1. Dépression Flashcards
Chez un pt avec dépression, tjrs
- évaluer risque suicidaire
- PEC selon hospit vs suivi étroit
Pt à risque élevé de dépression
- statut socio-écon
- post partum
- personnes souffrant de dlr chronique
- co-morbid psy disorder
- co-morbid physical disorder
- abus (sexual, physical, emotional)
Si sx inexliqués au plan médical quoi faire
évaluer sx dépressifs
Possibles comorbidités
anxiété
tb bipolaire
tb de la personalité
TLU
Non-mood related presentations 5
Multiple visits with unexplained symptoms
Work/relationship dysfunction
Weight/sleep/energy/memory/cognitive complaints
Comorbidity (IBS, obesity, CVA, cancer)
Substance abuse
DSM 5 criteria for major depressive disorder
≥ 5 (with depressed or decreased interest) for >2w with change in functioning
Depressed mood most of the day
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor agitation/retardation
Suicidal ideation
+ could have a specifier: atypical, anxious, catatonic, seasonal etc
Ddx dépression (psychiatrique) 7
- Deuil
- Trouble d’adaptation avec humeur dépressive
- MAB: Épisode maniaque avec sx mixtes
- Trouble affectif secondaire à une condition médicale
- Trouble affectif induit par une substance
- Trouble anxieux avec sx dépressifs
ADHD
Ddx dépression (médical) nomme 5
insuffisance surrénalienne
hypothyroidism
Mononucleose
Apnée obstructive du sommeil
prise de corticostéroides
*
autres:
hypercortisolism
Multiple sclerosis, Huntington disease, Parkinson disease, systemic lupus erythematosus
Stroke, traumatic brain injury
Vitamin B12 insufficiency
Medications: interferon, antiretrovirals
Dépression investigations to consider
CBC (anemia), electrolytes (creat), TSH, B12/folate, LFTs
B-hCG
UA, urine toxicology
EKG (QT)
Neuroimaging if focal neurological sign or elderly
Suicidal risk - SAD PERSONS
Sex (male)
Age>60yo
Depression
Previous attempts
Ethanol abuse
Rational thinking loss (psychosis)
Suicide in family
Organize plan
No spouse/support
Serious illness/pain
If low risk of suicide (d/c home), discuss elements of safety plan(5)
Keep home environment safe (remove access to weapons)
Recognize early warning signs
Coming up with ways to cope personally with suicidal thoughts
Identify people to contact for help/distraction
Identify place to go to for safety (eg. hospital)
Frame depression as
an adaptation - functional signal (less self-stigma, greater offset efficacy)
Management (4 big categories)
- Safety plan
- Lifestyle
- CBT
- Pharmacothérapie (choose on comorbidity/previously used)
When to consider Adjunct/Augment tx and which one
if ≥ 2 antidepressant trials
well tolerated, partial response, specific symptoms to target, less time to wait (severe, functional impairment)
Consider Aripripazole (abilify), Quetiapine, Risperidone
1st line pharma tx for adolescents (after cbt) (1)
fluoxetine (prozac)
1st line pharma tx for Pregnancy/Breastfeeding (after cbt) (3)
Citalopram (celexa)
escitalopram (cipralex)
sertraline (zoloft)
cheapest anti-depressant
Citalopram (celexa) 20mg PO daily
Common side effects of SSRI (variability, depending which one) 8 common
Nausea (21%), xerostomia (20%), diaphoresis (20%), drowsiness (18%), insomnia (15%), sexual dysfunction (up to 50%), weight gain, headache
1st line antidepressant for perimenopausal women
Desvenlafaxine
1st line antidepressant for late-life onset (above 60)
Duloxetine, mirtazapine (low weight), nortriptyline
Si effet indésirable de baisse de libido, anti-dépresseurs à privéligier
bupropion
mirtazapine (augmentation de l’appétit)
Pire anti-dépresseurs pour la prise de poids (4)
mirtazapine ((≥7 % poids) chez 50% des pt)
ad 15% des pt
paroxetine
escitalopram
duloxétine
Common side effects of SSRI (variability, depending which one) 6 dangerous
Dangerous: Serotonin syndrome, suicidality, upper GI bleed (increased risk if taken with NSAIDs), osteoporosis, hyponatremia, prolonged QT
