Depressive Disorders Flashcards
Major depressive disorder (MDD)
Recurrent depressive episodes lasting at least 2 weeks.
- 15% of patients seen in primary care can meet this criteria
- up to 50% of patients also possess chronic medical illnesses
Episodes require at least 5 of the following 9 symptoms: *note MUST have at least one of the first 2 as well* “DIGS SPACE” - Depressed mood - decreased Interest/pleasure (anhedonia) - Guilt or feelings of worthlessness - Sleep disturbances - Suicidal ideation - Psychomotor retardation or agitation - Appetite/weight changes - decreased Concentration - decreased Energy
also must screen for previous manic or hypomanic episodes (would then be bipolar disorder)
MDD w/ psychotic features
MDD + hallucinations/psychosis
- hallucinations usually are related to depressive themes/death and only occur in at the same time as the MDD
Treatment = antidepressant w/ possible atypical antipsychotic
Persistent depressive disorder (Dysthymia)
Recurrent mild depressive episodes lasting at least 2 years
- remission lasts less than 2 months as well
Episodes require at least 2 but no more than 5 of the following 9 symptoms:
“DIGS SPACE”
- Depressed mood
- decreased Interest/pleasure (anhedonia)
- Guilt or feelings of worthlessness
- Sleep disturbances
- Suicidal ideation
- Psychomotor retardation or agitation/anxiety
- Appetite/weight changes
- decreased Concentration
- decreased Energy
- is typically milder than MD*
Tx =Lifestyle changes and SSRIs
Depression with atypical features
Is similar to MDD except mood is transiently improved in response to a positive event
Symptoms
- hypersomina
- hyperphagia
- Leiden paralysis (heavy feeling in arms and legs)
Treatment:
CBT and SSRI = first line
MAOIs = second line
Epidemiology of depression
Female
40s and elderly
Single
Previous diagnosed mental health of chronic health conditions
Genetic components are present
Having a poor psychosocial base
Postpartum women
Maternal (postpartum) blues/depression
50-85% incidence rate 2-3 days after giving birth
Symptoms:
- Depressed affect
- tearfulness
- fatigue
doesnt hit MDD criteria
Tx: supportive care (usually self-limiting after 2 weeks)
must follow up for possible MDD w/ peripartum onset
MDD peripartum onset
Postpartum depression
10-15% incidence rate
is essentially MDD within 1 year after giving birth
Treatment: cognitive behavioral therapy CBT and SSRIs are first line
Postpartum psychosis
0.1-0.2 incidence rate within 1 year after giving birth
Is MDD but also adds on delusions and hallucinations on top of it
-usually centered around death and harming either their baby or themselves
Risk factors:
- first pregnancy
- family history
- previous diagnosed with bipolar
- previous diagnosed with psychotic issues
- recent changes in antipsychotic medications
Tx: immediate hospitalization with initiation of new atypical antipsychotic
- second line = electroconvulsive therpoaies
Risk factors for actually committing Suicide
Being male
Family history of suicide
Young adult or elderly
Diagnosed with depression
Previous attempt (highest risk factor!)
Alcohol or drug use
Loss of rational thinking (presence of psychosis)
Diagnosed with medical illness (often chronic)
Has an organized/detailed plan to do so
No spouse/significant other or social support
Has a will/stated future intent to do so
women try more often, but men are usually most successful at doing so
most common method of trying = OD, most common method of actually doing = firearms
Electroconvulsive therapy (ECT)
Rapid-acting method to treat refractory depression, depression with psychosis, Catatonia, and acute suicidal ideation
- usually last line but highly effective
Induces tonic-clinic seizures under anesthesia and NMJ blockers to “reset” wiring in brain
ADRs:
- disorientation
- headaches
- anterograde/retrograde amnesia
- often resolves after 6 months, not usually permanent*
- No contraindications and safe in pregnancy/elderly*
Depressive symptoms
“DIGS SPACE”
- Depressed mood
- lowered Interest
- Guilty feelings
- Sleep disturbances (increased or decreased)
- Suicidal ideation
- Psychomotor agitation
- Appetite/weight changes
- decreased Concentration
- decreased Energy
Screening tools for MDD
PHQ-2/9
Beck depression inventory
Zung self-rating scale
Edinburgh postnatal depression screening
Geriatric depression scale
5 stages of grief
Denial
Anger
Bargaining
Depression
Acceptance
can occur in any order, but usually in this order
usually resolves within 6-12 months, anything longer is MDD
symptoms include shock/guilt/ sadness/anxiety/ yearning/ somatic symptoms that came in waves/ simple hallucinations of deceased
treatment with MDD or moderate to severe depression
SSRIs or SNRIs and psychotherapy (CBT)
Treatment of mild-moderate depression?
Psychotherapy (CBT) only usually
