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Mood Disorder: Depression, Depression coggle - Coggle Diagram
Mood Disorder: Depression
Etiology
Biochemical imbalance.
Decreases levels of norepinephrine and/or serotonin in the brain.
At least five symptoms must be present for at least 2 weeks.
Depressed mood, markedly diminished interest or pleasure in activities, weight gain, sleep changes, feelings of worthlessness or guilt, poor concentration, thoughts of death, and fatigue or loss of energy.
Common illness and affects approximately 5-10% of the population.
Drug Interactions of Dental Significance:
EPI is inactivated by either the enzyme catechol-O-methyl transferase (COMT) or reuptake into the nerve terminal.
TCAs block the reuptake of both NE and EPI, allowing accumulating levels.
It is not necessary to avoid using epi-containing local anesthetics, but to limit the amount to 0.04 mg, which is present in about two cartridges of lidocaine 2% with 1:100,000 epinephrine.
Antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Drug Names
Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox)
Paroxetine (Paxil)
Sertraline (Zoloft)
Oral side effects: xerostomia, taste change, aphthous stomatitis glossitis
no epinephrine interaction
avoid levonordefrin-containing local anesthetic
Tricyclic antidepressants (TCAs)
Drug Names
Amitriptyline (Elavil)
Comipramine (Anafranil)
Desipramine (Norpramin)
Doxepin (Adapin, Sinequan)
Imipramine (Tofranil)
Nortriptyline (Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)
Dental side effects: xerostomia, blurred vision, urinary retention, constipation, increased heart rate, and memory dysfunction
Adverse effects of TCAs are due to the nonselective affinity and blockade of other receptors, including muscarinic (cholinergic), histaminic, and a-adrenergic receptors
Delay or onset of action of antidepressants - takes 2-3 weeks until therapeutic effects are seen.
Monoamine oxidase inhibitors (MAOIs)
Drug Names
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)
Increase in blood pressure which could lead to
stroke, heart attack.
Foods to avoid
High in tyramine, such as alcohol, legumes (e.g., fava and soy beans),
cheese, fish, ginseng, meat, sauerkraut, shrimp paste, soups, and yeast
extracts
Other side effects:
Dizziness, fainting, headache, tremors, muscle twitching, confusion, memory, impairment, anxiety, agitation, insomnia, weakness, drowsiness, chills, blurred vision, and heart palpitations.
