Depression Flashcards
When is Major Depressive Disorder diagnosed?
when a pt experiences 1 or more major depressive episodes without a history of manic, mixed or hypomanic episodes.
Which age group experiences the highest rates of depression?
18-29
Which sex experiences the highest rate of depression?
Female
Is prevalence of depression influenced by genetic factors?
Yes. first degree relatives of patients with depression are 1.5-3x as likely to develop depression.
Medications that are effective for depression act at which 2 NT systems?
Serotonin and Norepinephrine
BDNF
Brain-derived neuroptropic factor (A growth factor protein that regulates differentiation and survival of neurons).
Which neuroendocrine abnormality may be partially responsible for depression?
Hypersecretion of cortisol (or lack of cortisol suppression)
What are potential negative consequences of excess circulating cortisol?
Associated stress response, and disruption of BDNF expression.
How many symptoms must be present to diagnose a depressive episode?
5 or more
What symptoms are considered diagnostic of a depressive episode?
- depressed mood, 2. diminished interest in activities, 3. wt loss or wt gain, 4. Insomnia or hypersomnia, 5. Psychomotor agitation or retardation, 6. fatigue, 7. feeling of worthlessness or inappropriate guilt, 8. Diminished ability to think or concentrate, indecisiveness, 9. recurrent thoughts of death/ suicide
How severe must symptoms be to diagnose depression? (ABCD on symptom chart)
A. 5 or more symptoms for 2 weeks, B. Cause clinically significant distress or impairment in social or occupational settings, C. Not due to a substance D. Not due to bereavement (or last more than 2 months if they are).
Which depression rating scale is often used in drug trials?
Montgomery-Asberg Depression Rating Scale (MADRS)
Which depression rating scale is self administered?
Beck Depression Inventory (BDI)
Physical symptoms of depression
Fatigue (often worse in the morning, doesn’t improve with rest), pain (headache), hypersomnia, appetite loss, palpitations, loss of sexual interest.
Emotional symptoms of depression
Diminished ability to experience pleasure, loss of interest in usual activities, sad, pessimistic, worthlessness, inappropriate guilt, anxiety.
Cognitive symptoms
slowed/ impaired thinking, inability to concentrate, poor memory for recent events, indecisiveness.
Psychomotor symptoms
slowed or retarded physical movements, thought processes or speech. OR psychomotor agitation (purposeless restless motion).
In what age group can antidepressants possibly increase the risk of suicide?
Children, adolescents, and possibly 18-24 year olds
What are the 3 stages of MDD treatment, and how long do they last?
- Acute (6-12 weeks) goal: remission 2. Continuation (4-9 months) goal: eliminate residual symptoms and prevent relapse 3. maintenance (12-36 months) prevent recurrence
Who is at greatest risk for recurrence?
Pts under 40 who have 2 or more prior episodes and any pt with 3 or more prior episodes.
Nonpharm therapy
Psycotherapy, cognitive therapy, behavioral therapy, Electroconvulsive therapy (ECT), and repetitive transcranial magnetic stimulation (rTMS)
