Depressive Disorders, Weiss Flashcards
depressive disorders more common in M or W
W
age onset depresstion
40 y.o average
cause depression
unknown
causative factors for depression
biological
genetic
pyschosocial
biological factors for depression
dysregulation with NT
neuroendocrine dysregulation of adrenal or thyroid axis
growth hormones etc
genetic factors for depression
pattern unknown
1st degree relatives 2-10 x more likely
50% monozygotic twins
psychosocial factors for depression
stressful events premorbid personality factors learned helplessness cognitive theory psychodynamic theory early childhood trauma
what is dysthymia
peristent depressive disorder that is chronic low grade
does not respond well to antidepressants
tyeps of depressive disorders
major, single major, recurrent persistent depressive disorder substance. med induced premenstrual dysphoric disorder depressive from another medical condition
Dx depression
significant distress with funcitonal impairment
not due to direct physiological effects of a substance
major depressive disorder
at least a depressed mood or anhedonia(lack of interest of pleasurable activity)
at least 2 weeks
at least 4 Sx
clinical features depression
depressed mood marked dec interest dec/inc appetite, weight change sleep disturbance psychomotor agitaiton/retardation loss of E guilt, worthlessness poor concentration, indecisiveness recurrent thoughts of death, suicidal thoughts
mental status exam general description
appearance, hygiene level cooperativeness eye contact posture pyschomotor agitation/retardation
mental status exam
speech perceptual disturbances thought content suicidal thoughts orientation memory concentration attention judgement, insight, reliability
what general medical conditions can lead to depression
infections, endocrine disorders, inflammatory disorders, neuro disorders, vitamine deficiencies
neoplasms
course of depression
chronic relapsing
poor pronostic indicators for depression
coexisting dythymic disorder, alcohol abuse, anxiety disordesr, multiple episodes, hospitalizaiton, men, poor support, late age initial onset, personality disorder, psychotic component
first decision when Tx depressed patient
safety
do need to hospitalization, at risk of self?
risk factors for suicide
male elderly caucasian Hx previous attempts co morbic medical illness drug/alcohol abuse comorbid psych illness social isolation low job satisfaction, financial stress
risk factors for suicide
male elderly caucasian Hx previous attempts co morbid medical illness drug/alcohol abuse comorbid psych illness social isolation low job satisfaction, financial stress
Tx for depression
hospitalization vs outpatient
complete Diagnostic eval
establish plan
psychosocial therapies
pharmacotherapy depression
TCA, SSRI, SNRI, MAOI, bupropion, mirtazapine, atypical antipsychs, augmenting: lithium, thyroid, stimulants and combinations
what TCA are used in depression
nortriptyline
amitriptyline
imipramine
desipramine
SSRIs for depression
fluoxetine paroxetine sertraline citalopram escitalopram fluvoxamine
what is first line for depression
SSRI
MAOI for depression
phenelzine
selegiline
tranylcypromine
isocaroxazid
SNRI used in depression
venlafaxine
duloxetine
desvenlafaxine
side effect venlafaxine
HTN
Bupropion
dec seizure threshold significantly
no sexual dysfunction with this drug
mirtazapine
great for elder woman not eating or sleeping
no sexual dysfunction
lithium warning
can overdose easily, low therapeutic index
major side effects of antidepressants
GI sexual withdrawal flu weight gain seizure threshold HTN sedation/stimulation
