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39 Cards in this Set
- Front
- Back
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What are the features of Major Depression Disorder (MDD)?
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Depressed mood & markedly diminished interest or pleasure in all, or almost all activities
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What are the features of Dysthymic Disorder?
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Chronically depressed mood
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What are the symptoms of MDD?
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>=5 symptoms of:
1) Depressed mood 2) Diminished interest in activities 3) Weight loss or weight gain 4) Insomnia or Hypersomnia 5) Psychomotor agitation or retardation 6) Fatigue 7) Feelings of worthlessness or guilt 8) Diminished ability to think or concentrate 9) Thoughts of death or suicidal ideation |
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What are the symptoms of Dysthymic Disorder?
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>=2 symptoms of:
1) Depressed mood 2) Diminished interest in activities 3) Weight loss or weight gain 4) Insomnia or Hypersomnia 5) Psychomotor agitation or retardation 6) Fatigue 7) Feelings of worthlessness or guilt 8) Diminished ability to think or concentrate 9) Thoughts of death or suicidal ideation |
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What is the duration of MDD?
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>2 weeks
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What is the duration of Dysthymic Disorder?
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>2 years
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What is "Secondary Depression"?
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Depressive episodes caused by:
a) use of or withdrawal from a drug b) A medical condition [e.g. cancer] c) A situation [e.g. grieving] |
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What is the pathophysiology of Depression?
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A combination of interactions involving:
1) Monoamine Neurotransmitter Function (NE, DOP, 5-HT) 2) Brain Derived Neurotrophic factor 3) Neuroendocrine regulation 4) Neuroimmune regulation 5) Sleep Abnormalities 6) Abnormal Neuronal Circuits |
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What is the Acute Phase of Depression?
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8-12 weeks
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What is the Maintenance Phase of Depression?
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6-24 months
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What is the therapeutic goal of acute phase of depression? (3)
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1) Eliminate Symptoms
2) Restore Psychosocial functioning 3) Prevent Suicide |
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What is the therapeutic goal of maintenance phase of depression? (2)
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1) Return to baseline function and quality of life
2) Prevent Recurrence |
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What are the common NHPS used in Depression? (3)
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1) Omega-3 Fatty Acids
2) S-Adenoxylmethionine (SAMe) 3) St JohnS Wort |
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What are the clinical uses of St Johns Wort? (2)
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1) Mild-Moderate Depression
2) As a Sedative |
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What is the proposed mechanism of St Johns Wort?
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1) Inhibit reuptake of serotonin, dopamine, NA, GABA and L-glutamate
2) Increased serotonin receptors 3) Weak MAO inhibiting effects [in-vitro only] |
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What are the pharmacokinetics of St Johns Wort?
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B/A: 14% Peak: 2-6hrs T1/2: 24-36hours
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What is the recommended dose for St Johns Wort?
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300mg TID increase dose to 1200-1800 mg/day after 2 weeks if no response.
Take in AM if causes sleep disturbances. |
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What is the summary of efficacy for St Johns Wort for Depression?
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MA for RCT: Effective for mild-moderate depression; better than placebo as effective as convential medications.
NO studies for Augmentation. |
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Is St Johns Wort Recommended in pregnancy and lactation?
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Limited Human Date - Probably compatible
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What are the ADRs of St Johns Wort?
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Insomnia, Skin Rash, GI symptoms, Phototoxcity, Serotonin Syndrome, Withdrawal Symptoms, Photosensitivity and Few cases of Bipolar disorder (mania)
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What are the relevant drug interactions in St Johns Wort?
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1) Strong Inducer of PGP or CYP3A4
2) Serotonergic Drugs 3) Metformin |
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What are the contraindications to taking St Johns Wort?
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"Do not use if you are taking anti-cancer medications, blood thinners, antidepressants medications (SSRI), anti-HIV agents, CV medications, immunosuppressants and/or contraceptive medications"
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What are sources of Omega-3 Fatty acids?
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1) Fish Oils: (Salmon, anchovy, sardine and/or mackerel)
a) Eicosapentaenoic acid (EPA) b) Docosahexanoic acid (DHA) 2) Cod Liver Oil: Generally contains less EPA and DHA per gram. But also has vit D and vit A |
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What is the proposed mechanism of Omega-3 fatty acids?
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a) Reduces inflammatory eicosanoids
b) Increased synaptic plasticity, neurotransmission c) Membrane integrity and fluidity d) Receptor function, neurotransmitter levels 5-HT, DOP and metabolism of monoamines. |
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What is the proposed mechanism of DHA?
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Membrane integrity, neuronal excitability and synaptic function
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What is the summary of efficacy for Omega-3 fatty acids for depression?
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MA: Effective vs. Placebo; no studies versus convential different conclusions.
Augmentation: Preliminary evidence only. |
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What are the ADRs of Omega-3 fatty acids?
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GI Symptoms and safety long term.
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What are some of the precautions of Omega-3 fatty acids? (3)
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1) Mercury Contamination [some species of fishes, negligible/undetectable levels in fish oil supplements]
2) Cancer [while 3 cases of polyps developed, most studies show it has anti-colorectal cancer activity] 3) Bipolar Disorder [reports of mania; decreased bipolar symptoms] |
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Are Omega-3 fatty acids recommended in pregnancy or lactation?
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Compatible
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What are the relevant drug interactions for Omega-3 fatty acids?
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Increases bleeding risk with anticoagulants and anti-platelet agents with larger doses
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What are the uses of S-Adenosyl-L-methionine? (2)
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1) Depression
2) Anxiety Osteoarthritis |
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What are the sources of SAMe?
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1) Amino acid derivative synthesized in the body from ATP and Methionine (linked to vit B12 and folate metabolism)
2) Also protein food sources |
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What is the proposed mechanism of SAMe in depression?
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a) Methyl donor to neurotransmitters, hormone, phospolipids
b) Increased serotonin turnover c) Increased NorEpinephrine and Dopamine levels d) Normalize histamine levels in the brain e) Alters cellular membrane fluidity --> Facilitation of signal transduction across the membrane |
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What is the recommended dose for SAMe?
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400-800mg PO BID with meals
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What is summary of efficacy for SAMe?
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MA: Superior to placebo, comparable to convential therapy/TCAs (imipramine) Augmentation to SSRIs: Preliminary Evidence
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What are the ADRs of SAMe?
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GI Symptoms, Skin Rash, Headache, Safety Long Term.
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Is SAMe recommended in pregnancy and lactation?
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Insufficient evidence, probably compatible
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What are the relevant drug interactions for SAMe?
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None reported
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What is the major adherence issue of SAMe?
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The Cost: 125-500 dollars/90 days
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