Janey, Kevin,

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Major Depression Bipolar Disorder

• Janey, Kevin, Brittany

2
Ch 15 Major Depression

• MDD vs Bipolar
• Depression is an affective disorder characterized
  by loss of interest or pleasure
• Bipolar disorder (manic-depressive disorder) is
  characterized by recurrent episodes of mania and
  depression

3
Ch 15 Major Depression

• Depression and the Brain
• Deficiencies in the brain catecholamines(norepinep
  hrine and dopamine) are thought to underlie major
  depressive episodes while acute drug-induced
  increases correlate with relief from depression
• inconsistencies in the pattern have also been
  found

4
Ch 15 Major Depression

• Effects of Antidepressants
• Antidepressasnt drugs may increase the
  sensitivity of post-synaptic catecholamine and
  serotonin receptors and may decrease the
  sensitivity of presynaptic receptor sites. The
  net effect is the reregulation of an abnormal
  receptor-neurotransmitter relationship speeding
  up the patients natural recovery process from
  the depressive episode by normalizing
  neurotransmitter efficacy. Stress and other
  insults to the brain decrease the expression of
  BDNF, which leads to atrophy of vulnerable
  neurons in the hippocampus and cerebral cortex
  Antidepressant drugs must work to reverse the
  atrophy

5
Ch 15 Major Depression

• Seven Classes of Antidepressants
• 1. Tricyclic Antidepressants
• 2. Atypical Antidepressants
• 3. SSRIs
• 4. Dual-Action Antidepressants
• 5. MAOIs
• 6. COMT Inhibitors
• 7 SNRIs

6
Ch 15 Major Depression

• Imipramine vs Fluxetine
• Imipramine is a tricyclic antidepressant that
  blocks the presynaptic transporter of protein
  receptor for either dopamine or norepinephrine
• Fluoxetine (Prozac) was the first SSRI-type
  antidepressant available in the U.S. It blocks
  the function of the presynaptic transporter for
  serotonin reuptake, but does not appear to block
  reuptake of other neurotransmitter to any
  significant degree

7
Ch 15 Major Depression

• Tricyclics and Overdosing
• The patient that overdoses on tricyclics exhibits
  excitement, delirium, and convulsions, followed
  by respiratory depression and coma, which can
  persist for several days. TCAs are also
  cardiotoxic and potentially fatal.
• Whos at risk?
• Children, adolescents and the severely depressed
  (suicidal) are particularly at risk

8
Ch 15 Major Depression

• Side effects of SSRIs
• Anxiety, agitation, and insomnia
• Serotonin Syndrome?
• Occurs when SSRIs are taken in high doses or
  combined with other drugs. Increased central
  accumulation of serotonin leads to an exaggerated
  response, characterized by alterations in
  cognition (disorientation, confusion, hypomania),
  behavior (agitation, restlessness), autonomic
  nervous system functions (fever, shivering,
  chills, sweating, diarrhea, hypertension,
  tachycardia), and neuromuscular activity (ataxia,
  increased reflexes, myoclonus)

9
Ch 15 Major Depression

• Serotonin Withdrawal Syndrome
• characterized by disequilibrium (dizziness,
  vertigo, ataxia) gastrointestinal symptoms
  (nausea, vomiting, diarrhea) flu-like symptoms
  (fatigue, lethargy, myalgia, chills) sensory
  disturbances (paresthesia, sensation of electric
  shocks) sleep disturbances (insomnia, vivid
  dreams)
• psychological symptoms include anxiety,
  agitation, crying spells and irritability
• sexual dysfunction occurs in about 60 of patients

10
Ch 15 Major Depression

• Antidepressants and Children
• TCAs are considered no more effective than
  placebo for MDD
• SSRIs have efficacy in treatment for 13
  different conditions including depression and OCD
• Antidepressants and Anxiety Disorders
• TCAs, MAOIs, SSRIs and venlafaxine XR
  (effexor) are all in use for anxiety disorders.
  The newer antidepressant-anxiolytic drugs are
  equally or more efficacious than
  benzodiazepine-type. They are less prone to
  compulsive abuse but impair learning, memory and
  concentration to a lesser degree than do the
  benzodiazepines

11
Ch 15 Major Depression

• What is DHEA?
• DHEA is a major glucocorticoid hormone secreted
  by the adrenal glands
• It has been promoted (with minimal evidence) to
  prevent heart disease, cancer, diabetes, obesity,
  dementia, aging, multiple sclerosis, and lupus
  it increases feelings of physical and
  psychological well being. DHEA, but not placebo,
  exerted a robust effect on mood, improving low
  energy, anhedonia, lack of motivation, emotional
  flattening (numbness), sadness, excessive worry
  and inability to cope.
• Potential side effects include acne, male-pattern
  baldness, hirsutism, voice changes. Also may
  cause breast or prostate cancer and liver damage