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Mood Disorders

Mood Disorders. Lesson 24. Mood Disorders. Unipolar depression Mania Bipolar disorder Seasonal Affective Disorder (SAD) ~. Unipolar Depression. Extreme sadness & despair extent & duration important Prevalence females 9-26% males 5-12% 2:1 females ~. Unipolar Depression.

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Mood Disorders

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  1. Mood Disorders Lesson 24

  2. Mood Disorders • Unipolar depression • Mania • Bipolar disorder • Seasonal Affective Disorder (SAD) ~

  3. Unipolar Depression • Extreme sadness & despair • extent & duration important • Prevalence • females 9-26% • males 5-12% • 2:1 females ~

  4. Unipolar Depression • endogenous vs. reactive • Genetic component • DZ twins  25% concordance • MZ twins  70% concordance

  5. Diagnosis & Symptoms • Disrupted eating & sleeping • increased or decreased • Impaired concentration • Changes in activity • increased or decreased • Feelings of guilt / worthlessness • Preoccupation w/ death or suicide ~

  6. Diagnosis & Symptoms • NOT • uncomplicated bereavement • organic • Diagnosis • 5 of 9 symptoms • not complete list • duration > 2 weeks ~

  7. Treatment • Psychotherapy • Drug Therapy • Electroconvulsive-shock Therapy • Sleep Deprivation • Light Therapy ~

  8. Etiology • Catecholamine hypothesis • DA & NE • deficiency • Evidence from drug side effects • Produce depression • reserpine – monoamines • propranalol - NE antagonist ~

  9. Monoamine Hypothesis • Fluoxetine (Prozac) • therapeutic effects • blocks 5-HT reuptake • 5-HT modulates other NTs? • usually more than one NT involved ~

  10. Drug Treatment • Monoamine oxidase inhibitors – MAOIs • NT not degraded • more NT in synapse • Cheese effect • foods with tyramine • metabolism  amphetamine-like • risk of cerebral hemorrhage ~

  11. Tricyclic Antidepressants • Indirect agonists • block monoamine reuptake • imipramine, desipramine • Side effects • Sympathetic arousal • Possible overdose ~

  12. SSRIs • Selective serotonin reuptake inhibitors • Prozac (fluoxetine) • Zoloft (sertraline) • Paxil (paroxetine) • Luvox (fluvoxamine) • blocks 5-HT reuptake • Less effect on NE & DA ~

  13. SSRIs vs Tricyclics • Fewer side effects • less danger of overdose • As effective as tricyclics • Neither addictive • Animals don’t self-administer • negative reinforcement ~

  14. Criticisms • Immediate effects on NT level • Therapeutic effects  2-4 weeks • Explanation? • Compensatory responses • Autoreceptor desensitization ~

  15. Tetracyclic Antidepressants • Block reuptake & autoreceptors • Faster therapeutic effects? • yes... • but still a delay ~

  16. Other Selective Reuptake Inhibitors • Norepinephrine Dopamine Reuptake Inhibitor (NDRI) • bupropion (Welbutrin) • Also tx bipolar & Smoking cessation (Zyban) • Side fx • less sexual dysfuntion than SSRI • Insomnia • seizures - 150 mg/dose limit • no subjective euphoria, abuse ~

  17. Other Selective Reuptake Inhibitors • Selective Serotonin Norepinephrine Reuptake Inhibitor (SNRI) • venlafaxine (Effexor) • Serotonin-2 Antagonists/Reuptake Inhibitors (SARI) • Trazodone (Desyrel) • 5HT2 –R: autoreceptor • Anxiety disorders, bulimia • Off-label use of antidepressants • wide variety of disorders ~

  18. Electroconvulsive Therapy - ECT • Rapid effects - few days • Indications • drug therapy ineffective • danger of suicide • Risk of drug interactions • Mechanisms unknown ~

  19. Sleep Deprivation • Depression  Early & frequent REM • Tricyclics inhibit REM • REM deprivation • gradual therapeutic effects • Total sleep deprivation • immediate therapeutic effects • Mechanisms unknown ~

  20. Mania & Bipolar • Mania Symptoms • Euphoria • grandiose plans • reduced need for sleep • high risk activities • Bipolar Disorder • Cycling between mania & depression ~

  21. Etiology • Induced by drugs • Monoamine agonists • cocaine, amphetamine, antidepressants • Mostly NE & DA ~

  22. Treatment: Mania & Bipolar • Lithium most common • Dangerous, but thresholds well known • Mechanism unknown • affects almost all NTs • Also • Anticonvulsants • atypical neuroleptics ~

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