Depression Flashcards
Depression Diagnosis
5 or more symptoms including depressed mood and/or anhedonia for > 2 weeks:
S leep changes: increase during day or decreased sleep at night
I nterest (loss): of interest in activities that used to interest them
G uilt (worthless): depressed elderly tend to devalue themselves
E nergy (lack): common presenting symptom (fatigue)
C ognition/C oncentration: reduced cognition &/or difficulty concentrating
A ppetite (wt. loss); usually declined, occasionally increased
P sychomotor: agitation (anxiety) or retardations (lethargic)
S uicide/death preocp.
NO Hx mania
NOT due to substance or medical condition
Prevalence of MDD with Psychosis
10-15% of individuals with MDD
Hallucinations or delusions only occur during mood symptoms (dist. from schizophrenia and schizoaffective DO)
Often have prominent features of guilt, punishment death, and physical decay
Prevalences of Depression
16-17% lifetime prevalence
5-6% 12-month prevalence
Depression Risk Factors
- Family history (3x higher risk for 1st degreee relative)
- Female gender (2:1)
- Neuroticism
- Negative cognitive bias
- Stressful life events
- Adverse childhood experiences
Course of illness
Onset: 20-25y/o (10% of pts <12y/o)
20-25% with chronic course
Risk of recurrence
50% after 1st episode
70% after 2nd episode
90% after 3rd episode
Comorbidities with Depression
Anxiety DOs (70%)
Substance Use DOs (30%)
Medical illnesses - chronic painful conditions
Treatments for Depression
Psychotherapy (talk, CBT, etc)
Pharmacological (Antidepressants)
Somatic therapies (ECT, Repetative Transcranial Magnetic Stimulation, Vagal Nerve Stimulation)
Alternative Therapies (herbal)
Antidepressant Types
SSRIs (Selective Serotonin Receptor Inhibitors) (citalopram, escitalopram, fluoxetine, paroxetine, sertraline, fluroxamine)
SNRIs (venlafaxine, duloxetine)
Atypicals (mirtazepine, buproprion)
Tricyclics
MAOIs (Monoamine Oxidase Inhibitor)
Common Antidepressant Side-Effects
1) (Usually transient) agitation, insomnia, sedation, nausea
2) Longer-term sexual dysfunction (5-HT effects)
3) Weight gain (mirtazepine, paroxetine)
4) Increased sweating
5) Discontinuation (withdrawl) effects (venlafaxine, paroxetine)
Infrequent Serious Antidepressant Side-Effects
1) Mania
2) Suicidal ideation
3) “Serotonin Syndrome” on highly serotonergic agents combined with others (MAOIs, meperidine)
4) “Hypertensive crises” on MAOIs and sympathomimetics with tyramine-containing foods
5) Prolonged QTc, cardiac arrhythmia (high dose tricyclic antidepressants)
6) Priapism (TrazaBone)
3 Phases of Pharmacological Tx
Acute: > 12wks to establish remission
Continuation: 4-9mo beyond remission (~1yr total) to consolidate recovery
Maintenance: 1yr or more (more complex, chronic, recurrent, suicidal pts)
