Prescribing pearls: sertraline (Zoloft) - ANSWERalso treats social anxiety and hypersomnolence
Prescribing pearls: bupropion (Wellbutrin) - ANSWERNDRI may improve energy, alertness, and
motivation; not first line treatment for anxiety; contraindicated in clients with a history of seizures
Prescribing pearls: duloxetine (Cymbalta) - ANSWEReffective 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) - ANSWERtreats both depression and anxiety disorders,
ensure trial of higher dose before switching to a different medication
Prescribing pearls: desvenlafaxine (Pristiq) - ANSWEReffective for perimenopausal vasomotor
symptoms
considered when selecting a medication: - ANSWER-Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
if a medication is not achieving efficacy: - ANSWER-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 - ANSWERlithium
MDD and BPD genetics - ANSWERgenetic factors contribute 31-42% of the disease risk in MDD and
59-85% in BPD
monoamine hypothesis of depression - ANSWER-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
- ANSWERThree 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 ___________________ - ANSWERdepressive
disorders and bipolar disorders
Major depressive disorder (MDD) - ANSWERone 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 - ANSWER-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) - ANSWERfemale gender
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