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Depression with catatonia

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This document discusses depression and catatonia. It defines depression as characterized by episodes of depressed mood and reduced energy and activity. It discusses several hypotheses for the etiology of depression related to neurotransmitters like serotonin and norepinephrine. Clinical presentations of depression include emotional, physical, cognitive, and psychomotor symptoms. The DSM-IV criteria for diagnosing major depressive disorder are outlined. Treatment options discussed include pharmacological treatments like SSRIs and SNRIs as well as non-pharmacological treatments like counseling and CBT. Catatonia is defined as a disturbance of motor behavior that can be psychological or neurological in origin. Clinical presentations and treatments for catatonia including benzodiazepines, ECT, and antip

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PRESENTED BY: E. Meena Reg. NO: 12Y01T0006 PHARM.D; 6th YEAR.
DEPRESSION • Depression is a condition characterized by episodes of depressed mood. Each episode is characterized by lowering of mood, reduction of energy, and decrease in activity. • Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common.
ETIOPATHOGENESIS Biogenic amine hypothesis. Depression may be caused by decreased brain levels of the neurotransmitters norepinephrine (NE), serotonin (5-HT), and dopamine (DA). • Postsynaptic changes in receptor sensitivity. Studies of many antidepressants have demonstrated that desensitization or downregulation of NE or 5- HT1A receptors may relate to onset of antidepressant effects. • Dysregulation hypothesis. This theory emphasizes a failure of homeostatic regulation of neurotransmitter systems, rather than absolute increases or decreases in their activities. Effective antidepressants are theorized to restore efficient regulation to these systems. • 5-HT/NE link hypothesis. This theory suggests that there is a link between 5-HT and NE activity, and that both the serotonergic and noradrenergic systems are involved in the antidepressant response. • The role of DA. Several reviews suggest that increased DA neurotransmission in the mesolimbic pathway may be related to the mechanism of action of antidepressants.
Depression with catatonia
CLINICAL PRESENTATIONS • Emotional symptoms may include diminished ability to experience pleasure, loss of interest in usual activities, sadness, pessimistic outlook, crying spells, hopelessness, anxiety (present in almost 90% of depressed outpatients), feelings of guilt, and psychotic features (e.g., auditory hallucinations, delusions). • Physical symptoms may include fatigue, pain (especially headache), sleep disturbance, appetite disturbance (decreased or increased), loss of sexual interest, and GI and cardiovascular complaints (especially palpitations). • Intellectual or cognitive symptoms may include decreased ability to concentrate or slowed thinking, poor memory for recent events, confusion, and indecisiveness. • Psychomotor disturbances may include psychomotor retardation (slowed physical movements, thought processes, and speech) or psychomotor agitation.
DSM-IV CRITERIA FOR MAJOR DEPRESSIVE DISORDER (MDD) • Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks. • Mood represents a change from the person's baseline. • Impaired function: social, occupational, educational. Specific symptoms, at least 5 of these 9, present nearly every day: 1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). 2. Decreased interest or pleasure in most activities, most of each day 3. Significant weight change (5%) or change in appetite. 4. Change in sleep: Insomnia or hypersomnia. 5. Change in activity: Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt 8. Concentration: diminished ability to think or concentrate, or more indecisiveness 9. Suicidality: Thoughts of death or suicide, or has suicide plan
TREATMENT: PHARMACOLOGICAL: • Fluoxatine 20-60mg/day • Sertraline 50- 200mg/day • Escitalopram- 10-20mg/day • Venlafaxine- 75-225mg/day • Mirtazapine- 15-45mg/day • Tricyclic antidepressants- imipramine or amitriptyline
NON PHARMACOLOGICAL • Counselling, reassurance, psychological support, encouragement • Cognitive behavioral therapy is given.
CATATONIA Catatonia is a disturbance of motor behavior that can have either a psychological or neurological cause. Its most well- known form involves a rigid, immobile position that is held by a person for a considerable length of time— often days, weeks, or longer. Types of catatonia • catatonic schizophrenia. • depression with catatonic features • catatonic disorder due to general medical condition.
CLINICAL PRESENTATION • Stupor • Posturing • Waxy flexibility • Negativism • Automatic obedience • Ambitendency • Forced grasping • Obstruction • Echopraxia • Aversion • Mannerisms • Stereotypies • Excitement • Speech abnormalities
TREATMENT: Benzodiazepines are the drugs of choice for catatonia • Lorazepam was the most commonly used treatment, resolving symptoms in 70% of reported cases. • Other benzodiazepines such as diazepam, oxazepam, and clonazepam have also been reported to treat catatonia • Zolpidem, like the benzodiazepines, is a GABA-A agonist and has been reported in one case series to be effective in the treatment of catatonia • Continue the benzodiazepines until the causative illness has been fully treated. • Combination of lithium and an antipsychotic may be an option in treatment- resistant catatonic stupor ECT • ECT alone resulted in resolution of symptoms in 85% • In malignant catatonia, the response to ECT was 89%,
Depression with catatonia

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Depression with catatonia

  • 1. PRESENTED BY: E. Meena Reg. NO: 12Y01T0006 PHARM.D; 6th YEAR.
  • 2. DEPRESSION • Depression is a condition characterized by episodes of depressed mood. Each episode is characterized by lowering of mood, reduction of energy, and decrease in activity. • Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common.
  • 3. ETIOPATHOGENESIS Biogenic amine hypothesis. Depression may be caused by decreased brain levels of the neurotransmitters norepinephrine (NE), serotonin (5-HT), and dopamine (DA). • Postsynaptic changes in receptor sensitivity. Studies of many antidepressants have demonstrated that desensitization or downregulation of NE or 5- HT1A receptors may relate to onset of antidepressant effects. • Dysregulation hypothesis. This theory emphasizes a failure of homeostatic regulation of neurotransmitter systems, rather than absolute increases or decreases in their activities. Effective antidepressants are theorized to restore efficient regulation to these systems. • 5-HT/NE link hypothesis. This theory suggests that there is a link between 5-HT and NE activity, and that both the serotonergic and noradrenergic systems are involved in the antidepressant response. • The role of DA. Several reviews suggest that increased DA neurotransmission in the mesolimbic pathway may be related to the mechanism of action of antidepressants.
  • 5. CLINICAL PRESENTATIONS • Emotional symptoms may include diminished ability to experience pleasure, loss of interest in usual activities, sadness, pessimistic outlook, crying spells, hopelessness, anxiety (present in almost 90% of depressed outpatients), feelings of guilt, and psychotic features (e.g., auditory hallucinations, delusions). • Physical symptoms may include fatigue, pain (especially headache), sleep disturbance, appetite disturbance (decreased or increased), loss of sexual interest, and GI and cardiovascular complaints (especially palpitations). • Intellectual or cognitive symptoms may include decreased ability to concentrate or slowed thinking, poor memory for recent events, confusion, and indecisiveness. • Psychomotor disturbances may include psychomotor retardation (slowed physical movements, thought processes, and speech) or psychomotor agitation.
  • 6. DSM-IV CRITERIA FOR MAJOR DEPRESSIVE DISORDER (MDD) • Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks. • Mood represents a change from the person's baseline. • Impaired function: social, occupational, educational. Specific symptoms, at least 5 of these 9, present nearly every day: 1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). 2. Decreased interest or pleasure in most activities, most of each day 3. Significant weight change (5%) or change in appetite. 4. Change in sleep: Insomnia or hypersomnia. 5. Change in activity: Psychomotor agitation or retardation 6. Fatigue or loss of energy 7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt 8. Concentration: diminished ability to think or concentrate, or more indecisiveness 9. Suicidality: Thoughts of death or suicide, or has suicide plan
  • 7. TREATMENT: PHARMACOLOGICAL: • Fluoxatine 20-60mg/day • Sertraline 50- 200mg/day • Escitalopram- 10-20mg/day • Venlafaxine- 75-225mg/day • Mirtazapine- 15-45mg/day • Tricyclic antidepressants- imipramine or amitriptyline
  • 8. NON PHARMACOLOGICAL • Counselling, reassurance, psychological support, encouragement • Cognitive behavioral therapy is given.
  • 9. CATATONIA Catatonia is a disturbance of motor behavior that can have either a psychological or neurological cause. Its most well- known form involves a rigid, immobile position that is held by a person for a considerable length of time— often days, weeks, or longer. Types of catatonia • catatonic schizophrenia. • depression with catatonic features • catatonic disorder due to general medical condition.
  • 10. CLINICAL PRESENTATION • Stupor • Posturing • Waxy flexibility • Negativism • Automatic obedience • Ambitendency • Forced grasping • Obstruction • Echopraxia • Aversion • Mannerisms • Stereotypies • Excitement • Speech abnormalities
  • 11. TREATMENT: Benzodiazepines are the drugs of choice for catatonia • Lorazepam was the most commonly used treatment, resolving symptoms in 70% of reported cases. • Other benzodiazepines such as diazepam, oxazepam, and clonazepam have also been reported to treat catatonia • Zolpidem, like the benzodiazepines, is a GABA-A agonist and has been reported in one case series to be effective in the treatment of catatonia • Continue the benzodiazepines until the causative illness has been fully treated. • Combination of lithium and an antipsychotic may be an option in treatment- resistant catatonic stupor ECT • ECT alone resulted in resolution of symptoms in 85% • In malignant catatonia, the response to ECT was 89%,