387: Week 6 - Mood Disorders Flashcards
What is the DSM IV definition of “Major Depressive Disorder” (MDD)?
DSM IV – TR diagnostic criteria
- Depressed mood or a loss of interest or pleasure in nearly all activities - anhedonia
- Anhedonia must be present for at least 2 weeks
- Involves a change from previous functioning
- Impairs social/occupational functioning
Major symptoms of Major Depressive Disorders include… (how many must be present to make a diagnoses of MDD?)
At least 4 of the following symptoms must be present:
- Disruption in appetite (or weight) -> forgetting to, disinterest in or neglecting to eat
- Sleep disturbance
- Disruption in concentration
- Fatigue or loss of energy
- Psychomotor agitation or retardation
- Excessive guilt or feelings of worthlessness
- Recurrent thoughts of death or suicide-
What is “Dysthmia”? What is the diagnostic criteria for “Dysthmia”?
- Rather than discreet episodes of depression, individual feels depressed nearly all of the time – depression is more low grade compared to MDD
- Depressed mood for most of the day for more days than not for at least 2 years
OR
2 or more of the following symptoms:
-poor appetite or overeating
-insomnia or oversleeping
-low energy or fatigue
-low self-esteem
-poor concentration or difficulty making decisions
-feelings of hopelessness
Risk factors of for MDD include…
- Prior episode of depression
- Family history of depressive disorder
- Lack of social support
- Stressful life event
- Substance use
- Medical co-morbidity
- Economic difficulties
Discuss the 2 Neurobiologic theories that exist regarding MDD
Genetics:
- 1.5 - 3 times more common among first degree relatives.
- There is increased risk of developing MDD when a first degree relative has/had a diagnoses of MDD
Biological hypotheses:
- norepinepherine and serotonin produced in very localized areas of the brainstem
- there is a dysregulation of serotonin and norepinephrine w/i the body
- MDD are influenced by this dysregulation or deficiency in [CNS] of the neurotransmitters norepinepherine, dopamine and serotonin or in their receptor functions
- PET scans – depressed persons do not metabolize glucose well in temporal and frontal lobes – normalizes when depression resolved
Discuss the Psychodynamic theory of MDD. What type of theory is this?
- Characterized as a psychological theory
- conflict between the ego (perception, memory, motor control) and the superego (ethics, standards, self-criticism)
- anger/aggression turned inward
- other contributors to this theory include:
- > avoidant coping styles that may be contribute to the onset of depression
- > distorded, negative beliefs and thoughts about the self, environment and the future are all psychological variants that can induce and perpetuate depressive symptoms
Discuss the parameters of “Object Loss Theory” with regards to MDD. What type of theory is this?
- Characterized as a psychological theory
- Bowlby’s theory of attachment - absence of a consistent mother/mother like caregiver in early life can lead to difficulties in later life
- Depression results from the loss of a parental figure through death or separation or lack of emotionally adequate parenting
- > these factors may prohibit or delay the realization of appropriate development milestones and inadequate coping strategies
Discuss the theory of “Learned Helplessness” with regards to MDD. What type of theory is this?
- Psychological theory
- Seligman –> there is no specific situation/event that causes depression
- individual’s belief that he/she cannot control life events
Discuss “Cognitive theory” as it relates to the development of MDD.
- focus is on how person thinks about his/her feelings
- correction of distorted or faulty thoughts
Discuss the “Social theories” pertaining to the development of MDD.
Family factors:
- > maladaptive circular patterns in family interactions contribut to the onset of depression in family members
- > disruption in family dynamics (b/c of multiple causes) can manifest as depression in a single family member
Social factors:
–> social isolation, poverty/deprivation and financial distress are risk factors that contribute to the development of MDD
What are 3 types of interventions use to treat MDD?
- Psychotherapy
- Somatic therapies: ECT, light Therapy for SAD
- Pharmacology
Discuss the various types of “Psychotherapy” treatment for MDD
- Brief, dynamic therapy –> the number of counseling sessions are limited
- Marital/family therapy –> address relationship issues that may contribute, or be affected by depression
- Cognitive therapy –> challenge distorted thinking patterns
What are two types of “Somatic therapies” used to treat MDD?
- ECT (Electroconvulsive therapy)
2. Light therapy
What is the main “Pharmacological” treatment for MDD?
- Antidepressants
- usually prescribed for 4-9 mos, however pts may remain on them indefinitely
What are the 4 classes of antidepressants?
- MAOIs (Monamine Oxidase Inhibitors) -> rarest
- Tricyclics (TCAs)
- Selective Serotonin Reuptake Inhibitors (SSRIs) -> usually first choice for pharmacological intervention
- Atypicals/Novel
Discuss the effectiveness and side effects commonly associated with many antidepressants
- Delayed onset for full clinical effects (3-6 weeks)
- Many side effects ARE NOT delayed
- Many potential drug interactions (St. John’s Wart)
- Need to taper off if the pt is discontinuing pharmacological treatment (prevention of Serotonin syndrome)
- Non-compliance with Rx is common -> attributed to: adverse side-effects; individuals may begin to feel better and decide they no longer need meds; may not feel benefits immediately and t/f stop taking them
What are MAOIs? Describe how they work and to whom they are commonly Rx to.
- Monamine Oxidase Inhibitors
- Decrease the breakdown of serotonin, epinepherine and norepinepherine, thereby increasing their concentrations in the CNS
- Not often prescribed because of dietary and OTC medication restrictions
- Only prescribed for treatment resistant depression
Examples of MAOIs: phenelzine, tranylcypromine
What dietary restrictions accompany the use of MAOI antidepressants?
- Avoid Tyramine rich foods (see list below) b/c they prevent the breakdown of MAOI’s and can result in severe hypertension
- > cheese (except cottage cheese and cream cheese)
- > smoked, dried, pickled, cured or preserved meats and fish
- > caviar
- > fava beans
- > avocados
- > yeast extracts
- > chianti
- > beer containing yeast
- > coffee & chocolate should be consumed in moderation
What medications are contraindicated with MAOI use?
Prescription: TCAs, Prozac, Demerol, Amphetamines
Non-prescription: Cold/allergy medications; Nasal decongestants; Cough medications except plain guaifenesin; Stimulants; Pain medications except for ibuprofen, aspirin, acetaminophen
What are the major side effects associated with MAOI use?
Headache, blurred vision, drowsiness, weight loss, dry mouth and throat, postural hypotension, nausea, agitation, dizziness, constipation, sedation, urinary retention, decrease memory, hypertensive crisis
What is a “Hypertensive Crisis”? What antidepressant is this a side effect of?
- Sudden, severe pounding headache, racing pulse, flushing, stiff neck, chest pain, nausea and vomiting
- Adverse side effect of MAOI use
What are TCA’s? What is a major concern regarding TCA use?
-Tricyclic antidepressants
-Highly lethal when overdosed -> t/f not commonly Rx to suicidal pt’s
- has been mostly replaced with other antidepressants with safer side effects
- still used for treatment resistant depression that has failed to respond to other therapy with newer antidepressants
Examples: amitriptyline, doxepin, clomipramine
What are the common side effects associated with TCA use?
-Sedation, drowsiness
-Anticholinergistic effects –> dry mouth, constipation, blurred vision, urine retention
-Tachycardia
-prolonged QT
orthostatic hypotension
-Weight gain
-Memory disruption
-death (when overdosed)
