depressive disorders (329 E2) Flashcards
depression epidemiology
-2x more common in women than men
-more prevalent in caucasians but more severe in African Americans
-seasonality worse in decreased sunlight
-socio economic status areas
etiology of depression: biological factors
-genetic
-biochemical abnormalities (neurotransmitter, electrolyte, cortisol, hormonal imbalances)
-inflammatory process
what type of thyroid disorder is commonly seen with depression
hypoactive thyroid
check T3, T4 & TSH levels
etiology of depression: psychological factors
-cognitive theory psychological predisposition (negative and/or unrealistic expectations and perceptions)
-learning theory: learned helplessness
contributing factors to depression: child
based on diathesis stress model
-detachment of primary caregiver
-parental separation or divorce
-death of loved one, including pet
-relocation
-academic failure
-physical illnesses
contributing factors to depression: teens
adult & child theories apply as well
-conflicts w/ independence and maturation
-role confusion
-grief/loss
contributing factors to depression: older adults
-societal attitudes: self esteem, helplessness
-major stressors: financial problems, life changes, physical illness, grief/loss, decreased functional ability
Major depressive disorder (MDD)
5 or more daily in 2wk period
-wt loss & appetite changes
-sleep disturbances
-fatigue
-psychomotor agitation or retardation
-worthlessness or guilt
-loss of ability to concentrate
-recurrent thoughts of death
+ at least one sx is also either
-depressed mood
OR
-loss of interest or pleasure (anhedonia)
what is chronic MDD
lasting more than 2 years
MDD cannot have
mania or hypomania episodes
would then be classified as a bipolar disorder
MDD dx in children & teens
5 or more sx present during 2wk period
-depressed or irritable, cranky mood
-loss of interest or pleasure
and any 3 of the following
-significant wt loss or decrease in appetite
-insomnia or hypersomnia
-psychomotor agitation or retardation
-fatigue or lack of energy
-feelings of worthlessness or guilt
-decreased concentration or indecisiveness
-recurrent thoughts of death or suicide
other symptoms of MDD in children and teens
-frequent, vague, nonspecific physical complaints (“my tummy hurts”)
-frequent absences from school or poor performance in school
-being bored
-alcohol or substance abuse
-increased anger or hostility
-reckless behavior
depression symptoms in children: up to age 3
-failure to thrive
-feeding problems
-lack of playfulness
-lack of emotional expression
-delay in speech or motor development
depression symptoms in children: age 3-5
-prone to accidents
-phobias
-aggressiveness
-excessive self reproach for minor infractions
depression symptoms in children: age 6-8
-vague physical complaints
-aggressive behavior
-cling to parents
-avoid new peopel and challenges
-behind in social skills/academic performance
depression symptoms in children: ages 9-12
-morbid thoughts
-excessive worrying
-lack of interest socially
-think they have disappointed parents
disruptive mood dysregulation disorder (DMDD)
-ages 6-18 y/o
-onset before age 10
-sx include anger and constant, severe, irritability
-prevalence rate is 2-5%
-more common in males and in children than adolescents
-temper tantrums w/ verbal and behavioral outbursts at least 3x weekly
-display irritability, anger and temper tantrums in at least 2 settings
persistent depressive disorder
-formerly known as dysthymia
-low level depressive feelings through most of each day, the majority of days
-sx for at least 2 years in adults, 1 yr in children/adolescents
-must have 2 or more: decreased appetite or overeating, insomnia or hypersomnia, low energy, poor self-esteem, difficulty thinking and hopelessness
response to mediations in persistent depressive disorder
2/3 of individuals respond favorable to antidepressants, specifically MAOIs and SSRIs
premenstrual dysphoric disorders
-sx cluster in last week prior to onset of a women’s period
-sx include: mood swings, irritability, depression, anxiety, feeling overwhelmed, and difficulty concentrating
-physical manifestations include lack of energy, overeating, hypersomnia or insomnia, breast tenderness, aching, bloating and wt gain
-sx decrease significantly or disappear with the onset of menstruation
medication for premenstrual dysphoric disorders
give SSRIs just for the premenstrual periods, stop once period starts
substance induced depressive disorder
person does not experience depressive symptoms in the absence of drug or alcohol use or withdrawal
depressive disorder associated with another medical condition
-can be caused by kidney failure, parkinson’s disease, and alzheimer’s disease
-symptoms that result from medical diagnoses or certain medications are not considered major depressive disorder
psychomotor retardation
-visible slowing of physical activity such as movement and speech
-slow talking or long pauses before beginning to talk, taking long time to cross a room or slow chewing / waiting longer between bites
-associated w/ severe depression
psychomotor agitation
-increased in activity brought on by mental tension
-restlessness, pacing, tapping of fingers or feet, abruptly starting and stopping tasks, meaninglessly moving objects around
-associated w/ agitated depression
general antidepressant mediation education
-May not see symptom improvement until 4-6 weeks.
-Physiological symptoms improve before psychological symptoms with increased energy danger of SI
-Look for improved sleep; less daytime fatigue and crying; & increased frustration tolerance.
-Side effects may occur but handled by adjusting dosage or switching to different med in same class.
-Discontinuing meds as soon as you feel better may result in relapse. Meds usually needed for 6-9 months past symptom relief- up to 12 -24 months.
-Antidepressants are not addictive.
-Abrupt stopping of meds will result in withdrawal- nausea, anxiety, insomnia, flu-like symptoms
-Do not drink alcohol
antidepressants
-SSRIs
1st line therapy & low risk for serotonin syndrome
-SNRIs
not as well tolerated better
-tricyclic antidepressants
anticholinergic adverse reactions
-monoamine oxidase inhibitors
effective for unconventional depression & has tyramine restrictions
