Depressive Disorders Flashcards
criteria for major depressive disorder:
depressed mood (e.g. sad or empty feeling) or loss of interest or pleasure most of the time for 2+ weeks plus 4 or more of the following:
-sleep [insomnia or hypersomnia]
-interest [markedly diminished interest/pleasure]
-guilt [excessive feelings of guilt/worthlessness]
-energy [loss of energy/fatigue
-concentration [diminished]
-appetite [increase or decrease]
-psychomotor [agitation]
-suicide [recurrent thoughts]
major depressive episode
*not “organically caused” (i.e. caused by a body system other than the brain such as thyroid disease or due to medications/drugs/alcohol)
*not uncomplicated bereavement (grief)
persistent depressive disorder
*similar to major depressive episode but “less severe”, lasting at least 2 years
premenstrual dysphoric disorder
*one or more of the following during the menstrual cycle:
-marked affective lability
-marked irritability or anger
-marked depressed mood with feelings of helplessness or self-deprecating thoughts
*one or more:
-decreased interests, concentration, energy
-change in appetite
-change in sleep
-feeling overwhelmed
-physical changes such as bloating or breast tenderness
disruptive mood dysregulation disorder
*severe recurrent temper outbursts manifested verbally or behaviorally
*3+ times per week
*mood between outbursts is irritable
*symptoms present for a year
*ages 6-18
substance/medication-induced depressive disorder
*a prominent and persistent disturbance in mood characterized by depressed mood or markedly diminished pleasure
*there is evidence that the symptoms developed during or soon after the substance intoxication or withdrawal or after exposure to a medication
*the involved medication/substance is capable of producing the symptoms
depressive disorder due to another medical condition
*a prominent and persistent disturbance in mood characterized by depressed mood or markedly diminished pleasure
*there is evidence that the disturbance is the direct pathophysiological consequence of another medical condition
*examples: cerebrovascular disease, syphilis, pancreatic cancer, Parkinson’s, etc
proposed mechanisms of action of antidepressants
-blockade of neuronal reuptake of monoamines
-adaptive down-regulation of receptors
-blockade of serotonin-2 receptors
-inhibition of MAO
-post-synaptic cascades giving rise to neuroadaptive changes
-hormonal effects of antidepressants
screening questions for depression
*have you been feeling sad, blue, or depressed?
*have you lost interest in or do you get less pleasure from things you used to enjoy?
-sensitivity of 97%, specificity of 67%
risk factors major depression
*2x as likely in women
*peak age of onset is 20-40 years
*family history is 1.5 to 3x higher risk
*higher rates in separated, widowed, and divorced persons
screening questions for suicide
when things have gotten really bad…
-have you had increased thoughts about death or dying?
-have you thought about hurting yourself?
-have you ever acted on those thoughts?
-do you have access to those means?
**what keeps you from doing this?
management of a suicidal patient
*think through risk factors
*assess acuity
*assess means
*past history, family history
*what prohibitions exist?
*support, who are the partners in management?
treatment of depression
*start on antidepressant (can take 4-8 wks for maximum effect)
* +/- psychotherapy
*continue to assess adequacy of response
common antidepressants
-fluoxetine
-mirtazapine
-bupropion
-sertraline
-paroxetine
-citalopram
-escitalopram
-duloxetine
-venlafaxine
-trazodone
side effects of antidepressants
*serotonergic side effects (GI upset, sexual dysfunction, sleep disturbance, weight gain, etc)
*noradrenergic side effects (tremor, tachycardia)
*dopaminergic side effects (psychomotor activation, aggravation of psychosis)
