Depression Flashcards
What are the causes of depression by percentage prevalence?
30% - 40% Genetic predisposition
60% - 70% Life events
How do life events precipitate depression?
Increased stress ==> Increased cortisol ==> Decreased neurotransmitters ==> Depression
Describe common depression screening instruments.
PHQ-2:
- included in PHQ-9
PHQ-9:
- If PHQ-2 is positive, give PHQ-9
- Medicare mandated
- Validated for:
- Older adults
- Cognitively-impaired adults
DSM-5 (PROMIS):
- Children and adults
Geriatric Depression Scale (GDS):
- 15 questions
What is the role of sensitivity and specificity in depression diagnostic tools?
Sensitivity: Rule in diagnosis (true positive rate)
Specificity: Rule out diagnosis (true negative rate)
When should labs be considered in conjunction with a depression work-up?
- 1st episode of depression
- Precipitant unclear
- Severe depression
- Older age
Which labs should be considered in conjunction with a depression work-up?
- CBC with chem panel (especially with older adults)
- TSH
- Glucose (finger-stick)
- B12/folate (especially with older adults)
- Pregnancy test
- Urine drug screen (if use suspected)
What are the criteria for mild to moderate depression?
2 - 4 symptoms present:
- not all day
- not every day
What are the criteria for major depression?
> /= X symptoms present:
- most of the day
- nearly every day
> /= 2 weeks
Before prescribing meds for depression, what screening should be performed? Why?
Bipolar disorder
Rationale:
- 1st manifestation of BD is depression
- SSRI’s can precipitate a manic episode
- Most patients don’t seek help with 1st episode of mania
- Average 7 - 10 years to diagnose BD
What are the elements of depression management?
- Psychotherapy (refer, insurance may not cover)
- Medication
- *Combination medication and therapy:
- the most effective - Lifestyle changes:
- less evidence to support it but still worthwhile recommending
