Depression Flashcards
**what causes the largerst global burden of disease
depression
**features of depression episode
M - mood S - sleep I - interest G - guilt E - energy C - concentration A - appetitie/weight P - psychomotor retarded S - suicidal
what is episode vs. disorder
- episode is deiscrete period
- MDE can be part of another disorder
- MDD requires it not being better explianed by another disorder
DDx for depression
- bipolar
- persistent depressive dis
- premenstrual DD
- substance induced DD
- DD due to GMC
- adjustment with depressed mood
- bereavement
def. bipolar
type 1 - manic episode
type 2 - hypomania and MDE required - no mania allowed
def. persistent DD
depression for most of the day, for more days than not for 2 years
def. PMDD
mood in week before period and then goes away
- impariment
3 keys to substance induced MD
- occurs after substance
- persists after substance stopped
- can be meds
what is adjustment disorder with depressed mood
Sx that come within 3 months of a stressor and go away within 6 months
- don’t meet MDE requirements
lifetime prev of depression
10-20%
what is trigger for first and subsequent depression
1st - multiple stressors
after - don’t always seem to have stressors - at risk
what are 3 major monaamines of depression
- 5HT
- NE
- DA
what are treatments for types of depresison
mild/mod - CBT and IPT
severe - drugs +/- therapy
best with both
6 main classes of anti-dep
SSRI SNRI SDRI NaSSA TCA MAOi
SSRI SE
HANDS Headache Anxiety Nausea Diarrhea SEX and sleep
what is MoA of SNRI
block reuptake of S and R
- can be good in pain and vasomotor
what is good about NDRI
no sex SE
what is caution about NDRI
can cause seizures
what is SE and use of NaSSA
weight gain, sedation, nausea prevention - can be good for cancer patients
problems with TCAs
lots of SE
prolonged QT interval
what is only reversible MAOi
moclobemide
*** what is first line, second line and thrid line antidepr
1 - SSRI, SNRI, NDRI, NaSSA, moclobemide
2 - TCA, quetapine
3 MAOi
what to do when small effect
optimize - increase dose
what to do when can’t increase dose more
combine - with drug of another class - esp for SE
augment - with different drug
what if not working
switch to another
what is best treatment for psychotic depresison
ECT
