Depression Flashcards
What is the lifetime risk for major depressive disorder?
Men: 7-12%
Women: 20-25%
What percent of patients in primary care settings have significant depressive symptoms?
Significant: 10-40%
What percentage of depressed patients present to their doctors only with somatic complaints?
70%
Patients’ “explanations” for their somatic complaints may “anchor” physicians to one set of ideas and blind them to a broader view and, ultimately, the correct diagnosis. For instance, psychological explanations (I am fatigued because I am stressed) lead to a proper diagnosis in 62% of depressed patients; “normalized” explanations (I am fatigued because I don’t exercise) lead to correct diagnoses in only15%; a “somatized” explanation (My fatigue makes me wonder if I have cancer or anemia) lead to the correct diagnosis of depression in 17% of depressed patients.
4. The two key psychic symptoms of depression are depressed mood and loss of interest (anhedonia) in normal activities. Therefore, people with depression may not feel depressed, will deny being depressed, and feel numb and disconnected instead.
5. The suicide rate in depression is ~15%.
6. Diagnosis: asking two questions about mood & anhedonia may be as effective as longer questionnaires:
“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?”
7. Early loss increases risk of developing depression later in life.
8. 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.
9. Chronic depression leads to morphological changes in the brain, including hippocampal cell death and pruning of specific neurons in the brain due to prolonged stress, and ↓ brain-derived neurotrophic factor (BNDF).
10. Fleeting suicidal thoughts in grief are normal. The neurobiology of grief is similar to that of depression, and it is normal for the bereaved to hallucinate briefly the person who died. But, if symptoms of depression appear, treat it as such.
11. 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.
12. 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.
13. The “Baby Blues” exists in all cultures, symptoms peak within 3-5 days of delivery & consist of tearfulness, mood lability, irritability and rejection hypersensitivity, and resolve within 24-72 hours.
14. 50% of women with a history of bipolar mood disorder or previous postpartum depression will develop post-partum depression.
15. Cognitive behavioral and interpersonal therapies have the most empirical support for depression at this time. Cognitive treatment addresses cognitive distortions such as negative thinking & catastrophizing.
16. 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.
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