Depression Flashcards
True or false: many ppl suffering from depression dont report depressed mood
True!
Some classic signs and symptoms of depression (Mr. George) and appropriate next step if present in patient
anhedonia, insomnia, weight gain…
–> perform standardized screening questionnaire for major depression (assist in making diagnosis)
Two most common conditions seen by primary care physicians
- hypertension
2. depression
Point prevalence of depression in outpatient setting vs. inpatient setting
outpatient: 4.8-8.6%
inpatient: 14.6%
% of men predicted to suffer an episode of major depression (at some point in life)
7-12%
% of women predicted to suffer an episode of major depression at one point in their lives
20-25%
Bipolar disorder lifetime prevalence men vs. women
men: 0.4%
women: 1.6%
but has no gender difference?
Peak onset depression
age 20-30
high risk for relapse and recurrence (>half of ppl who experience one episode)
Cost of depression in US
> 43 billion every year (medical treatments, lost work productivity)
Global disease burden depression
4.4% of disease burden
(similar to that of diarrheal diseases and ischemic heart disease)
300 mill ppl worldwide, 18 mill of them in US!
Morbidity and mortality of untreated depression: what patients complain of
not nec “feeling depressed”, but rather:
lack of interest or pleasure in activities
somatic complaints
vague unexplained complaints
–> “Unexplained physical symptoms”; more likely to be considered “undifferentiated” patients in primary care settings vs. pts w depression in psychiatric inpatient or outpatient care settings
Depression is often undiagnosed and untreated
even when it is diagnosed it is undertreated!
Barriers to effective depression screening
inadequate education and training, limited coordination w mental health resources, time constraints, poor systematic follow up, inadequate reimbursement
Further barriers (demographic) to diagnosis of depression in pri care
gender, age, culture, language of patient and physician
Patients with the following dzs with concurrent depression have poorer outcomes than those without depression
diabetes, ischemic heart disease, stroke, lung disorders
Depression and higher risk of death from other dzs
heart dz, respiratory disorders, stroke, accidents, suicide
% of patients with severe mood disorders who die from suicide
15%
% of patients who visited their pri care physician on same day as their suicide
20%
Etiology of mood disorders
neurotransmitters, genetics, psychosocial stressors all play a part
True or false: same depressed patient may have variable clinical symptoms from one major depressive episode to another
True
Neurotransmitter deficiencies
serotonin, norepinephrine, dopamine, GABA, peptide neurotransmitters (somatostatin, thyroid-related hormones, brain-derived neurotrophic factors)
all hypothesized to contribute!
Overactivity in neurotransmitters
substance P, acetylcholine; elevated cortisol (w lack of diurnal variation) also proposed
Genetics and mood disorders
no specific genes found but clear genetic component (depression and bipolar disorder are inheritable)
)
Risk of depression in First degree relatives of patients w recurrent major depression
1.5-3 times higher risk of depression compared to gen pop