12: Depression in Adults Flashcards
T/F Inflammatory markers become depressed with depression.
False. They become elevated, though unsure as to correlation.
T/F Once in remission, it is ok to stop medication and psychotherapy.
False. Do not stop both simultaneously. Work together to determine best course of action.
T/F Recovery can be delayed when depression and anxiety overlap.
True. Can be difficult to recognize both components.
Which type of depression: major depressive episode, dysthymic disorder, or double depression?
Dysthymic or major depression with anxiety symptoms.
Double depression
_____ of adults have anxiety.
3.1%
What medical illnesses mimic depression (5)?
- Hypothyroidism
- Low blood sugar
- Vitamin D deficiency
- Caffeine withdrawal
- Early dementia
T/F Severe or intractable depression patients may benefit from ECT.
True
Are women or men more commonly affected by depression?
Women 2:1. It is a 1:1 ratio when expanded criteria include depression related to substance abuse, anger attacks, aggression and irritability, and risk-taking behavior.
_____ of adults have unreported lifetime risk of schizophrenia.
1.1%
T/F Depression is often recurrent.
True. 50% recur after 1 episode without treatment. 70% after 2 episodes. 90% after 3 episodes.
Depression is often a comorbidity with what 5 conditions?
- Fibromyalgia
- Migraines
- PMS (severe)
- IBS
- Chronic fatigue
Risk factors for depression (4)?
- Genetic basis
- Personal/family hx of depression
- Parental loss, early life abuse or trauma
- Female (esp during hormonal shifts)
What medication is offered as a natural remedy to depression?
St. John’s Wort (900-1800 mg/day for a month)
T/F Moderate drinking (no more than 1/day) predisposes people to depression.
False
_____ of adults have bipolar disorder.
2.6%
_____ of adults have unreported lifetime risk of depression.
6.9%
T/F Antidepressants can be addictive.
False
What treatment is the most effective, statistically, but is not done in primary care?
Electroconvulsive Therapy (ECT)
Which type of depression: major depressive episode, dysthymic disorder, or double depression?
Not a major depression, but living at a subpar level.
Dysthymic disorder
What type of depression: seasonal affective disorder, depression secondary to substance abuse, or postpartum depression?
Occurs directly after childbirth. Can be severe. Screen every woman.
Postpartum depression
In pure depression, any antidepressant will yield _____% positive responses.
60-70%
What are the 5 points of patient education regarding medication?
- Take medication as prescribed every day.
- It may take time to see a response.
- Do not stop taking medication without contacting me.
- Do not stop the medication just because you start to feel better.
- Call me with any concerns or questions.
_____ of adults have a diagnosable personality disorder.
9%
T/F When a woman presents with initial depression during a hormonal shift, treating the hormonal shift will often cure the depression.
False. Treat s/sx of hormonal fluctuation AND depression.
T/F St. John’s wort works better in combination with SSRIs than tricyclics.
False. Do not combine St. John’s wort with prescription antidepressants.
Which type of depression: major depressive episode, dysthymic disorder, or double depression?
Maintains mood/function until depression hits.
Major depressive episode
What type of depression: seasonal affective disorder, depression secondary to substance abuse, or postpartum depression?
Depressed in fall/winter with less exposure to ambient light.
Seasonal affective disorder
Antidepressants should be taken for a minimum of _____ from the time the patient feels well (remission).
4-6 months
T/F 3 of 9 biomarkers are elevated when someone becomes depressed.
True. Potential for screening at-risk patients.
Antidepressants must be taken daily to build up in the system. They may take _____ days to begin to work.
10-14 days
What type of depression: seasonal affective disorder, depression secondary to substance abuse, or postpartum depression?
“Chicken or the egg” situation: difficult to determine which brought on the other. Attack on both angles.
Depression secondary to substance abuse
What are the 5 traditional depressive signs?
- Sadness, tearfulness, depressed mood
- Sleep disturbance
- Appetite disturbance
- Poor concentration
- Suicidal ideation
Which type of depression: major depressive episode, dysthymic disorder, or double depression?
Endorse the depression by sharing symptoms of fatigue, feeling down, lack of interest.
Double depression
What is a concern with women who take St. John’s wort?
It may lower estrogen levels. Backup contraception should be used until levels are confirmed.
_____ of adults have OCD.
1%
T/F Majority of patients stop antidepressants before completing the full course.
True. 77%. 50% stop in the first 30 days. Important to stress why adherence is important, since it takes a while to see results.
T/F Everyone should be tried off medication, usually within the first 12 months.
True. Collaborate with patient as to when that should happen. If fearful, remind patient that if depression recurs, you know which med works.
Treatment with _____ will often relieve both sets of symptoms with double depression.
Antidepressants
Which type of depression: major depressive episode, dysthymic disorder, or double depression?
Report anxiety symptoms, insomnia, racing thoughts, inability to sit still.
Double depression
How can you minimize side effects of ECT?
Unilateral treatment
Which type of depression: major depressive episode, dysthymic disorder, or double depression?
Single or recurrent. Most common type.
Major depressive episode
T/F Depression is partly a personality weakness.
False. It is a medical condition. Brain scans show differences between depressed and normal brains. Normal brain shows more brain activity. Depressed brain has fewer areas of cognitive function lit up on MRI.
What is the duration of treatment for ECT?
6-12 treatments over 4-6 weeks.
What is the most effective depression treatment?
Psychotherapy + medication
What adjunctive recommendations (not specific to depression) can be helpful (3)?
- Exercise
- Diet
- Sleep hygiene and daily structure
T/F All depression merits treatment, no matter the cause.
True. Never insinuate that the patient is not trying hard enough or that they did this to themselves.
