Depression Flashcards
major depressive disorder (MDD) criteria
A) must have at least 5 of SIGECAPS during a 2 week period.
-at least 1 has to be depressed mood OR anhedonia
B) cause social/occupational impairment
C) not due to a substance or other medical condition
SIG E CAPS
Sleep Interest (anhedonia) Guilt Energy Concentration Appetite Psychomotor agitation Suicidality
Must have 5. 1 must be depressed mood or anhedonia
anhedonia
- inability to experience pleasure
- hallmark of MDD
- no sex drive
terminal insomnia
-early morning awakenings
sleep latency
takes longer to actually fall asleep
things to screen for if suspect MDD
- endocrinopathies (Cushings, Addisons, diabetes, hypoglycemia, thyroid issues)
- stroke patients
- substance induced mood disorders
- pancreatic cancer
- carcinoid syndrome
- Parkinsons
- collagen vascular diseases
- viral illness (mono)
- heart disease
MDD: peak age of onset
in the 20s
-can occur at any age
MDD: lifetime prevalence
10-15% (worldwide)
factors contributing to MDD
- decreased levels of serotonin in brain
- high cortisol levels
- genetics
- psychosocial events
MDD vs bereavement
- same clinical presentation of SIGECAPS
- MDD has PERSISTENT symptoms, while bereavement symptoms wax and wane
- MDD can last more than a year, bereavement is usually less
- MDD more common feelings of guilt
- MDD tx includes support and meds, while bereavement is just support (no meds)
- MDD has suicidality, bereavement does not
leaden paralysis
-heavy feelings in arms/legs
non pharmacologic treatments for MDD
PSYCHOTHERAPY
- CBT
- supportive therapy
- interpersonal psychotherapy
- psychodynamic psychotherapy
pharmacologic treatment of MDD
- SSRIs
- SNRIs
- TCAs
- MAOIs
- misc antidepressants
- second generation antipsychotics
- electroconvulsive therapy
- transcranial magnetic stimulation (TMS)
SSRIs
- first line Tx for MDD
- take 4-6 WEEKS to achieve max efficacy
- most common side effect: GI disturbances
- most reported side effect: sexual dysfunction
- other side fx: headaches, rebound anxiety, weight gain, vivid dreams
SNRIs
- 2nd line agents after ineffective Tx with SSRIs
- increased NE causes HYPERTENSION
- also used for neuropathic pain
- takes 4-6 weeks to reach max clinical efficacy
TCAs
- original MDD Tx
- overdose: lethal cardiac arrythmias
- cause sedation, weight gain, QT prolongation, orthostatic hypertension, anticholinergic fx
- now used for neuropathic pain, migraines, enuresis, OCD
MAOIs
- rarely used for MDD (old)
- risk of hypertensive crisis
- don’t take with tyramine
- risk of serotonin syndrome, orthostatic hypotension
ECT
- controlled seizures to restart the brain
- given if pt cannot tolerate pharmacologic Tx
- can cause anterograde and retrograde amnesia (transient, resolves)
Transcranial Magnetic Stimulation (TMS)
- new
- FDA approved for MDD
dysthymia
Persistent Depressive Disorder
A) depressed mood for most days for at least 2 YEARS
B) 2+ of:
-poor appetite/overeating
-insomnia/hypersomnia
-low energy
-low self esteem
-poor concentration
-feelings of HOPELESSNESS*
C) not been without symptoms for more than 2 months
D) not due to side fx of a substance/condition
E) social/occupational impairment or distress
*distinguishing feature
treatment of dysthymia
- same as MDD
- SSRIs not used as often
manic-depressive illness (MDI)
OUTDATED (pre-1980, both bipolar and MDD were under this single diagnosis.)
MDI meant the present of recurrent manic OR depressive episodes.
It is NOT the same thing as bipolar illness, which means the presence of manic AND depressive episodes. In other words, MDI means bipolar disorder PLUS MDD, not just bipolar disorder.
episode of depression
vs.
chronic depression
episode of depression –> 2 wks of depressive sx (SIGECAPS)
chronic depression –> persistent sx that have not remitted for over 6 mo.
Which sx distinguishes dysthymia from MDD?
dysthymia includes feelings of HOPELESSNESS
disruptive mood dysregulation disorder
- out of proportion temper outbursts, inconsistent w/ developmental level
- outbursts 3+/ week
- mood between outbursts –> persistently irritable
- sx for 12mo.
- sx in 2/3 settings and severe in at least 1
- dx between 6-18 y/o
- age of onset before 10 y/o
