Depression Flashcards
Define depression
Common mental disorder characterized by loss of pleasure or interest in activities for a long time
DSM-5 for diagnosis of Major depressive disorder
An individual must experience 5 or more symptoms during the same 2 week period and at least one of the symptom should either be depressed mood or loss of interest or pleasure
Not better accounted for by another illness
Symptoms must cause individual clinical distress or impairment of functioning ie work
Requires 5 or more symptoms for diagnosis:
Weight loss/gain
Fatigue
Suicidical thoughts
Diminished concentration
Feelings of worthlessness
Using monoamine theories of depression explain the pathophysiology
Causative factor of depression is marked by functional decrease in levels of neurotransmitters such as serotonin , noradrenaline and dopamine.
Give supportive factors of the monoamine theory
Support-TCA, MAOIs shown to be effective in treatment as they target level of neurotransmitters in the synapse .
Reserpine decreases level of neurotransmitters and has been associated with depression
Give issues with monoamine theory
Atypical antidepressant do not affect monoamine pathway yet show effect
Drugs acting on depression manipulate monoamine transmission but effects of neurotransmitters are immediate yet antidepressant effects take several weeks to arise. Thus could be due to some secondary change such as neurogenesis , plasticity
Other probable mechanism
Hypothalamic-pituitary-adrenal axis activated by stress enhances excitoxic effect of glutamate, mediated by NMDA and switches on expression of genes that promote neural apoptosis in the hippocampus and prefrontal cortex. Anti depressive pathway involve NA and 5-Hydroxytryptamine which act in kinase linked receptor switching on genes that protect neurons against apoptosis and promote neurogenesis
Examples of quick screening tools
Patient health questionnaire 2 . Brief screening tool used to assess presence of depressive symptoms. It consists of 2 questions that asses frequency of depressed mood and anhedonia.
Questions also include any suicide -screening questions
Differential diagnosis
Thyroid disorder-hyperthyroidism
Neurological disorder-Parkinson’s
Chronic illness -Cardiovascular disease, diabetes,cancer
Other psychiatric conditions -bipolar, PTSD, anxiety disorder
Variants of depressive disorder
Major depressive disorder- persistent, and severe symptoms of depression that interfere with daily functioning
Post partum-occurs following childbirth
Seasonal affective disorder-due to seasonal changes ie presence of sun
Depression with catatonia such as motor and behavioral manifestation such as mutism, posturing
Risk factors and mrps for depression
Asssess for dose of antidepressant ie setraline
Assess for need of 1st gen antihistamine as can lead to drowsiness
Alcohol interaction and antidepressant-ie TCA increase sedative effects, MAOI, hypertension and can also worsen depression
Alcohol impairs liver functions
Aspirin and setraline increase risk of bleeding
Transform with other antidepressant increase risk of serotonin syndrome
St. John’s wort- no known dose, increase risk of serotonin syndrome , not FDA approved
Asssess lag time as antidepressant effect could be seen at the 6th week
Nifedipine + captopril increase risk of depression
Risk factors -lifestyle, neurological factors(meningitis?), env , genetics ,
Severity of depression assessment
Mild-not more than 5 , and functional impairment mild
Moderate - functional impairment moderate
Severe >5 symptoms
Marked impairment function with or out psychotic disturbances
Non pharmacological
Physical activity
Gratitude journal
Limit alcohol , caffeine
Spend time with loved ones
Improve sleep hygiene
Eat nutritional meals
Spend alone time doing things they enjoy
CBT
Cognitive behavioral therapy good for depression and anxiety . Tested scientifically and proven to be successful. Aids to face fears, tackle self limiting thoughts and behaviors, puts things into perspective, offers skill to cope with stress. Downside-expensive , need professionals , long waiting period
List pharmacotherapy drugs available for depression with examples
TCA’s-impiramine, amitryptyline
SSRI-citalopram, setraline , fluoxetine
SNRI- venlafaxine, duloxetine
MAOI-selegiline, isocarboxazid, phenelzine
Discuss MOA and S/E of SSRI and SNRI
SSRI-block serotonin receptor on presynaptic neurons thus prevent reuptake of serotonin in synaptic cleft thus increased serotonin which enhance mood
SE: N/V, sexual interest decrease, vivid dreams, headache, diarrhea
SNRI- inhibit reuptake of NA and Serotonin which aids to regulate mood and alleviate depressive symptoms
SE: similar to SSRIs - but due to NA cause tremor, sweating, hypertension