (F) Flight of ideas 5. (A) increase in goal directed activity 6. (S) more talkative than usual or pressure to keep talking 7. (T) excessive involvement in pleasurable activities that have a high potential for painful consequences

• Symptoms of schizophrenia

• Symptoms of depression, mania or mixed symptoms

• Decreased level of functioning

• Age of onset late: Teens, early adulthood

• ECT: electro convulsive therapy

• Light Therapy

• Psychosurgery

• Seclusion and Restraint

• TMS: trans-cranial magnetic stimulation

• Medications

• fluoxetine (Prozac)

• fluvoxamine (Luvox)

• paroxetine (Paxil)

• sertraline (Zoloft)

• citalopram (Celexa)

• escitalopram (Lexapro)

Low incidence of side effects

– Sexual side effects

– Discontinuation syndrome

– Headache, GI upset, dry mouth, muscle stiffness, akathesia, insomnia (although these tend to go away after a month or two)

• Low lethality in overdose

• No anticholinergic side effects (except for Paroxetine (Paxil)

• Serotonin Syndrome

• Very small possibility of drug-related suicidality

• Venlafaxine (Effexor)

• Desvenlafaxine (Pristiq)

• Duloxetine (Cymbalta) - associated with liver failure

• Treat depression as well as other antidepressants

• Considered to be slightly more energizing or activating

• Sexual side effects similar to SSRIs

• Anticholinergic side effects

Serotonin Norepinephrine Re-uptake Inhibitors (SNRI)

Contradictions

Hypertension may be an issue

Can result in serotonin syndrome if taken in combination

MAOIs in combination with SNRIs can cause hypertensive

SNRIs potentially fatal in overdose

• Atomoxetine (Strattera)

• Reboxetine (Vestra)

• Gingko Biloba

Norepinephrine Reuptake Inhibitors (NRIs)

Usage and Side effects

• Stimulating and hence are used in treating ADHD and narcolepsy

• Relatively few side effects

• Bupropion (Wellbutrin, Zyban)

• Relatively few side effects

– Lowers seizure threshold – hence contraindicated for

individuals with seizure disorder

– No reported instances of sexual side effects

– Not sedating

– No weight gain

– Relatively safe in overdose

Noradrenergic and Specific Serotonergic Antidepressant (NASSA)

• Mirtazapine (Remeron)

– Approximately as effective as other antidepressants

– Slightly faster onset of antidepressant action than

other antidepressants

– Side effects include weight gain, increased appetite,

sedation, dry mouth, constipation, joint/muscle pain

– Discontinuation syndrome calls for slow taper

– Relatively safe in overdose

• Desipramine (Norpramine)

• Imipramine (Tofranil)

• Amitriptyline (Elavil)

• Nortriptyline (Pamelor)

• Doxepin (Sinequan)

• Clomipramine (Anafranil)

Tricyclic Antidepressants (TCAs)

Usage and Side Effects

• Effective antidepressant action

• Anticholinergic side effects

• Cardiac side effects

• High potential for lethal overdose (due to cardiac

side effects)

• Orthostatic hypotension

• Sedating

• Used to be a first line treatment for depression

but have been largely overlooked due to availability of newer agents

• Phenelzine (Nardil)

• Tranylcypromine (Parnate)

• Selegiline (Eldepryl and Emsam)

– Emsam is selegiline in a transdermal patch

• Isocarboxazid (Marplan)

Monoamine Oxidase Inhibitors (MAOIs)

Usage and Side effects

• Interactions caused by tyramine in the diet

• Interact unfavorably with SSRIs, SNRIs, DNRIs, TCAs,

• The most frequent Side effects include orthostatic hypotension,insomnia, weight gain, edema and sexual dysfunction

• High potential for lethal overdose

• Not a first line treatment for depression

Selegiline (Emsam)

MAOI

• Selegiline (Emsam)

– Owing to its being a trandermal patch, dietary and

drug-drug interactions aren’t as much of a concern

since it isn’t absorbed in the gut but rather directly

into the blood-stream

– Serotonin syndrome due to interaction with SSRI

drugs still a concern however

Trazodone (Desyrel)

serotonin antagonist and reuptake inhibitor (SARI)

• Not very effective as an antidepressant

• Very sedating

– typically only used as a PRN for insomnia

• Orthostatic hypotension

• No anti-cholinergic side effects

• May cause priapism at higher doses

• Lithium (Lithium)

• Valproate (Depakote)

• Carbamazepine (Tegretol)

• Oxcarbazepine (Trileptal)

• Lamotragine (Lamictal)

• Topiramate (Topamax)

• First line treatment of mania

• Decreases frequency, severity and duration of

manic episodes

• Reduces risk of suicide

• Reduces impulsivity

• Sometimes used to treatment depression

Lithium

Contradictions

• Excessive dietary sodium decreases the serum

concentraion of lithium

• Not enough dietary sodium increases the serum

concentration of lithium

• Dehydration increases the serum concentration

of lithium

• Lethal in overdose

1. Severe hand shake (tremor)
2. Blurred Vision
3. Stomach ache along with feeling sick and having diarrhoea
4. Being unsteady on their feet
5. Difficulty in speaking or slurring words
6. Muscle twitches
7. Clumsiness
8. Feeling unusually sleepy
9. Confusion
10. Muscle weakness

• First line treatment for mania

• Anticonvulsant

• Useful in treating and preventing acute

mania

• Used for treating depression

• Increases GABA (gamma-aminobutyric acid) levels in the brain

Depakote

Side Effects

• Side effects include weight gain, sedation,

alopecia, nausea, vomiting, diarrhea, tremor

• Side effects can also include liver enzyme

elevations and possible thrombocytopenia

and platelet dysfunction

• Serum concentration levels every week until

dose is stabilized, then every six months

• 50-150 mcg/mL = therapeutic level

• Abrupt discontinuation is not recommended

due to increased seizure risk