AIM • Step 10
Student Memory Support
Mood Disorders: Depression, Bipolar Disorder, Suicide Prevention and Pharmacotherapy
4th Year MBBS • High-yield memory reinforcement and last-minute KMU revision
1. High-Yield Flashcards
Tap each question to reveal the answer.
Which monoamines are mainly involved in the monoamine hypothesis of depression?
Serotonin, noradrenaline and dopamine.
Why does antidepressant clinical improvement occur later than the initial increase in synaptic monoamines?
Clinical benefit also depends on slower downstream receptor, signalling and neural-network adaptations.
Which clinical question is essential before treating apparent unipolar depression?
Ask about previous mania or hypomania to exclude bipolar illness.
Which features suggest atypical depression?
Mood reactivity, hypersomnia, increased appetite, leaden paralysis and rejection sensitivity.
What treatment specifically addresses the seasonal component of seasonal affective disorder?
Bright-light therapy.
What is the main mechanism of selective serotonin reuptake inhibitors?
Inhibition of the serotonin transporter, increasing serotonergic transmission.
Which receptor actions explain many adverse effects of tricyclic antidepressants?
Muscarinic, histamine H1 and alpha-1 adrenergic receptor blockade.
What pharmacological action makes tricyclic antidepressant overdose particularly dangerous?
Cardiac fast sodium-channel blockade causing conduction abnormalities and arrhythmias.
What causes the hypertensive “cheese reaction” with MAO inhibitors?
Tyramine escapes normal MAO metabolism and causes excessive catecholamine release with severe hypertension.
Which neuromuscular findings strongly support serotonin syndrome?
Clonus and hyperreflexia.
Why can St John’s Wort cause clinically important drug interactions?
It can enhance serotonergic activity and induce drug-metabolizing enzymes and transport proteins.
What is augmentation therapy in depression?
Adding another therapeutic agent to a partially effective antidepressant regimen.
When is ECT particularly valuable in depression?
When a rapid response is required, such as severe suicidality, psychotic depression, catatonia or severe resistant illness.
What distinguishes bipolar I disorder from bipolar II disorder?
Bipolar I includes a manic episode; bipolar II includes hypomania with major depression and no full manic episode.
Why is lithium especially sensitive to changes in hydration and sodium balance?
Lithium is renally eliminated and its handling is linked to sodium reabsorption; dehydration or sodium depletion can raise lithium levels.
Which findings should raise concern for lithium toxicity rather than a simple therapeutic adverse effect?
Coarse tremor, ataxia, confusion, marked gastrointestinal symptoms, seizures or reduced consciousness.
2. Mnemonics
Mnemonic Title: Serotonin Syndrome Core Pattern
CAM
Meaning: Changed mental state → Autonomic overactivity → Motor hyperactivity with clonus/hyperreflexia.
Mnemonic Title: Recognizing Mania
MAD
Meaning: Mood elevated or irritable → Activity increased → Decreased need for sleep.
3. Memory Tables
Antidepressant Classes — High-Yield Comparison
| Feature | SSRIs | TCAs | MAOIs |
|---|---|---|---|
| Main action | Block serotonin reuptake | Block serotonin and noradrenaline reuptake | Reduce monoamine breakdown |
| Typical problem | GI and sexual adverse effects | Anticholinergic, sedative and postural effects | Food and drug interactions |
| Major danger | Serotonin syndrome | Cardiotoxic overdose | Tyramine hypertension / serotonin toxicity |
Bipolar I vs Bipolar II
| Feature | Bipolar I | Bipolar II |
|---|---|---|
| Elevated mood episode | Mania | Hypomania |
| Major depression | Common but not required for diagnosis | Present |
| Functional impact of elevated episode | Marked impairment may occur | No marked impairment from hypomania |
4. Rapid Revision Points — Last-Minute Revision
Must Remember:
- The monoamine hypothesis is useful but does not completely explain depression.
- Always assess previous mania or hypomania before assuming depression is unipolar.
- Atypical depression commonly combines mood reactivity with hypersomnia and increased appetite.
- Active suicidal intent, a specific plan or inability to remain safe requires urgent psychiatric assessment.
- SSRIs increase serotonergic transmission by inhibiting the serotonin transporter.
- TCA receptor blockade explains dry mouth, constipation, sedation and postural hypotension.
- MAOI plus tyramine can produce a severe hypertensive reaction.
- Clonus and hyperreflexia are high-yield clues to serotonin syndrome.
- Antidepressant switching must consider drug half-life and interaction risk.
- Lithium requires attention to serum concentration, renal function and thyroid function.
KMU Trap: Antidepressant monotherapy in bipolar depression can destabilize mood and precipitate mania; bipolarity must be considered before treatment.
5. Clinical Memory Hooks
Depressed patient with previous episodes of reduced sleep and excessive activity
→
Think bipolar disorder before prescribing antidepressant monotherapy.
→
Think bipolar disorder before prescribing antidepressant monotherapy.
Antidepressant combination followed by agitation, sweating, clonus and hyperreflexia
→
Serotonin syndrome.
→
Serotonin syndrome.
MAOI user develops severe headache and hypertension after tyramine-rich food
→
Hypertensive cheese reaction.
→
Hypertensive cheese reaction.
Lithium user becomes dehydrated and develops coarse tremor, ataxia and confusion
→
Suspect lithium toxicity.
→
Suspect lithium toxicity.
⭐ 6. Starred High-Yield Exam Points
- ⭐ Depression plus a history of mania or hypomania strongly changes diagnosis and management toward bipolar disorder.
- ⭐ SSRI + MAOI or another major serotonergic combination can cause life-threatening serotonin syndrome.
- ⭐ TCA overdose can cause dangerous cardiac conduction abnormalities because of fast sodium-channel blockade.
- ⭐ Tyramine exposure during MAO inhibition can cause severe catecholamine-mediated hypertension.
- ⭐ Severe suicidal depression requiring rapid improvement is an important indication for ECT.
- ⭐ Lithium has a narrow therapeutic index and its concentration rises with dehydration, sodium depletion, thiazides, NSAIDs and ACE inhibitor/ARB therapy.
- ⭐ Fine tremor may occur during lithium therapy, but coarse tremor with ataxia or confusion should suggest toxicity.