NR 547 WEEK 5 2024 QUESTIONS AND ANSWERS (VERIFIED) 100% CORRECT A+ GRADE

Medications for depression - SSRIs SNRIs SDRIs TCAs MAOIs SSRIs - -Action: inhibit 5-HT reuptake -Examples: citalopram, escitalopram, fluoxetine, paroxetine, sertraline -Adverse effects: • nausea • agitation • diarrhea • headache • weight gain • sexual side effects SNRIs - -inhibit 5-HT reuptake -inhibit NE reuptake (↑ energy, focus) -increase DA in prefrontal cortex (↑ cognition) -Examples: desvenlafaxine, duloxetine, levomilnacipran, venlafaxine -Adverse effects: • elevated blood pressure • nausea • sweating • tremors • anxiety • insomnia • constipation • anorexia • sexual dysfunction SDRIs - -inhibit DA reuptake (↑alertness, motivation) -inhibit NE reuptake (↑energy) -Adverse effects: • agitation • headache • dry mouth • constipation • weight loss TCAs - -Action: inhibits the reuptake of serotonin and norepinephrine; blocks norepinephrine, histamine, and acetylcholine receptors -Examples: amitriptyline, clomipramine, desipramine, doxepin -Common Side Effects: • dry mouth • constipation • blurred vision • urinary retention • sedation • weight gain • hypotension • tachycardia • sexual dysfunction MAOIs - -Action: increases norepinephrine and serotonin by inhibiting the enzyme that inactivates it -Examples: isocarboxazid, phenelzine, tranylcypromine -Common Side Effects: • sedation • dizziness • sexual dysfunction • hypertensive crisis Prescribing pearls: citalopram (Celexa) - mild antihistamine effects Prescribing pearls: escitalopram (Lexapro) - no known drug interactions Prescribing pearls: fluoxetine (Prozac) - longest half-life Prescribing pearls: paroxetine (Paxil) - also treats social anxiety and insomnia Prescribing pearls: fluvoxamine (Luvox) - treats anxious depression smokers require increased dose Prescribing pearls: sertraline (Zoloft) - also treats social anxiety and hypersomnolence Prescribing pearls: bupropion (Wellbutrin) - NDRI may improve energy, alertness, and motivation; not first line treatment for anxiety; contraindicated in clients with a history of seizures Prescribing pearls: duloxetine (Cymbalta) - effective for atypical pain at higher doses; appropriate for clients who present with somatic symptoms of depression; effective for atypical pain, such as fibromyalgia and diabetic neuropathy Prescribing pearls: venlafaxine (Effexor) - treats both depression and anxiety disorders, ensure trial of higher dose before switching to a different medication Prescribing pearls: desvenlafaxine (Pristiq) - effective for perimenopausal vasomotor symptoms considered when selecting a medication: - -Client preference -Prior treatment response -Anticipated adverse effects -Comorbidities -Half-life and interactions -Cost if a medication is not achieving efficacy: - -Increase dose gradually -Switch to a different drug within the same class -Switch to drug in a different class -Add a second medication Use to protect against suicide - lithium MDD and BPD genetics - genetic factors contribute 31-42% of the disease risk in MDD and 59-85% in BPD monoamine hypothesis of depression - -posits that depression occurs as a result of a deficiency of one or all three monoamine transmitters • serotonin, norepinephrine, and dopamine -while mania may result from an excess *Emphasis is now shifted from the monoamines to their receptors and other downstream events such as the regulation of gene expression, growth factors, environmental factors, and epigenetic changes - Three principal neurotransmitters -norepinephrine (NE), dopamine (DA), and serotonin 5HT • comprise the monoamine neurotransmitter system • implications for the pathophysiology and treatment of mood disorders • All known pharmacologic treatments for mood disorders act upon one or more of these three neurotransmitters -Many of the symptoms of mood disorders are hypothesized to involve dysfunction of various combinations of the monoamine neurotransmitters Mood disorders include ____________________ and ___________________ - depressive disorders and bipolar disorders Major depressive disorder (MDD) - one of the most prevalent psychiatric disorders -estimated that more than 300 million people suffer from -leading cause of disability worldwide -7.1% of adults and 13.3% of adolescents in the U.S. had at least one major depressive episode -An imbalance of specific neurotransmitters, including dopamine, serotonin, and norepinephrine, can influence brain activity and result in depression -decreased neurotransmitter activity in the prefrontal cortex (PFC) MDD dx - -occurrence of at least one episode of major depression lasting at least two weeks. -must experience 5 or more of the following symptoms in two weeks to be diagnosed with a major depressive episode: • feeling low most of the day for most days • decreased interest in activities • substantial weight loss, significant change in appetite • fidgeting, random movement (i.e. pacing) • decreased energy • sense of guilt or worthlessness • lack of focus or ability to make decisions • repeated thoughts of death and suicide risk factors associated with major depressive disorder (MDD) - female gender older adults with multiple health problems and disabilities non-white populations family history of MDD, suicide attempts and completion, substance abuse history of abuse/neglect financial, job loss, divorce, or other life stressors low socioeconomic status lack of relationships and support systems Certain conditions are associated with depression, including: - epilepsy post-stroke Parkinson's disease multiple sclerosis degenerative brain disease Alzheimer's disease coronary artery disease depression in malignancy hypothyroidism hyperthyroidism hyperparathyroidism Cushing's syndrome Addison's disease diabetes mellitus key symptoms of depression: - depressed mood and a loss of interest or pleasure -may also present with physical symptoms, including fatigue, inattention, poor appetite, decreased libido, psychomotor retardation, or agitation -often report difficulty sleeping, lack of motivation, or trouble completing tasks -severe cases, depressed clients may report delusions or hallucinations -may even present as catatonia MDD by severity: mild, moderate, or severe - Mild: The intensity of symptoms is manageable with minimal impairment in functioning. There are few symptoms beyond those required for diagnosis. Moderate: The number of symptoms, intensity, or impairment in functioning is between mild and severe. Severe: The intensity of symptoms is unmanageable and distressing. Symptoms interfere with functioning. The number of symptoms is beyond what is required for diagnosis. melancholic features - Symptoms worse in the morning, excessive guilt, significant weight loss atypical features - Weight gain, hypersomnia, heavy feeling in arms or legs Screening tools for depression severity - -Patient Health Questionnaire (PHQ) -Beck Depression Inventory-II (BDI-II) -Hamilton Depression Rating Scale (HAM-D) -Edinburgh Postnatal Depression Scale (EPDS) in post-partum and pregnant women -Children's Depression Inventory (CDI) -Children's Depression Rating Scale (CDRS) -Geriatric Depression Scale (GDS) in older adults The United States Preventive Services Task Force (USPSTF) recommends depression screening: - for adults 18 years of age or older and adolescents ages 12-18 years old. The American Academy of Family Physicians recommends screening for depression in: - the general adult population, including pregnant and post-partum women. The American Academy of Pediatrics recommends maternal screening for postpartum depression at: - infants' 1, 2, and 4- month visits. The American Academy of Pediatrics' Bright Futures program recommends: (screenin) - annual screening in adolescent clients for emotional and behavioral problems. Medicaid's child health component, the Early and Periodic Screening, Diagnosis and Treatment program recommends: - screening to detect physical and mental conditions at various age intervals. If a risk is identified, the provider should follow up with diagnosis and treatment. Immuno-Psychiatry (neuroimmunology) - explores how the immune system interacts with the brain and the mind -This interaction can affect both physical and mental health -The immune system protects the body from infection • Macrophages are the centurions of the immune system. Macrophages warn the immune system of a potential threat by secreting cytokines alerting more macrophages to come to the injured site • Cytokines (inflammatory proteins in the blood) can send signals across the blood-brain barrier. • Nerve cells exposed to cytokines are more likely to die than regenerate • In rat studies, rats injected with cytokines exhibited social withdrawal, less movement, and altered sleeping and eating patterns. • Inflamed nerve cells cannot effectively transmit 5-hydroxytryptamine (5HT) or serotonin receptors. • Persons with inflammatory conditions are significantly more depressed than the general population. *People who frequently eat foods known to cause inflammation (carbs) are more likely to exhibit depressive symptoms • People tend to feel better when they eat clean, possibly due to the decreased inflammation Medical Diagnoses that Mimic Depressive Disorders - hypothyroidism vitamin D deficiency anemia chronic fatigue syndrome Medications with side effects mimicking depression include: - cannabis, alcohol, clonidine, antidepressants, anticonvulsants, antimigraine agents, corticosteroids, contraceptives, and varenicline (Chantix) Depression treatment: pharmacological - Selective Serotonin Reuptake Inhibitors (SSRIs) Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) Tricyclic Antidepressants (TCAs) Monoamine Oxidase Inhibitors (MAOIs)