Depression: Pathophysiology, Clinical Presentation and Tx.

Question 1

List the diagnostic criteria for major depressive episode.

Answer 1

Five or more of the following symptoms for at least the last two weeks (at least one must be #1 or #2) which impairs function and is not better attributed to other illness:

1. dysphoria
2. anhedonia
3. changes in weight
4. changes in sleep
5. psychomotor agitation or retardation
6. fatigue
7. feeling worthless or guilty
8. decreased concentration/ indecisiveness
9. suicidal ideation

Question 2

List the diagnostic criteria for major depressive disorder.

Answer 2

a patient that has experienced one or more episodes of major depression

Question 3

List the diagnostic criteria for persistent depressive disorder. (dysthymic)

Answer 3

2+ years with at least two of the following symptoms:poor appetite/overeating, lower energy/fatigue, insomnia/hypersomnia, poor concentration or feelings of hopelessness

if experienced with episodes of major depression is considered “double depression”

Question 4

State the substance/medication induced etiologies of depression.

Answer 4

alcohol
opioids
stimulants
sedative-hypnotics
corticosteroids
antibiotics

dysthymic disorder
bipolar disorder

Question 5

State the other medical etiologies of depression.

Answer 5

endocrine
neurodegenerative 
cerebrovascular
cardiovascular
nutritional
neoplastic
sleep disorder

Question 6

Describe biological, psychological or social factors that contribute to depression including risk factors.

Answer 6

family history/genes, personal history, gender
stressful life events and social supports
childhood abuse, early loss of parent
divorced or widowed men
other anxiety or substance use disorder

Question 7

What are important elements of a suicide assessment?

Answer 7

assess if the patient is actively or passively contemplating their death, and if actively, assess their intent (ask about plans, specific preparations, writing a letter)

Question 8

Describe psychotropic medications available for depression, give examples.

Answer 8

antidepressants like TCA, SSRI, SNRI

meds to decrease suicide ideation: lithium, clozapine, and dialectical behavioral therapy

Question 9

List behavioral interventions used in treating depression.

Answer 9

cognitive behavior therapy: learning adaptive behavior coupled with meds to increased neuroplasticity and increased neurogenesis

increasing exercise, eating more omega 3-FA

Question 10

What is the lifetime prevalence of depression?

Answer 10

16%

Question 11

Describe the criteria for subtypes of major depressive episode including psychotic features, permpartum onset and seasonal pattern.

Answer 11

Psychotic features: 20% of MDD is accompanied by hallucination or somatic delusions

peripartum: full major depressive episode w/in 1mo of delivery
seasonal: during a particular time of year

Question 12

What is diathesis-stress framework?

Answer 12

a person may inherit the vulnerability to express certain behaviors which are activated only under certain conditions

Question 13

What brain structures/systems are implicated in depression?

Answer 13

associated with loosening regulatory control of PFC over amygdala

Brain structures implicated: prefrontal cortex, anterior cingulate, amygdala and hippocampus (areas of emotional and stress regulation)

Question 14

What is neuromodulation therapy?

Answer 14

deep brain stimulation and electroconvulsive therapy

Question 15

Describe how the monoamine system dysfunction contributes to depression.

Answer 15

Serotonin in raphe nuclei and norepinephrine in locus ceruleus (brainstem) have projection that modulate subcortical and neocortical structures important in cognition, emotion and behavior

Question 16

Describe how the HPA and other endocrine system dysfunction contributes to depression.

Answer 16

Activation of amygdala and certain prefrontal cortex stimulate HPA and cortisol secretion, cortisol acts to shut down the hippocampus and prefrontal cortex

Variation in hormones important for stress and depression- peripartum, during menopause and in men with low testosterone or hypothyroidism

Question 17

Discuss the clinical presentation of depression.

Answer 17

outwardly sad or muted emotions
expression of hopelessness, blame or guilt
overly interpretation of life events/ perspective
failure to cope with upsetting events or dysfunctional coping methods
irritability
feeling of tired
slowed speech, minimal conversation content
hunched over body language, lack of eye contact
suicidal thoughts
history of depressive episodes