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
