Drugs Used for mood disorders

1. MOOD DISORDERS

2. • Elevation/depression in mood over a period of time
that affects the ability of a person to function.
• Can lead to suicides and impair social and
occupational functioning.
Mood disorders

3. • Major depression
• Bipolar disorder
2 common types

4. • Mood disorder in which the patient has one/more
episodes of major depression but has no history
of mania episodes.
Major depression

5. • Occurs more frequently in women than men, women
having a lifetime risk of 1.7-2.7 times higher than men
• Highest risk of depression occurs in adults ages 25-44,
although depression may occur at any age
A. Epidemiology

6. • GENETIC THEORIES
-people who have parent/sibling w/ history of depression
have greater risk of having depression than the general
population
B. Pathophysiology

7. • BIOGENIC AMINE THEORY
-depression is assoc. w/ decreased levels of
norepinephrine, serotonin & dopamine in the brain.
• DYSREGULATION THEORY
-impaired homeostasis of NE, 5-HT, & DA in the brain is
assoc. w/ depression rather than their absolute levels.
B. Pathophysiology

10. Upon major depressive episodes, patients should
experience at least five/more persistent
symptoms for at least 2 weeks.
C. Diagnosis & clinical features

11. C. Diagnosis & clinical features

12.  Symptoms impair social and occupational functioning
and should not related to a general medical
condition/substance abuse.
 Patients w/ excessive sedation, increased appetite, wt.
gain, and agitation are classified as experiencing atypical
depression.
C. Diagnosis & clinical features

13. • 2 common options(pharmacotherapy, psychotherapy)
• The choice should be patient specific & influenced by the
severity of symptoms.
D. Treatment options

14. • Aka antidepressants
• Use for mild-severe major depression & produces a
response of 40-70% of patients
• Have similar efficacies but, differ in adverse effects,
MOA, medication interactions & cost.
1. Pharmacotherapy options

15. • MAOIs
• TCAs
• SSRIs
• SNRIs
• Bupropion
• Mirtazapine
• Trazodone
• Nefazodone
1. Pharmacotherapy options

16. • Indications. Patients experiencing atypical depression.
• MOA. MAOIs inhibit monoamine oxidase, w/c is
responsible for the breakdown of neurotransmitters s/a
DA, 5-HT, NE.
• AE. hypertensive crises, serotonin syndrome, orthostatic
hypotension, peripheral edema, wt. gain, & sexual
dysfunction.
Monoamine oxidase inhibitor

20. • Indications. Not usually indicated first-line for the
treatment of depression, should no be used in pt. w/
suicidal ideations, cardiovascular conditions, urinary
retention and severe prostate hypertrophy.
• MOA. TCAs inhibit the reuptake of 5-HT & NE.
• AE. anticholinergic effect, sedation, wt. gain, orthostatic
hypotension, tachycardia, & seizures.
Tricyclic amines

22. • Indications. Considered first line for treatment of
depression, indicated for anxiety, panic disorder, post-traumatic
stress disorder & obsessive compulsive
disorder.
• MOA. SSRIs blocks the reuptake of serotonin.
• AE. Nausea, vomiting, insomnia, somnolence, dry
mouth, sedation, sexual dysfunction, headache & tremor.
Selective serotonin
reuptake inhibitors

23. SSRI

24. • Indications. Use in treatment not only of depression but
also of painful peripheral neuropathies.
• MOA. Inhibit reuptake of 5-HT & NE, increased their
levels.
• AE. Similar to SSRIs assoc. w/
elevations of diastolic blood pressure.
Serotonin & norepinephrine
reuptake inhibitors

25. • Indications. Depression and for smoking cessation.
• MOA. Inhibit reuptake of dopamine.
• AE. Nausea, vomiting, & insomnia.
Bupropion(Wellbutrin)

26. • MOA. Cause an increase in levels of 5-HT & NE.
• AE. Sedation, wt. gain, increase appetite.
Mirtazapine (Remeron)

27. • Indications. Indicated for treatment of depression but not
frequently used because of sedation. Used in low doses for
insomnia in depressed patients.
• MOA. Increase 5-HT.
• AE. Sedation, nausea, & orthostatic hypotension.
Trazodone (Desyrel)

28. • MOA. Blocks reuptake of NE & 5-HT.
• AE. Dry mouth, nausea, constipation, orthostatic
hypotension & sedation
Nefazodone (Serzone)

29. 3 Phases of Treatment
• Acute phase -begins w/ the initiation of therapy until
remission is reached, last b/w 6-12 weeks.
• Continuation phase -begins after remission is reached,
last b/w 6-9 months.
*Medication from the acute phase is continued during this
phase to prevent relapse of depression.
E. Duration of treatment

30. • Maintenance phase –used in patients with high risk of
recurrence of depression, s/a those w/ history of multiple
episodes, suicidal thoughts & severe depression.
These patients should receive MT for 2-3 years & many
may receive life-long therapy.
E. Duration of treatment

31. • Usually started at low doses & slowly titrated
• If patients receive only a partial/no response, other
antidepressants may be consider.
• When changing to another antidepressant agent, caution
should be used to prevent serotonin syndrome.
F. Administration & dosage

32. • FDA has issued a Black box warning for all
antidepressants that an increase in suicidal thoughts &
actions may occur with therapy & that adolescents &
children receiving therapy should be closely monitored.
H. Suicide risk