Depressive Disorders 1 Flashcards
What are the main risk factors of depression?
Family history
Female
Peaks in 20s
What is the pathophysiology of depression?
Alteration in neurotransmitters
What is a common secondary physiology of depression?
Endocrine
What patient demographic has higher rates of suicide?
Males
What health questionnaire is used for depression screening?
PHQ 2 -> PHQ 9
Diagnostic Criteria for MDD:
-At least ______, almost every day for at least 2 weeks
-1 symptom must be depressive mood or anhedonia
Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation
-The symptoms must cause significant distress or impairment (social or occupational)
-The symptoms are not due to substance abuse, bereavement or medical conditions
2 distinct episodes of 5 associated symptoms
Diagnostic Criteria for MDD:
-At least 2 distinct episodes of 5 associated symptoms, ______
-1 symptom must be depressive mood or anhedonia
Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation
-The symptoms must cause significant distress or impairment (social or occupational)
-The symptoms are not due to substance abuse, bereavement or medical conditions
almost every day for at least 2 weeks
Diagnostic Criteria for MDD:
-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks
-1 symptom must be ________
Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation
-The symptoms must cause significant distress or impairment (social or occupational)
-The symptoms are not due to substance abuse, bereavement or medical conditions
depressive mood or anhedonia
Diagnostic Criteria for MDD:
-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks
-1 symptom must be depressive mood or anhedonia
Symptoms:
_________________
-The symptoms must cause significant distress or impairment (social or occupational)
-The symptoms are not due to substance abuse, bereavement or medical conditions
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation
Diagnostic Criteria for MDD:
-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks
-1 symptom must be depressive mood or anhedonia
Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation
-The symptoms must _________
-The symptoms are not due to substance abuse, bereavement or medical conditions
cause significant distress or impairment (social or occupational)
Diagnostic Criteria for MDD:
-At least 2 distinct episodes of 5 associated symptoms, almost every day for at least 2 weeks
-1 symptom must be depressive mood or anhedonia
Symptoms:
Depressed mood
Fatigue
Weight change
Sleep disturbances
Interest (anhedonia)
Guilt or worthlessness
Energy changes
Concentration difficulties
Appetite changes
Psychomotor symptoms
Suicidal ideation
-The symptoms must cause significant distress or impairment (social or occupational)
-The symptoms are not due to _________
substance abuse, bereavement or medical conditions
What is the first line medical management for MDD
SSRIs
How long should an SSRI be trialed in MDD?
4 weeks
If an SSRI is unsuccessful after 4 weeks in MDD, what should be done?
Try a second SSRI before going to second line
What is second line for MDD?
SNRI
What are later line options for MDD?
TCAs, Tetracyclics, MAOIs
What is first line non-medical intervention for MDD?
Pyschotherapy (CBT, interpersonal therapy and supportive therapy)
What therapy is available for patients with MDD who are unresponsive to medical therapy?
Electroconvulsive therapy
When is electroconvulsive therapy indicated for MDD?
-Nonresponsive to medical therapy
-Unable to tolerate medical therapy (pregnancy)
-Need for rapid symptom reduction
What are the four subtypes of MDD?
- Seasonal Affective Disorder (Seasonal Pattern)
- Atypical Depression
- Melancholia
- Catatonic depression
What characterizes SAD MDD?
Presence of symptoms at the same time annually, usually in winter
What is treatment for SAD MDD? (3)
SSRIs
Light therapy
Bupropion
What is the characteristic of atypical depression?
Mood reactivity (mood improves in response to positive events)
What symptoms are typically characteristic of atypical depression? (5)
-Mood reactivity
-Significant weight gain
-Hypersomnia
-Heavy/leaden feelings in arms or legs
-Oversensitivity to personal rejection
What is the management of atypical depression?
MAOIs
What characterizes melancholia?
- Anhedonia
- Lack of mood reactivity
- Depression
- Severe weight loss
- Excessive guilt
- Psychomotor agitation/retardation
- Sleep disturbance
What does sleep disturbance in melancholia present like?
-Increased REM and reduced sleep
-Possible early AM awakenings or worse mood in mornings
What characterizes catatonic depression? (3)
Motor immobility
Stupor
Extreme withdrawal
What is Persistent Depressive Order (PDD) same same as?
Dysthymia
What is the criteria for PDD?
-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months
-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness
-May have depressive episodes or meet the criteria for MDD continuously
-Must never have manic or hypomanic episode
What changes in the criteria for PDD in children/adolescents?
Depression for 1 year instead of 2
-Chronic _______ that lasts most of the day more days than not. Patient is never symptom free for > 2 months
-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness
-May have depressive episodes or meet the criteria for MDD continuously
-Must never have manic or hypomanic episode
depressed mood for at least 2 years
-Chronic depressed mood for _________. Patient is never symptom free for > 2 months
-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness
-May have depressive episodes or meet the criteria for MDD continuously
-Must never have manic or hypomanic episode
at least 2 years that lasts most of the day more days than not
-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never ________
-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness
-May have depressive episodes or meet the criteria for MDD continuously
-Must never have manic or hypomanic episode
symptom free for > 2 months
-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months
-At least ____ of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness
-May have depressive episodes or meet the criteria for MDD continuously
-Must never have manic or hypomanic episode
two
-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months
-At least two of the following conditions must be present:
__________
-May have depressive episodes or meet the criteria for MDD continuously
-Must never have manic or hypomanic episode
- Insomnia or hypersomnia
- Fatigue
- Low self esteem
- Under or overeating
- Hopelessness
- Poor concentration or indecisiveness
-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months
-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness
-May have ______ or ________
-Must never have manic or hypomanic episode
depressive episodes or meet the criteria for MDD continuously
-Chronic depressed mood for at least 2 years that lasts most of the day more days than not. Patient is never symptom free for > 2 months
-At least two of the following conditions must be present:
1. Insomnia or hypersomnia
2. Fatigue
3. Low self esteem
4. Under or overeating
5. Hopelessness
6. Poor concentration or indecisiveness
-May have depressive episodes or meet the criteria for MDD continuously
-Must never have ________
manic or hypomanic episode
What is the treatment for PDD?
Combination treatment with psychotherapy and pharmacotherapy (SSRIs, SNRIs, TCAs and MAOIs) more efficacious than either alone
What is cyclothymic disorder?
Similar to Bipolar II but less severe
Approximately ____ of patients with cyclothymic disorder will eventually develop BPD
1/3
Cyclothymic disorder may coexist with ____
BPD
Cyclothymia:
-At least ____ of milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes
-Symptom free periods don’t last longer than 2 months at a time
-No major depressive, manic or mixed episodes
2 years
Cyclothymia:
-At least 2 years of ______
-Symptom free periods don’t last longer than 2 months at a time
-No major depressive, manic or mixed episodes
milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes
Cyclothymia:
-At least 2 years of milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes
-Symptom free periods don’t last longer than ____
-No major depressive, manic or mixed episodes
2 months at a time
Cyclothymia:
-At least 2 years of milder elevations and depressions in mood that do not meet the criteria for full hypomanic episodes or major depressive episodes
-Symptom free periods don’t last longer than 2 months at a time
-No ________ or _____
major depressive, manic or mixed episodes
Cyclothymia treatment
Similar to Bipolar I:
-Mood stabilizers (lithium, valproic acid)
-Second gen antipsychotics
