Depression Flashcards
Risk factors for depression later in life
Brain neurocircuitry - frontolimbic pathways this is affected by storke PD and AD
Loss of loved one
relocation
disability
presentation in elderly
somatic complaints, weightloss, decreaed appetitive. Higier rate of psychotic and melancholic (severe depression). Less guilt or low self esteem.
What is subsyndromal depression
mild depression - often occurs with chronic illness leading to functional decline ie vision loss - common depression in elderly
Do elderly get dysthymic disorder (chronic depression).
Not really but may extend from midlife to later life
WHen does grief become complicated
Longer than 6 moths, symptoms more extreem, more focused on the loss - poor results from antidepressants CBT better
What is the link between depression and cog imparement
dementia risk increased 20% with midlife depression, 70% later life depression, 80% with both
New depression later in life is more likely part of the AD prodrome
What causes vascular depression
Small vascular insults leading to brain dysfunction
What other disorders are strongly related to depression
Post stroke depression, inflammatory conditions eg arthritis, heart disease, cancer. Post MI
What labs should be used to rule out other cuased of mood symptoms
Thyroid function - TSH, vit deficiency seriom B12, 25-OH Vit D, folate, anemia, infection UTI
What are SSRI side effects in elderly
GI (seritonin receptors in gut). Hyponatremia, EPS, jitters, drug drug interactions (CYP450)
What does paroxetine do to the gut
Causes constipation
What does sertraline do to the gut
Causes diarrhea
Which 2 antidepressants have the biggest inhibitory effect on CYP2d6
Paroxetine and fluoxetine
What SSRI medication have the least impact on the P450 system
citalopram, escitalopram and sertraline
HOw quickly does hyponatremia occur
SIADH occurs within 2 weeks - check lytes after 2 weeks
