Depression Flashcards
Diagnose Major Depressive Disorder.
5+/9 for 2+ weeks representing a change from previous functioning, causing clinically significant distress or impairment, and not attributable to other causes (either 1 or 2 must be present): 1 - Depressed mood, 2 - Markedly diminished interest/pleasure, 3 - Significant weight/appetite loss or gain, 4 - Insomnia or hypersomnia, 5 - Psychomotor agitation or retardation, 6 - Fatigue or loss of evergy, 7 - Feelings of worthlessness or guilt, 8 - Inability to concentrate or make decisions, 9 - Recurrent suicidal thoughts or attempts. “D SIGE CAPS” - Depression, Sleep disturbance, Interest/Pleasure reduction, Guilt/Worthlessness, Energy loss/Fatigue, Concentration/Attention impairment, Appetite changes, Psychomotor symptoms, Suicidal ideation.
What is atypical depression to display?
Weight gain, hypersomnia, leaden paralysis, carb cravings, rejection sensitivity
What is pseudodementia?
A misdiagnosis of “dementia” in a depressed elderly patient with “cognitive symptoms”
What is diurnal variation in depression? What is this also known as?
More depressed in the AM versus PM; AKA “melancholic type depression”
What is seasonal affective disorder? How can this be treated?
MDD associated with shorter days in the winter and usually displaying atypical symptoms. Treat with full-spectrum light exposure (also: psychotherapy, antidepressants)
What is masked depression? What do these individuals seek primary care for? Who is this more typically seen in?
Depression in usually stoic patients presenting with physical ailments who are unaware/in denial of their depression. These patients seek their PCP for psychomotor or somatic symptoms. More typically seen in elderly, O-C, narcisstic.
What 4 main biological theories exist for depression? Are psychosocial factors involved? Estimate percentage contribution of each.
Biological factors: Monoamine deficiency (decreased DA, SR, NE), Monoamine receptor excess theory, Loss of neurotrophic factors and/or degeneration, genetics (esp. seretonin transporter gene). Psychosocial factors are definitely involved. Depression is probably about 35% genetic and 65% environmental.
As number of prior depressive episodes increases, what happens to the risk of depression onset? Especially true for what group? What happens to the risk for those in the low genetic risk group?
Risk increases, especially for those with a high genetic risk. For those with low genetic risk, with an increasing number of prior depressive episodes, risk is similar to those with a high genetic risk.
Explain the stress-cortisol-depression theory (AKA the “neurodgenerative hypothesis”)? How can we intervene?
STRESS –> ^ Glucocorticoids –> v Brain-derived neurotrophic factor (BDNF) –> v Dendritic branching –> Atrophy and death of neurons. Intervention must occur early! Strategy: Pharmacotherapy/ECT/Psychotherapy –> ^ NE & 5-HT –> v Glucocorticoids –> ^ BDNF –> Increased survival and growth of neurons.
What area of the brain is hyperactive? Hypoactive?
Hyperactive: Amygdala. Hypoactive: DLPFC.
Depression is more common in which sex? Which age group (especially when…)? What co-morbidities may exist?
Women. Elderly, especially when widowed or chronically ill. Co-morbidity of substance abuse, GAD.
What is front line drug treatment for depression? Then what? What are augmenting strategies? How long do antidepressents take to onset? What pharmaceutical may be faster?
Front line: SSRI, SNRI, NDRI. Next: MAOIs, TCAs (effective, but more side effects, and thus only used if front line tx fails), Sedating Antidepressants (ex: Trazodone, Mirtazapine – block 5HT2, H1 receptors, Mirtazapine also increases NE by blocking alpha2 NE receptor). Augmenting agents: Lithium, Thyroid hormone, Atypical antipsychotics. Antidepressents can take up to 8 weeks to work. Faster-acting pharmaceuticals include psychostimulatns, ketamine IV.
Despite drug treatment, what is the most effective and fasting acting treatment for depression? What is it used?
Electroconvulsive therapy (ECT AKA shock treatment). Used for severe depression, especially if non-responsive to meds, or if meds are causing toxicity/side-effects, or if immediate resolution is needed.
Are psychological treatments used for depression?
Yup.
What neurostimulation techniques exist for depression?
Vagus Nerve Stimulation, Transcranial Magnetic Stimulation, Deep Brain Stimulation, Transcranial Direct Current Stimulation
