Depression

Question 1

The lifetime risk for major depressive disorder is _____ percent for men and _____
percent for women.

Answer 1

7 to 12

20 to 25

Question 2

What percent of patients in primary care settings have significant depressive symptoms?

Answer 2

10-40%

Question 3

What percentage of depressed patients present to their doctors only with somatic complaints?

Answer 3

70% !

Question 4

What do patients’ explanations for somatic complains cause physicians to do?

Answer 4

Patients’ explanations cause physicians to anchor their diagnosis to a certain set of ideas and blind them to the broader view/correct diagnosis for a patient. Example: I’m tired because I don’t exercise.

Question 5

Two key psychic symptoms of depression are:

Answer 5

1) Depressed mood

2) Loss of Interest (Anhedonia) in normal activities

Question 6

Depressed people may say they feel….

Answer 6

numb and disconnected instead of actually acknowledging their depression.

Question 7

Suicide rate of depressed people is

Answer 7

15%

Question 8

Two important questions to ask about mood and anhedonia are:

Answer 8

“Over the past two weeks (or ever), have you felt down, depressed, or hopeless?”
and
“Over the past two weeks (or ever), have you felt little interest or pleasure in doing things?”

Question 9

What increases risk for depression?

Answer 9

Early loss increases risk of developing depression later in life.

Question 10

The hypothalamic-pituitary-adrenal axis is hyperactive in depression which can lead to….

Answer 10

endothelial inflammation and excessive clotting due to excessive cortisol secretion and hippocampal cell death.

Question 11

Morphological changes in the brain due to chronic depression are:

Answer 11

1) Hippocampal cell death
2) Pruning of specific neurons in the brain due to prolonged stress
3) Decreased Brain-derived neutrophic factor (BNDF)

Question 12

During grief is it normal for fleeting thoughts of suicide and to hallucinate briefly of the person who died?

Answer 12

Yes, but if symptoms of depression persist, treat it as such.

Question 13

What is the genetic predisposition for depression?

Answer 13

One or two copies of the short allele promoter variant of the serotonin transporter gene are more susceptible to developing depression after stressful life events
than people homozygous for the long allele variant.

Question 14

Patients with depression and sub-clinical hypothyroidism have a higher prevalence of..

Answer 14

associated panic disorder, and a poorer response to antidepressant drugs than euthyroid depressed patients.

Question 15

“Baby Blues” or postpartum depression symptoms

Answer 15

Symptoms peak within 3-5 days of delivery & consist of tearfulness, mood lability, irritability and rejection hypersensitivity, and resolve within 24-72 hours.

Question 16

What percent of women with a history of bipolar mood disorder or previous postpartum depression will develop post-partum depression?

Answer 16

50% !!!

Question 17

How to anti-depressants work?

Answer 17

Chemically, anti-depressants affect monoamine systems. Prescribing antidepressants to patients who might be bipolar – without first being on a mood stabilizer such as lithium - runs the risk of precipitating a hypo-manic or manic episode.

Question 18

What is the best treatment for depression?

Answer 18

Cognitive behavioral and interpersonal therapies have the most empirical support for depression at this time though there is also evidence for the use of dynamic psychotherapy as well. Cognitive treatment addresses cognitive distortions such as negative thinking & catastrophizing.