Many psychiatric conditions can be broken down into categories such as mood d/o, psychotic d/o, anxiety d/o, personality d/o etc. A very common mood disorder diagnosis is outlined below:
Major Depressive Disorder
Definition: at least one depressive episode without manic or hypomanic symptoms
Sx: MDD Episode at least 5 of the following for at least a 2 week period:
S: Sleep changes
I: Loss of interest in pleasurable activities (termed anhedonia)
G: Feelings of excessive guilt
E: loss of energy
C: difficulty concentrating on tasks
A: changes in appetite or weight
P: Psychomotor slowing or retardation
S: Recurrent thoughts of suicide or death
Symptoms must include depressed mood or anhedonia
SSRI's: Selective Serotonin (5HT) reuptake inhibitors Lower doses used for mood disorders, higher doses can be used for anxiety. Examples: citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), fluoxetine (Prozac), sertraline (Zoloft).
Week 1: HA, GI upset, worsening anxiety or suicidal ideations (BBW).
Later weeks: sexual dysfunction
TCA's: Tricyclic antidepressants Much older drugs that cause many side effects, not first line. Can be lethal in overdose.
Side effects: sedation, weight gain, orthostatic hypotension, cholinergic effects, QT prolongation
MAOI's: Monoamine Oxidase Inhibitors Can treat refractory depression. Not first line.
Side effects: Risk of HTN crisis with sympathomimetics or tyramine-rich foods like aged cheeses, chocolate, liver, smoked meats etc. Risk of 5HT syndrome with SSRI's or other similar acting drugs such as Linezolid (abx)
Behavioral therapy, cognitive therapy, supportive therapy, psychoanalysis and family therapy all basically involve talking it out
ECT: Electroconvulsive therapy
Indicated when all else has failed or if patient has shown improvement with ECT in the past. Can also be used during pregnancy when other medications are not tolerable. Can produce rapid reduction of symptoms in some cases. Patients are premedicated with anesthetics to "lightly" anesthetize them during the procedure. In our hospital, we were using three drugs: ketamine, sux and propofol. Based on the outcome, doses of the meds are altered for each session of ECT. On average a patient will receive about 6 sessions of ECT before improvement is appreciated. If a patient has received ECT in the past, it is likely they will need at least that many treatment before benefit. A visualized seizure needs to be induced for therapy to be effective, but the seizure is limited to prevent injury to patient. Typically the seizures are not very long, seconds. Electrodes are placed on the patients forehead/temples. There are different types of positioning used depending on the extent of therapy desired. With more antidepressive benefit there is more risk of SE. (On my rotation, I had a patient who was receiving ECT, so I was able to watch the procedure and track the progress)
Side effects: retrograde to anterograde amnesia can possibly disappear in 6 months, HA, nausea, muscle soreness (from the induced seizure)
Mood episodes: distinct periods of time with abnormal mood. Examples: depression, mania, mixed-state, hypomania
Mood disorders: defined by patterns of mood episodes. Examples: MDD, Bipolar I or II, dysthymic disorder, cyclothymic disorder etc