Depression Flashcards
What is the DSM-5 criteria for diagnosing MDD?
At least 5 symptoms experienced within the same 2 week period and represent a change from previous functioning.
One of the symptoms must be depressed mood or loss of interest
- Interest (Decreased interest)
- Sleep (Insomnia or Hypersomnia)
- Appetite (Decreased appetite, weight loss)
- Depressed (Depressed mood (adults); may be irritable mood in children)
- Concentration (Impaired concentration and decision making)
- Activity (Psychomotor agitation or retardation)
- Guilt (Feelings of guilt or worthlessness)
- Energy (Decreased energy or fatigue)
- Suicidal thoughts or attempts
(In SADCAGES)
Symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning.
Symptoms are not caused by an underlying medical condition or substance
Define Dysthymia
Depressed mood + 2 or more symptoms for 2 years but not fulfilling MDD diagnosis
Define Adjustment disorder
Sx occur within 3 months of onset of a stressor; but once the stressor is terminated, sx do not persist for additional 6 months
Antidepressant not indicated because disorder is not due to a biological deficit of neurotransmitters, counselling should be recommended
Define Acute Stress disorder
Sx occur within 1 month of a traumatic event and lasts 3 days - 1 month
Sx include intense fear, helplessness, horror, with dissociation, re-experiencing, avoidance, increased arousal.
State some non-pharmacological ways of managing depression
Sleep Hygiene
Psychotherapy (used in combination with medication in moderate-severe MDD)
Neurostimulation: ECT and rTMS (reserved for refractory/severe MDD, rTMS does not penetrate the skull like ECT, rTMS shows some evidence for reducing voices)
When are antidepressants indicated?
Moderate-Severe MDD, Dysthymia, certain anxiety disorders
Not routinely indicated for mild depression
How long is an adequate trial for antidepressants?
Adequate Trial = adequate dose + duration (4-8wks)
How long do the symptoms take to improve once initiated on antidepressants?
Physical symptoms (appetite, sleep) improve in 1-2 weeks
Mood symptoms may take longer (4-8 weeks)
Evaluate for mania if mood sx improve drastically in first few weeks
Why is there a delayed onset to improvement of symptoms when initiating antidepressants?
Due to gradual down regulation of pre-synaptic autoreceptors in the synapse, which in turn facilitates neurotransmitter release.
Which SSRI has the longest half life
Fluoxetine (4-6 days)
Norfluoxetine (4-16 days)
Which SSRI has a short half life
Paroxetine
What other indications is duloxetine indicated for?
Diabetic Peripheral Neuropathy, Fibromyalgia, Chronic musculoskeletal pain.
What are the common side effects of all serotonergic drugs
GI SE and sexual dysfunction
