Depression Flashcards
MDD
major depressive disorder
How common is MDD?
lifetime prevalence of approx 16% (almost 1 in 6)
How is MDD diagnosed?
when a person has 5 or more of the MDD symptoms consistently through a 2 week period
What are MDD symptoms?
- depressed most of the day
- anhedonia (lack of pleasure)
- weight loss
- sleep disturbance
- psychomotor changes
- fatigue
- feelings of worthlessness or guilt
- inability to concentrate or make decisions
- thought of death or SI (suicidal ideation)
How can neuropathology and/or neuroimaging help to diagnose MDD?
- a small reduction in hippocampal size
- increased activation of the amygdala by negative stimuli
- reduced activation of the nucleus accumbent by rewarding stimuli
- deep brain stimulation (DBS) of either the nucleus accumbent or subgenus area 25 elevates mood in normal and depressed individuals
What are some medical causes of depression?
- low thyroid
- anemia
- chronic pain
- infections
- electrolytes
- liver
- cardiovascular
- epilepsy
- parkinson’s
- alzheimer’s
- malignancy (cancer)
What are some substance-related causes of depression?
- ethanol ?? wtf
- THC ?
- nicotine
- opiates
- stimulants
What else can cause depression?
- drugs
- hormones
- stresses
- losses
Describe the screening process for depression
validated questionnaires or scales to screen for and measure depression/severity
** always have to consider thyroid function!! If someone is taking medication for depression and are not seeing any improvement, then a thyroid hormone is usually considered for a more desired therapeutic effect
Are benzodiazepines a good solution for depression?
Usually no. If they are being used, then the duration should be kept short and then have a follow up
What 4 disorders are all related to one another?
sleep disorders
anxiety
chronic pain
depression
What do antidepressants target?
neurotransmitters that are under-performing
Describe the use of st. John’s wort for depression
- multiple active components which impact many neurotransmitters/targets
- effective for mild to moderate depression
- poor evidence in moderate to severe cases
- potential for interacting with prescription medications.
List the 10 potential sites of drug action
- action potential in presynaptic fiber.
- synthesis of transmitter
- storage
- metabolism
- release
- reuptake into the nerve ending or uptake into a glial cell
- degradation
- receptor for the transmitter
- receptor-induced increase or decrease in ionic conductance
- retrograde singling
** see slide 14 for more info!
Describe the mechanism of action
- enhance impact of neurotransmitter in the synapse (esp. serotonin, norepinephrine and likely DA)
- immediate effects (adverse effects - titrate dose)
- effects on depression: sustained signalling normalizes downstream processes, appears to include gene expression, which increases brain derived neurotrophic factor (and other NF’s)
- do not cause addiction or dependency
Describe “brain-derived neurotrophic factor” (BDNF)
-various sites on it help to repair nerve cells, and enhance their function - known as “brain fertilizer”
long-term administration is needed for ___ and _______ benefits
full, optimal
List 4 markers of poor outcomes
- more severe presentation
- longer time undertreated
- increasing number of episodes
- frequency of relapse
List 4 markers of good outcomes
- access to supports
- adherence to treatment
- history of more rapid response
- lower life stressors
What is a pharmacists’ role in a patient with depression?
- adherance
- education
- adverse effect reduction/management
What are some things that can make you susceptible to having depression?
- factors that impact your psych immune system which include psycho-social elements such as feeling connected, valued, supported, or feeling threatened/vulnerable
- life events and stressors, socio-economic factors
- overall physical and medical health
