Depression Flashcards
characteristics of a major depressive episode
> = 5 of MSIGECAPS during 2wk period
M - mood depressed
S - sleep
I - interest decrease – anhedonia
G - guilt
E - energy down
C - concentration
A - appetite
P - psychomotor
S - suicide ideation
how to be dx with major depressive disorder (MDD)?
have a major depressive episode (MSIGECAPS for at least 2wks) + depressed mood/anhedonia
and it have a sig impact on daily functioning and not better explained by other conditions
what can impact can excess cortisol have?
- associated with decrease dopamine and serotonin
- damages the hippocampus and impairs hippocampal learning and memory
- causes functional atrophy of the HPA axis
during depression, what changes occur in the HPA axis?
increase of CRH ➔ increase ACTH ➔ increase cortisol
impaired negative feedback so the levels of cortisol continue to rise
what 2 common subtypes of MDD?
post partum depression: within 1M postpartum
seasonal affective disorder: w/ seasonal patterns
what is persistent depressive disorder?
occurs for >2Y and only needs to have >=2 of the MSIGECAPS
RF for major depressive disorder?
Female
FHx
Losing family members
Stressors: financial, legal, academic
Low SES
Meds: OCP use, glucocorticoids (prednisone can precipitate psychotic, manic, or depressive episodes), beta blockers
what is beck’s triad?
Beck’s cognitive triad: negative views of oneself, the world, and the future
RF for suicide
non-modifiable
- older men
- past attempt
- hx of self-harm
- sexual minority
- fhx of suicide
- hx of legal problems
modifiable
- active suicidal ideation
- psychotic symptoms
- anxiety
- hopelessness
- stressful life events
- victimization
- comorbid conditions: substance use disorders, PTSD, personality disorders, chronic conditions, cancer
screening tool for depression?
patient health questionnaire (PHQ-9)
to screen and assess severity of depression
how to assess for suicide risk?
Ask about suicide → investigate the severity of suicide intent → ask about suicide plans and access to means → Intent to act
giving away possessions? written a suicide note?
explore protective factors
examples of protective factors vs suicide
Pets, kids, religion, support system, future events
how to tx major depressive disorder
first-line: psychotherapy (CBT) and interpersonal therapy
- consider mindfulness-based cognitive therapy
patient education for lifestyle changes: increase aerobic exercise, and mindfulness-based stress reduction
- phototherapy forSAD
- severe tx refractory: electroconvulsive therapy
- consider transcranial magnetic stimulation
can consider pharmacootherapy
- firstline: SSRI or SNRI
*can increase suicide ideation esp in younger pts
- prozac is exclusively used for <24Y bc it has less of an impact for suicide ideation
other ex: zoloft, lexapro, effexor
how do SSRIs work?
block the neuronal reuptake of serotonin ➔ increase levels of serotonin
how do SNRIs work?
blocks the neuronal reuptake of serotonin and norepinephrine
