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
how to tricyclic antidepressants work?
blocks the reuptake of norepinephrine > serotonin > dopamine
what cx are we concerned about with psychiatric medications?
almost all can cause QT prolongation
what cx are we concerned about in pts that are taking multiple meds that impact serotonin
serotonin syndrome: too much serotonin in the body
can cause death
mild: shivering and diarrhea, high BP and HR
severe: muscle rigidity, fevers, and seizures
what are some differences between bereavement (grief) and a major depressive episode?
- pattern: waves/pangs of grief vs continuous negative emotions
- predominant affect: has occasional pleasant emotions vs pervasive depressed mood
- self esteem: preserved vs critical
- sociability: maintains connections vs withdrawal
- thoughts: memories of deceased vs self-critical
- thoughts of death/suicide: joining deceased vs feelings of worthlessness
- triggers: depressed mood by reminders of deceased vs not tied to specific thoughts
