Depression and Tx Flashcards
Causes of depression
T/F: multiple episodes of untreated depression can cause physiologic changes to the brain?
- genetics/epigenetics
- early life adversity
- social factors (isolation, poor social relationships, depression in social networks)
- psychological factors (personality, psychodynamic = early losses, cognitive/behavioral = negative thinking)
- 2ndry depression d/t medical disorders/meds/substance abuse
True, can alter brain structure and function.
Neurobiology of depression
- abnormal functioning of NT: serotonin, NE, dopamine, GABA, glutamate
- excess excretion of glucocorticoids
- abnormal neuronal networks
- sleep/circadian rhythms, decreased REM latency and slow wave sleep
- higher levels of inflammatory markers.
Sx of Major Depression
Psychological:
- numbness
- anhedonia
- irritability/anxiety
- guilt
- suicidal ideation
Neurovegatative:
- appetite (anorexia)
- sleep (wake up early)
- low energy
- concentration
Psychomotor:
- retardation
- agitation
physical:
-aches/pain
-weakness/malaise
-GI distress
“walking through mud”
Criteria for Depression
- sx occur in same two weeks most of the day nearly every day
- distress or impairment (social, work functioning)
What are the subtypes of depression?
What are the subcategories of depression?
- anxious
- atypical
- catatonic
- melancholic
- mixed features
- peripartum
- psychotic
- seasonal
Categories:
- bipolar
- 2ndry:
- -medical illnesses
- -medications
- -drugs of abuse
what is SIGECAPS
Sleep Interests Guilt/worthlessness Energy Concentration Appetite Psychomotor disturbance Suicidal ideation
Depression evaluation
Complete Hx
+/- Physical and neuro exam
Mini- mental status exam
Toxicological screen
Labs: CBC, TSH, LFTs, Chem7/BMP, B12, folate, HIV
Brain imaging (psychosis or neuro findings)
+/- EEG, LP (psychosis or neuro findings)
What are psychotic features?
delusions, hallucinations, disordered thought
*markedly higher risk of suicide.
What is the pneumonic for suicide risk factors
SAD PERSONS
- Sex (male)
- Age (elderly or adolescent)
- Depression
- Previous suicide attempts
- Ethanol abuse
- rational thinking loss (psychosis)
- social supports lacking
- organized plan to commit suicide
- no spouse (divorced, widowed, single)
- sickness (physical illness)
When do we hospitalize pts with depression?
when they are expressing suicidal ideations and have:
-plan, intent, means
*if less acute develop a safety plan
What is all included in the safety treatment plan?
crisis numbers (family, friends, suicide hotline, ER, clinic number)
Release of information for family in chart
Commitment to adhere to medications, appointments, contact office with concerns
Agree to remove lethal means
What is STAR*D
Sequenced Tx Alternative to Relieve Depression
S- switching classes does not improve remission
T- Tolerability similar between classes
A- augmentation may be better than switching*
R- Remission rates decreases with each failed medication trial
What are some positive and negative predictors of remission?
Positive:
-Caucasian, female, employed, education
Negative:
- longer index episodes
- drug abuse
- anxiety disorders
- medical disorders
- lower functioning
Acute Tx of Depression
- mild
- moderate-severe
- bipolar
- psychotic
Mild: psychotherapy alone
Moderate/severe: medication +/- therapy
Bipolar: mood stabilizer +/- antidepressant
Psychotic: antipsychotic + antidepressant.
What are the three phases of depression?
What is the lifetime recurrent rate of depression with:
- one episode
- two episodes
- three episodes
Acute phase (1st 12wks)
Continuation phase (4-6mo following remission)
Maintenance phase (relapse prevention)
Recurrence rate:
- 1 episode = 50%
- 2 episodes = 70% (medications are lifelong at this stage)
- 3 episodes = 90%
