Depressive Disorders Flashcards
How is MDD defined? List the symptoms
- Five or more of the nine symptoms that are present during same 2-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest or pleasure
- Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- Episode is not attributable to physiological effects of a substance or to another medical condition;
SIGECAPS
S: sleep disturbance (insomnia/hypersomnia)
I: interest/pleasure reduction (subjective or observation)
G: guilt, feelings of worthlessness
E: energy loss, fatigue
C: concentration/attention impairment (subjective or observed)
A: appetite changes (increase or decrease)
P: psychomotor symptoms (agitation or reduction that’s observed)
S: suicidal ideation (recurrent thoughts, or even an attempt)
What can be used to differentiate between normal sadness and depression?
At least one of the following (SWAG):
- Suicidality (serious thoughts or attempts at killing oneself)
- Weight loss (>5% loss of body weight without medical cause)
- Anhedonia (loss of pleasure/interest in previously enjoyable activities)
- Guilt (feeling responsible for negative life events without reason)
Other characteristics of MDD?
- Atypical depression (more likely to have weight gain and hypersomnia; also leaden paralysis, carb cravings, rejection sens)
- Pseudodementia
- Diurnal variation (more depressed in AM than PM, or MELANCHOLIC type depression)
- Psychomotor symptoms (physical complaints like body aches, headaches; agitation vs. retardation, and vegetative depression)
- Seasonal affective disorder (MDD can come along with winter, see atypical symptoms, treat with full-spec light exposure, psychotherapy, antidepressants)
- Masked depression (someone who’s depressed will have vague physical ailments but in denial/unaware of depression; they are STOIC; seek care for psychomotor or somatic symptoms and not depression; think more elderly and OC personalities)
DD of MDD?
- Hypothyroidism
- Cushing’s
- Anemia
- Brain injury, stroke
- Vit deficiency (B12, folate, Vit D)
- OSA
Etiology of MDD
- Monoamine deficiency
- Monoamine receptor excess theory
- Loss of neurotrophic factors and degen
- Genetics (serotonin transporter gene);
psychosocial factors: ability to cope with life stressors, low self-esteem, personality traits, addiction, learned helplessness, catastrophic loss, etc.
Occurrence of MDD?
- Women more so than men
- Women more likely to seek help/treatment
- Higher risk for ELDERLY who are widowed or chronically ill
- Co-morbidity of substance abuse, generalized anxiety
Treatment of antidepressants?
- SSRI’s, SNRI’s, NDRI’s, MAOI’s (the front line agents, with less severe SE’s)
- TCA;
Sedating antidepressants (e.g. trazodone, mirtazapine) that block 5HT2 receptors and H1 receptors instead of using SSRI; mirtazapine increases NE by blocking alpha-2a NE receptor;
if antidepressants not enough, use LITHIUM, thyroid hormone, atypical antipsychotic (SGA)
If antidepressants are too slow…
think electroconvulsive therapy:
SHOCK TREATMENT
1. effective for severe depression (especially if non-responsive to meds)
2. Used if antidepressants cannot be used due to toxicity/SE’s, or if they fail
3. Used when immediate resolution of symptoms is needed (suicidal/psychotic patients)
Other neurostim techniques?
- Vagus nerve stimulation (goes to NTS then LC and RN; can get hoarseness as SE with damage to recurrent laryngeal and worried about permanent hoarsness)
- Transcranial magnetic stimulation (good for mild-moderate depression)
- Deep Brain stimulation (disconnect hot and cold regions of brain, but worried about stroke and infection)
- Transcranial Direct Current Stimulation
Psychological treatments:
Think family, interpersonal, psychoanalytic/psychodynamic, behavioral, cognitive therapies
Ways to deal with neurophys of depression?
- Try and get more SR in system (make more neurotrophic factors)
- Try and downregulate the number of receptors for SR
need balance between number of receptors and amount of NT
Genetic and environmental risk factors in depression?
65% unique environmental, 35% genetic factors;
Theory on how depression could come about at neuronal level?
- Stress increases glucocorticoids and decreases BDNF
- Atrophy/death of neurons (decreased dendritic branching);
break cycle by increasing 5-HT and NE, decrease glucocorticoids, increase BDNF, increased survival and growth
General rule of thumb for depression neuroanatomy?
Hypoactive DLPFC, hyperactive amygdala!!!
Cold front, hot in middle
