Depression

Question 1

Two key symptoms of depression

Answer 1

depressed mood and loss of interest (anhedonia) in normal activities.

Question 2

Involvement of hypothalamus in depression

Answer 2

The hypothalamic-pituitary-adrenal axis is hyperactive in depression which can lead to endothelial inflammation and excessive clotting due to excessive cortisol secretion and hippocampal cell death.

Question 3

Morphologic changes in brain due to chronic depression

Answer 3

hippocampal cell death and pruning of specific neurons in the brain due to prolonged stress, and ↓ brain-derived neurotrophic factor (BNDF).

Question 4

What gene may predispose to depression?

Answer 4

People with 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 5

How does the thyroid afffect depression

Answer 5

Patients with depression and sub-clinical hypothyroidism have a higher prevalence of associated panic disorder, and a poorer response to antidepressant drugs than euthyroid depressed patients.

Question 6

When do symptoms of baby blues resolve

Answer 6

within 24-72 hrs

Question 7

Antidepressants and bipolar disease

Answer 7

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 8

Depression is a known risk factor for what heart problems

Answer 8

ischemic heart disease and MI. Incidence increases after MI

Question 9

depression and arrhythmias

Answer 9

Decreased heart-rate variability due to sympathetic activity override of parasympathetic influences via the vagus nerve, increases the risk of ventricular arrhythmias and sudden death.

Question 10

Mnemonic for evaluating depression patients

Answer 10

Dx SIG: ECAPS. Depressed mood, Sleep- too much or too little, Interest – decreased,Guilt – increased, Energy – decreased, Concentration – decreased, Appetite – decreased or increased, Psychomotor agitation/retardation, Suicidal ideation (rate in depression is ~15%)

Question 11

Other types of depression

Answer 11

seasonal affective disorder, pre menstrual dysphoric disorder, atypical depression (hypersomnia, weight gain, rejection hypersensitivity), dysthymia (low intensity mood disorder with low self esteem, low energy)

Question 12

Complications with partum and post partum depression

Answer 12

increased pre-eclampsia, low birth weight, premature suicide, adversely impacts mother-child bonding.

Question 13

Grief vs depression

Answer 13

Time course: 1-2months (G) vs longer (D). Suicidal ideation: transient (G) vs often present (D). Psychosis: transient voices/visions (G) vs sustained (D). Emotions: waves of feelings (G) vs pervasive depression (D). Self blame: related to deceased (G) vs focused on self (D).

Question 14

Treatment of depression

Answer 14

Cognitive behavioral and Interpersonal therapies among the proven effective psychotherapies. SSRIs in depressed patient post MI reduces subsequent morbidity and mortality. Alternative treatments include EPA, folate, B12, calcium and chamomile tea

Question 15

risks for developing depression

Answer 15

Loss before age 10, Hx of abuse, female, loss of social supports, family or prior history of depression, anxiety or substance use disorder, significant stressful life events

Question 16

DSM IV criteria for depression

Answer 16

During the same 2 week period: Depressed mood or diminished interest in almost all activities nearly every day, + at least 4 of the following: Significant weight loss or gain  Insomnia or hypersomnia  Psychomotor agitation or retardation  Fatigue or loss of energy  Feelings of worthlessness or guilt  Impaired concentration, indecisiveness  Recurring thoughts of death or suicide

Question 17

Monoamine deficiency hypothesis for depression

Answer 17

The monoamine transporter transports free NE, serotonin and dopamine from cytoplasm into vesicles for release from nerves and monoamine oxidase degrades unbound neurotransmitters. Monoamine oxidase inhibitors improve mood, suggesting that a deficiency of monoamines (NE, serotonin, etc) causes depresion