52 Depressive Disorders, Bipolar & Related Disorders

Question 1

describe diagnosis of MDD

Answer 1

• a person must experience ≥ 1 major depressive episode (MDE) for a diagnosis of MDD
• the person can’t have a history of mania or hypomania
  
  • the person never swings to the opposite “pole” of mood
  • if the person does swing, then the diagnosis is not MDD
    
    • also known as “unipolar” depression

Question 2

describe the graph of MDD

Answer 2

Question 3

describe a major depressive episode

Answer 3

• at least 2 weeks of ≥ 5 of the following, one of which MUST be 1 or 2
  
  1. depressed mood
  2. anhedonia
  3. significant weight change
  4. insomnia/hypersomnia
  5. loss of energy
  6. psychomotor changes
  7. feeling guilty/worthless
  8. decreased concentration
  9. thoughts of death/suicidal ideation

Question 4

mnemonic for MDE?

Answer 4

SIG: Energy CAPSules

• sleep change
• interest loss
• guilt
• energy problem
• concentration poor
• appetite change
• psychomotor changes
• suicidal ideation

Question 5

describe MDD specifiers (melancholic features)

Answer 5

• MDD with melancholic features
  
  • severe anhedonia, lack of mood reactivity, profound despondency and guilt
  • depression worse in the mornings
  • early-morning awakenings
  • significant appetite loss

Question 6

describe MDD specifiers (with atypical features)

Answer 6

• mood reactivity
• weight and sleep increase
• leaden paralysis

Question 7

describe MDD specifiers (with psychotic features)

Answer 7

• with psychotic features: hallucinations and/or delusaion are evident
  
  • with mood-congruent psychotic features
    
    • the content of delusions/hallucinations is consistent with typicall depressive themes
  • with mood-incongruent psychotic features
    
    • the content of delusions/hallucinations does NOT involve typical depressive themes

Question 8

describe MDD specifiers (with catatonia)

Answer 8

• mutism
• immobility
• waxy flexibility
• odd posturing

Question 9

describe MDD specifiers (with anxious distress)

Answer 9

• MDE associated with
  
  • feeling tense
  • restless
  • fearful

Question 10

describe MDD specifiers (with peripartum onset)

Answer 10

• MDE onset is during pregnancy or within 4 weeks post-delivery

Question 11

describe the general course of MDD

Answer 11

• although the diagnosis of MDD requires only 2 weeks of an MDE, the MDE usually lasts 6-12 months if untreated
• MDEs are likely recurrent
• some patients develop mania/hypomania after several MDEs (diagnosis of MDD then changes)

Question 12

contrast MDD and bereavement

Answer 12

• the normal grief response to death of a loved one (bereavement) may include depressive symptoms resembling a MDE and be present for many months
• a bereaved person has:
  
  • depressed mood characterized by emptiness.loss that occurs in waves when reminded of deceased person (in a MDE, sadness is persistent and pervasive)
  • thoughts of death relating to possibly reuniting with the deceased (in a MDE, thoughts relate to ending worthless feelings)

Question 13

describe common findings in MDD neurobiology

Answer 13

Question 14

give a summary of pathophysiological mechanisms in MDD

Answer 14

• reduced monoaminergic transmission
• hyperactivity of the HPA axis and the inflammatory response system
• inability of prefrontal cortex to inhibit overactivity of limbic regions

Question 15

describe MDD treatments

Answer 15

• psychotherapy
  
  • a variety of psychotherapies (especially CBT, cognitive behavioral therapy) may help to address some depressive symptoms, especially in milder depressions
    
    • cognitive: changing maladaptive thoughts
    • behavioral: changing maladaptive behaviors
• antidepressant drugs (ADs)
  
  • increase the monoamines (esp. serotonin and norepi) to varying extents
  • often take 4-6 weeks before observable therapeutic effect

Question 16

describe SSRIs and SNRIs

Answer 16

• SSRIs (selective serotonin reuptake inhibitors)
  
  • most popular class of ADs with relatively benign side effects
  • ex: fluoxetine (Prozac)
• SNRIs (serotonin-norepi. reuptake inhibitors)
  
  • venlafaxine (Effexor)

Question 17

describe TCAs (tricyclic antidepressants)

Answer 17

• TCAs
  
  • serotonin and norepi. reuptake inhibitors
  • less serotonin agonism relative to the SSRIs and SNRIs
  • cardiac side effects, such as postural hypotension and tachycardia

Question 18

describe MAOIs

Answer 18

• MAOIs = monoamine oxidase inhibitors
  
  • MAOIs prevent enzyme degradation of the monoamines (not selective to serotonin)
  • diet restrictions to avoid tyramine-induced hypertension
  • less widely used

Question 19

describe ECT (electroconvulsive therapy)

Answer 19

• involves electrical induction of a generalized seizure
• a patient is pre-treated with a muscle relaxant to prevent injury and an anesthetic to reduce consciousness
• electrode placement:
  
  • frontotemporal
  • unilateral (fewer side effects) vs. bilateral (more effective)

Question 20

describe initial side effects of ECT

Answer 20

• cardiac arrhythmias
• headache and confusion
• some memory loss for recent long-term memory and some consolidation difficulties surrounding ECT sessions

Question 21

describe transcranial magnetic stimluation (TMS)

Answer 21

• magnetic pulses are generated are used to stimulate a patient’s prefrontal cortex