Topic 2 Depression

• Duloxetine is used for depression and anxiety. It also helps treat nerve pain associated with Diabetes.
• Depressive Disorders Theories

  • Biological and Endocrine Theories
  • Psychosocial Theories
  • Cognitive Theory
  • Learned Helplessness / Hopelessness Theory
• What alterations are in biological and endocrine depressive disorder theories?

  • Neurochemical
  • Genetics
  • Endocrine function
  • Circadian rhythm function
• Based on psychosocial theories, depression results from cultural and ethnical perspectives.
• Based on cognitive theory, depression results from a low tolerance to stress, stress and stressful situations that are interpreted as negative.
• Depression from feelings of helplessness and unworthiness are from which theory?

  Learned helplessness / hopelessness
• Diathesis-stress model says that psychosocial stressors and interpersonal events can trigger neurophysical and neurochemical changes in the brain.
• What are the major depressive disorders?

  • Disruptive Mood Dysregulation Disorder (DMDD)
  • Major Depressive Disorder (MDD)
  • Persistent Depressive Disorder (Dysthymia)
  • Premenstrual Dysphoric Disorder (PDD)
  • Substance / Medication Induced Depressive Disorder
  • Unspecified Depressive Disorders
• What does it take for the DSM-5 to diagnose you with Major Depressive Disorder?

  Five or more symptoms present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure.
• Mental Health Parity Act (1996)

  Insurance must cover mental illness the same as other conditions.
• Affordable Care Act (ACA) - A federal law that expanded health insurance coverage to millions of Americans


  Banned annual dollar limits and eliminated pre-existing condition exclusions.
• Mental disorders with strong biological influences

  • Schizophrenia
  • Bipolar
  • Major depression
  • Obsessive - compulsive and panic
  • Post traumatic stress
  • Autism
  • Anorexia nervosa
  • Attention deficit / hyperactivity
• Freud's Psychoanalytic Therapy

  Reveal unconscious mind and repressed memories, free association, psychodynamic therapy, transference and countertransference.
• Interpersonal Theory says that the purpose of all behavior is to get needs met through personal interactions and to decrease or avoid anxiety.
• Interpersonal Theory focuses on 


  current interpersonal relationships and social supports, the therapist is the problem solver, it primarily treats depression, lasts about 12 - 20 sessions (short term) and it does so by showing new patterns of communication and expectations for relationships.
• What did Pavlov's theory focus on?

  Classical conditioning.
• What did Watson's behaviorism theory focus on?

  Controlling the environment could mold behavior and anyone can be trained to be anything.
• What did Skinner's theory focus on?

  Behavior and its reinforcement.
• How do TCAs work?

  TCAs work by blocking the reuptake of neurotransmitters such as serotonin and norepinephrine, increasing availability at postsynaptic receptor sites.
• Which drug is used for childhood enuresis?

  Imipramine.
• Clomipramine is used for which condition?

  OCD.
• Stop TCAs how many days before surgery?

  2 - 3 days.
• How do SNRIs work?

  Inhibits serotonin and norepinephrine reuptake in the CNS. Both antidepressant and pain inhibition are centrally mediated.
• What are SNRIs used for?

  Major depressive disorder, managing peripheral neuropathy in diabetic patients (fibromyalgia, neuropathy pain)
• What is the main drug for SNRIs for this class?

  Duloxetine
• What is Ziprasidone?

  Antipsychotic, used also for acute agitation and schizophrenia. Treatment of acute manic or mixed episodes associated with BPD.
• What is Zyban used for?

  Smoking cessation.
• What is Buproprion used for?

  Depression, ADHD
• What are some warnings about SSRIs?

  Discontinue with dizziness, insomnia and taper off slowly.
• What are some side effects of SSRIs?

  Agitation, insomnia, headache, sexual dysfunction, hyponatremia.
• What are some side effects of SNRIs?

  Headache, dry mouth, blurred vision, sweating, reduced appetite, just a bunch of anticholinergic stuff.
• What are some warnings about SNRIs?

  Taper off slowly and can reduce pain associated with depression (Duloxetine for nerve pain)
• What are some side effects of SARIs?

  Sedation, hypotension, anticholinergic reactions.
• What are some warnings about SARIs?

  Priapism, liver failure, serotonin syndrome.
• What are some warnings about Bupropion?

  High doses increase seizure risk.
• How does Bupropion (NDRI) work?

  Blocks reuptake of norepinephrine and dopamine.
• How does Mirtazapine (NaSSA) work?

  Enhances release of norepinephrine and serotonin by blocking alpha 2 adrenergic receptors.
• What are some side effects of Mirtazapine?

  Weight gain, sedation, headache.
• What are some notes about Mirtazapine?

  Antidepressant effects equal SSRIs and can occur faster.
• What are some notes about Mirtazapine?

  Drug induced somnolence can be exaggerated by CNS depressants.