Depressive Disorders - Weiss Flashcards
depressive disorders
15% total population
-25% women
50 billion cost annually in US
2/3 ppl with depression
don’t realize they have it
only 20% those diagnosed with depression
receive appropriate tx
7x more likely to be unemployed
depression
depression epidemiology
average age 40yo
women > men
no socioeconomic correlation
higher prevalence - no close relationship
etiology of depression
unknown
-biologic, genetic, psychosocial
bio - dysregulation of NEs, serotonin, DA possible
genetics of depression
1st degree relative - 2-10x more likely
will respond similar to same tx**
adrenal axis and depression
hypersecretion of cortisol
dysthymia
chronic low grade depression
respond better to pharmacotherapy
dysthymia vs. major depression?
major depression
major depressive disorder
depressed mood
anhedonia - lack of interest
> 2 weeks
4 symptoms
sx - SIGECAPS
sx of major depressive disorder
S - sleep I - interest defect G - guilt E - energy deficit C - concentration issues A - appetite disorder P - psychomotor retardation S - suicidal
general appearance depression
appearance bad hygiene eye contact bad poor posture psychomotor agitation/retardation
will respond - if keep on encouraging
depression mental status exam
speech perceptual disturbance thought content suicide thought orientation memory concentration attention judgement, insight, reliability
antidepressants OTC
no - can trigger mania
cancer with depression
pancreatic cancer
course of depression
chronic and relapsing
tx for 1 year
natural course of major depression
6-12 months- will get better
-but suicide, divorce, substance abuse - can occur during this time
prognosis of depression tx
men don’t do as well with tx as women
tx of depression
1st SAFETY
- do you hospitalize
- voluntary vs. involuntary
risk of danger with depressed patient
admit if you are concerned
suicide in depression
15% of depressed people take their own lives
male, old, caucasian, hx previous attempt, substance abuse, co-morbid psych illness, social isolation, low job satisfaction
tricyclic antidepressants
nortriptyline
amitriptyline
imipramine
desipramine
narrow therapeutic window - dangerous
1st line depression
SSRIs
fluoxetine, paroxetine, sertraline, citalopram, escitalopram, fluvoxamine
if OD - much safer - probably won’t die
MAOIs
tx of depression
phenelzine
selegiline
tranylcypromine
isocaroxazid
adverse with certain meds/foods
SNRIs
venlafaxine
duloxetine
desvenlafaxine
very effective
venlafaxine adverse
HTN
buproprion
stop smoking
good antidepressant
lower seizure theshold
aplezin
buproprion
priaprism
trazadone
antidepressant
mirtazapine
antidepressant
- increase appetite
- sedative
good for old lady not eating or sleeping
no sexual dysfunction antidepressant
mirtazapine
buproprion
partial responder to depression patient tx
need to max dose
make sure diagnosis is right
substance abuse?
combo antidepressants
SSRI and tricyclics
combo - adverse effects
lithium
can help make antidepressant work stronger
risk with lithium
OD - death
thyroid combo with antidepressant
can increase effectiveness
main side effect of antidepressant
sex dysfunction
also GI, weight gain, HTN, withdrawal flu, HTN, sedation, stimulation
withdrawal flu
when stop taking antidepressant
