Depression- 18B Flashcards
Medical etiologies of secondary depression
- pancreatic cancer
- thyroid disease: hypo- OR hyper- thyroidism
- MS
- Epilepsy
- TBI
- post-stroke
- post- MI
Medications associated with depression
- anabolic steroids
- ACE-I’s
- corticosteroids
- Beta-blockers
- interferon alpha
- isotretinoin (acne)
- Reserpine
Depression and sleep
hard time falling asleep, and when asleep mind racing, therefore no deep sleep
- INCREASED sleep latency
- DECREASED REM latency
- INCREASED REM density
- DECREASED sleep continuity
Antidepressant effect on sleep
SUPPRESSES REM SLEEP
Depression and P11
- P11 is an intracellular protein that recruits the serotonin receptor to the neuron cell membrane surface
- ALL ANTIDEPRESSANTS AND ECT INCREASE P11 LEVELS
Describe depression and the HPA crisis
-increased HPA activity in depression leading to hypersecretion of cortisol
-the DEXAMETHASONE SUPPRESSION TEST (give 1 mg dexamethasone in the evening and measure serum cortisol in the morning and the levels SHOULD BE LOW: suppressing cortisol levels)
-non-suppression of HPA with DST
50% in depression with melancholia
80% in depression with psychotic features
Features of late onset depression
- initial onset after age 65y
- less associated with life events
- usually due to secondary cause (Alz Dz prodrome, hypertension and vascular disease)
Epidemiology of Depression
- average age of onset: 29y
- overall prevalence 6.6%
- 5-10% eventually develop bipolar disorder
- 7-15% commit suicide
Comorbidities of MDD
- 72% co-morbid with other mental disorders
- 60% co-morbid with anxiety
- 25% co-morbid substance use disorder
MDD is a recurrent illness
- risk after first episode 50%
- risk after 3 episodes >80%
- average length of episode 3 months
Features of ADDISON’s DISEASE
- darkened palmar creases
- HYPOCORTISOLISM
