This document discusses mood disorders such as major depression and bipolar disorder. It covers their symptoms, epidemiology, pathophysiology, diagnosis, treatment options and duration. The two most common types of mood disorders are major depression, which involves one or more depressive episodes without mania, and bipolar disorder. Treatment involves pharmacotherapy, usually antidepressants from classes like SSRIs, SNRIs and TCAs, as well as psychotherapy. Treatment duration is divided into acute, continuation and maintenance phases to prevent relapse.

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