Blades- Major Depression Flashcards
What are the three types of secondary depressive disorders?
- General medical conditions
- Substance induced
- Seasonally mediated
What are general medical conditions that cause depressive symptoms?
- Nutritional: B12, Folate, Vit D
- Hematologic: Anemia
- Endocrinologic: Hypothyroidism, adrenal insufficiency
- Trauma: brain injury
- Neurologic: parkinson’s, stroke
What causes substance induced depression?
CNS depressants- alcohol and cannabis (slow brain activity)
DA depleters- cocaine, amphet, MDMA
What causes seasonal affective disorder?
Shortened photo period (decreased light exposure) causes circadian rhythmic disturbances leading to neurovegetative changes and a depressed mental state.
What is the etiology of MDD?
Vulnerability + stressor –> depression
- Biological- genetic, acute illness
- Psychological- neglect, bereavement
- Social- poverty, loss of status
What gene is linked to genetic vulnerability?
5HTTLPR
Causes a 5HT transporter linked promoter region polymorphism
How is the length of gene related to resilience and depression?
Long, long, high R, low depression
Long, short, avg R, avg depression
short, short, low R, low depression
What is the criteria for diagnosing depression?
At least 2 weeks of low mood OR anhedonia +:
-appetite change, sleep change, psychomotor change, fatigue, trouble concentrating, thoughts of death
What is the prevalence of depression? Age of onset? Who is it more likely to affect?
16.5%
Age of onset 32
F: 70% more likely than M
What are the comorbidities for MDD?
Anxiety Pain Cardiovascular disease* (2x as likely to die after HA if you've have depression) Metabolic Disease Substance abuse
What is the tx for secondary depression?
- tx underlying medical conditions
- Neurologic- tx like MDD
- Substance induced- abstinence, +/- anti-depressant
- Seasonally mediated- phototherapy
What is the tx for SAD?
10,000 lucks for 30 mins daily in am
How does exercise affect MDD?
Reverses hippocampal atrophy
Releases endorphins
How does sleep affect MDD?
Sleep deprivation decreases resiliency
Circadian rhythm disturbance effect
How does diet affect MDD?
imp. general health
decreases biological vulnerability to depression
What psychotherapies are good for treating MDD?
- CBT: Identify chain of thinking that leads to neg thoughts
- Psychodynamic pscyhotherapy: resolution of intrapsychic conflicts
- Interpersonal therapy: relationships matter
What are somatic tx for MDD?
- Psychosurgery: trepanning, frontal lobotomy, anterior cingulotomy
- Neuromodulation: ECT, transcranial magnetic stimulation, deep brain stimulation
- Medications: manipulate neurotransmission
What is Prozac and how does it work? What is it used for? Efficacy?
SSRI
Increases 5HT in synapse
MDD and AD
50% of people get 50% better
What are the side effects of prozac?
common: GI, sexual
dangerous: platelet dysfxn, seizure, CYP2D6, 5HT syndrome, suicide
What is Effexor and how does it work? What is it used for? Efficacy?
SNRI
Increases synaptic 5HT and NE
MDD and AD
50% of people get 50% better
What are the side effects of effexor?
Common: GI, sexual, tachycardia, hypertension, discontinuation syndrome
Dangerous: CYP2D6, seizure, suicide, 5HT syndrome
What is Wellbutrin (bupropion) and how does it work? What is it used for? Efficacy?
DNRI
Increases synaptic DA and NE
MDD
Adjunct for residual sx
What are the side effects of wellbutrin?
common: HA, hypertension, irritability, increased anxiety
dangerous: CYP2D6, seizure
What are the special uses for wellbutrin?
Reverse sexual SE
ADHD
What is Remeron (Mirtazipine) and how does it work? What is it used for? Efficiacy?
Multi-modal AD
Increase synaptic NE and 5HT, block post synaptic 5HT receptor
MDD, Anxiety Disorders
Very effective in combination w/ an SNRI
What are the side effects of Remeron (Mirtazipine)?
Common: sedation, weight gain
dangerous: agraulyocytosis
What are the special uses of remeron (Mirtazipine)?
Elderly- good if elderly pt isn’t sleeping or eating
What is Imipramine and how does it work? What is it used for? Efficacy?
TCA
Increases synaptic 5HT and NE
MDD, Anxiety disorders, chronic pain
More effective than SSRI and SNRI
What are the side effects of Imipramine?
common: dry mouth , sedation, chronic pain
dangerous: CYP2D6, seizure, arrhythmia, lethal in overdose
What are special uses of imipramine?
fibromyalgia
neuropathy
insomnia
What is Nardil (phenelzine) and how does it work? What is it used for? Efficacy?
MAOIs
Increase synaptic 5HT, NE and DA
MDD, Anxiety Disorders
More effective than SSRIs, SNRIs, or TCAs
What are the side effects of Nardil (phenelzine)?
common: sedation, weight gain
dangerous: medication interactions, food interactions (tyramine), hypertensive crisis, 5HT syndrome
What are the special uses of Nardil (phenelzine)?
Treatment resistant depression
What is Abilify (Aripiprazole) and how does it work? What is it used for? Efficacy?
Atypical antipsychotic
Block post-synaptic 5HT receptor, post-synaptic DA receptor partial agonist
Schizophrenia, Bipolar, MDD
Useful in combination w/ SSRI/SNRI
What are the side effects of Abilify (Aripiprazole)?
cmmon: sedation, weight gain, parkinsonian side effects
dangerous: tardive dyskinesia
What are the special uses for Abilify (Aripiprazole)?
Treatment resistant depression
What is Lithium and how does it work? What is it used for? Efficacy?
Adjunct tx
Enhance serotonergic neurotransmission
Bipolar disorder, MDD (adjunct)
Useful in combination w/ SSRI/SNRI
What are the side effects of Lithium?
common: sedation, weight gain, tremor (propanolol to tx tremor)
dangerous: toxicity
What are the special uses for Lithium?
Treatment resistant depression
Mood instability
What is Cytomel and how does it work? What is it used for? Efficacy?
Thyroid hormone (T3)
Stimulate gene transcription
MDD (adjunct)
Useful in combination w/ SSRI/SNRI
What are the side effects of cytomel?
common: activation
dangerous: hyperthyroidism
What are the special uses of cytomel?
Treatment resistant depression
Mood instability
What is adderall (amphetamine/dextroamphetamine) and how does it work? What is it used for? Efficacy?
Psychostimulant
Stim release of DA, block DA reuptake
MDD (adjunct)
Useful inc ombination w/ SSRI/SNRI
What are the side effects of adderall?
common: activation, anxiety
dangerous: dependence, arrhythmia
What are the special uses for adderall?
lethargy, trouble concentration, poor motivation
What is ketamine and how does it work? What is it used for? Efficacy?
Emerging tx
NMDA receptor antagonist
Block NMDA receptor–> increase BDNF–> enhance neurogenesis
MDD (experimental)
What are the side effects of ketamine?
common: sedation
dangerous: hallucinations, dissociations
What are special uses of ketamine?
Treatment of resistant severe depression
