Depression Flashcards
Define stigmafree
we should treat patients without bias (or stigma)
Why is depression treatment so important?
- common problem –> massive public health consequences
- often undetected
- CAN be treated
- the generic meds we have are really effective and not expensive
- we have the ability to greatly improve function and health in seniors with careful screening
In what patients are we most likely to see depression?
females; age of onset in 20s
its really common
Depression increases risk of:
- DM
- HTN
- CVD
- stroke morbidity/mortality
What is needed for a MINOR depression diagnosis?
Depressed mood and/or loss of interest or pleasure
AND
- loss or change in appetite
- significant wt gain
- insomnia or hypersomnia
- psychomotor agitation (anxious/restlessness) or retardation (slowing down of thoughts/ decr. in physical movement)
- fatigue or loss of energy
- feelings of worthlessness or excessive or inappropriate guilt
- thoughts of death, suicide ideation with or without a specific plan, suicide attempt
What is required for a MAJOR depression diagnosis?
1+ major depressive episode
(it’s sx must be present every day for at least 2 weeks, be a change from baseline, and cause significant distress/impairment/functioning impairment)
AND
anhedonia (inability to feel pleasure) and/or depressed mood
AND
3 additional symptoms from DSM-V
What defines a major depressive episode?
1+ of these:
- depressed mood most of the day, nearly every day (subjective report or observation made by others)
- decr. interest/pleasure in all or most activities most of the day, almost every day (anhedonia)
others to make a total of 5:
- significant wt gain or loss/ change in appetite
- insomnia or hyperinsomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive/ inappropriate guilt
- indecisiveness or diminished ability to think or concentrate
- recurrent thoughts of death, suicidal ideation with or without a specific plan, suicide attempt
–> the sx must cause significant distress or impairment in social, occupational, or other important areas of functioning
(not due to a substance, a general medical condition, or bereavement)
What are the 9 diagnostic symptoms of MDD?
SIG E CAPS
- sleep
- interest
- guilt
- energy
- concentration
- appetite
- psychomotor
- suicide
What are some screening tools?
- PHQ2
- Ham-D (7+ points - normal)
- Macarthur PHQ (<10 mild or minimal sx)
- Geriatric Depression Scale (GDS)
–> should question the patient further if a + screen to indicate a more specific diagnostic criteria for one or more of the depressive disorders
What would a + PHQ-2 screen look like?
3+ score
over the past 2 weeks how often have you been bothered by any of the following problems?
- little interest or pleasure in doing things
- feeling down, depressed or hopeless
How is the GDS scoring broken down?
0-9 = normal 10-19 = mild depression 20 = severe
What is non-pharm tx for MDD?
- psychotherapy (CBT or interpersonal psychotherapy (IPT))
- electroconvulsive tx (ECT)
- ECT + TMS (transmagnetic stimulation)
Which is more beneficial: psychotherapy or medication?
work about equally well!
psychotherapy is found to be useful in cognitive intact patients
How does CBT work?
help patients modify maladaptive cognitions, beliefs, assumptions, and behaviors that maintain depressive sx
(time limited: 10-12 sessions)
How does IPT work?
focus on goals related to relationships, role transitions, role conflicts, prolonged grief, and interpersonal deficits
How does ECT work?
anesthesia prevents muscle movements associated with tonic-clonic seizures
–> may be the ONLY effective tx for withdrawn SEVEREly depressed older pts (illness is severe, preventing oral intake); ECT may be more effective than medication in elderly in general
(time limited: 6-12 sessions over 2-5 wks)
SE:
- anterograde/retrograde amnesia
- post-ictal confusion (mental/physical exhaustion)
- post-treatment muscle aches
SSRI MOA?
selectively inhibits reuptake of 5-HT at presynaptic neuronal membrane
SNRI MOA?
Inhibit reuptake of 5-HT and NE
weakly inhibit dopamine reuptake
MAOi MOA?
competitively inhibit monoamine oxidase
there are differences within class of reversibility and activity against MAOa and MAOb
serotonin modulators MOA?
selective inhibition of 5-HT reuptake, 5-HT antagonist
trazadone, trazadone ER
dopamine-NE inhibitor MOA?
inhibit dopamine reuptake with some effect on NE
bupropion
NE and specific 5-HT antidepressants MOA?
block presynaptic central a2-adrenergic autoreceptors
–> incr. neurotransmission of NE and 5-HT
block post synaptic 5-HT2 and 5-HT3 receptors
(mirtazapine)
TCADs MOA?
inhibit reuptake of NE and 5-HT into presynaptic terminals
amitriptyline, nortriptyline, imipramine, desipramine
SSRI + partial agonist 5-HT1A MOA?
5-HT reuptake inhibitor with partial agonist activity at 5-HT1A
(vilazodone)
