24. It is necessary that every patient, whom we suspect to have mood disorders, should be thoroughly assessed by careful and full history and mental state examination. The notes of the social worker and clinical psychologists should be studied too. The necessary investigations to exclude other possible causes should be done including full blood count, drug screening , hormonal essays including thyroid function tests, EEG, CT scan and if necessary other neuroimaging techniques.

25. The line of management depends on whether the disorder is acute or chronic, bipolar unipolar, recurrent or a single episode. The choice of the treatment method should be made by discussion with the patient, his relatives and individual physician. The treatment methods include: Psychological Pharmacological Physical

30. In mild depression psychotherapy is the first line treatment and pharmacological therapy is not recommended routinely as first line therapy. In moderate to sever depression when other treatments for two weeks fail antidepressants should be first line treatment. In dysthymia antidepressants could be used as first line treatment.

31. Tricyclic antidepressants: These drugs have many side effects including anticholinergic effects, hypotension and tachycardia and cardiac toxicity which makes them dangerous in toxicity and overdoses. Tricyclic antidepressants should not be used as first line treatment in mild to moderate depression. They are recommended for severely ill inpatients.

32. Specific serotonin reuptake inhibitors : Including fluoxitine, paroxitine, fluvoxamine, citalopram, sertraline, escitalopram. They are recommended by NICE as first line pharmacological treatment of depression because they have less side effects compared to tricyclic antidepressants. They are relatively safer in overdoses. However they might lead to gastric irritation, nausea, vomiting, headache, increased anxiety and sexual dysfunction.

33. Specific serotonin reuptake inhibitors : They cause decreased arousal, drive and difficulty reaching orgasm. These side effects might lead to noncompliance. The initial increased anxiety might lead to suicide.

34. Monoamine oxidase inhibitors MAOIs : They are used for atypical depression with reversed biological symptoms as increased appetite and weight. It is recommended by NICE for those who do not respond to SSRIs. The ireversible MAOIs have serious interaction with drugs and food containing tyramine.

35. Monoamine oxidase inhibitors MAOIs : The reversible MAOIs as Meclobemide has less risk of interaction but therapeutically less effective. Those drugs lead to postural hypotension , overstimulation, sexual dysfunction, weight gain and possibly addiction.

36. Serotonin and noradrenaline reuptake inhibitors SNRIs: Venlafaxine and duloxetene. Venlafaxine is more potent than SSRIs and recommended by NICE for severely depressed patients with monitoring the blood pressure. Doluxetene is not as potent as Venlafaxine and it might lead to initial nausea. Both drugs lead to nausea, hypertension, increased anxiety and sexual dysfunction .

37. Other antidepressants: reboxetene: is selective noradrenaline reuptake inhibitor. It has anticholinergic side effects and sexual dysfunction. Neverthelss it is well tolerated but evidence of its effectiveness is scarce. mirtazepine: is α 2 adrenoceptor antagonist. It cause sedation and weight gain. Therefore it liked by patients with insomnia and disliked by obese patients.

38. Other antidepressants: Mianserine is a tetracyclic drug and is α 2 adrenoceptor antagonist. It is less popular now because of agranulocytosis.

39. Treatment resistant depression: Augmetation therapy: Antidep and psychtherapy Antidep and atypical antipsychotic Antidep and thyroid hormone

40. Mania

50. Treatment….Cont’d Mood Stabilize Adverse Effects Special Concerns Lithium carbonate (Eskalith CR, Lithobid) Gastrointestinal distress, lethargy or sedation, tremor, Hypothyroidism, diabetes insipidus, renal disease valproic acid (Depakote, Depakene Sedation, platelet dysfunction, liver disease, alopecia, weight gain Elevated liver enzymes or liver disease, drug-drug interactions, bone marrow suppression Carbamazepine (Tegretol) Suppressed WBC, dizziness, drowsiness, rashes, liver toxicity (rarely) Drug-drug interactions, bone marrow suppression