Evaluation of Depressive Disorders & Postpartum Depression

Question 1

Secondary Depression

Answer 1

Medical illness: sleep apnea, hypothyroid, diabetes, chronic pain, stroke, heart disease

Medications: INF, steroids, benzos, opioids, Chantix, BB

Drugs of abuse

Question 2

Depression w/ drugs of abuse

During withdrawal

During intoxication

Answer 2

During withdrawal: PCP, meth, cocaine, marijuana

During intoxication: Sedative-hypnotics, ETOH, opiates, steroids

Question 3

Neurobiology

Answer 3

Abnormal function serotonin, NE, dopamine, GABA, glutamate

Excess glucocorticoids from HPA axis => hippocampal atrophy

Also decreased REM and increased inflammatory markers

Question 4

Depression Qualifiers

Answer 4

Symptoms occur in the same 2 weeks

-most of the day nearly every day

Distress or impairment

r/o substances, medical condition, bereavement

Question 5

Mental Status Exam screening categories

Answer 5

Affect

Cognition

Psychomotor activity

Ruminative thought process

Speech

Psychosis

Suicidal thoughts

Question 6

Remission Negative and Positive predictors

Answer 6

Positive: caucasian, female, employed, education

Negative: longer episodes, drug abuse, anxiety/medical disorder, low functioning patient

Question 7

Acute Treatment of Depression

Including Bipolar and psychosis

Answer 7

1st 12 weeks

Mild: consider psychotherapy

Moderate/severe: medication +/- therapy

Bipolar: Mood stabilizer +/- antidepressant

Psychotic: Antipsychotic +/- antidepressant

Question 8

Overdose lethality

TCA

SSRI

Lithium

Answer 8

TCA: highly lethal

SSRI: much safer

Lithium: lethal

Question 9

Drugs to augment SSRI sexual side effects

Answer 9

Drug holiday => have to monitor for withdrawal

Buproprion

Trazodone

ED meds

Busiprone

Question 10

Postpartum Blues

Incidence, duration, symptoms and treatment

Answer 10

50-85%

Occurs in 2-3 days, resolves w/in 10 days

Tearful, fatigue, depressed affect, irritability

Reassurance and watch

-20% develop postpartum depression w/in 1 year

Question 11

Postpartum Depression

Incidence, duration, symptoms and treatment

Answer 11

10-15%

Occurs 2 weeks to 12 months

Depressed affect, anxiety, worse @ night, poor concentration, decreased libido

Antidepressants medications, psychotherapy

Question 12

Postpartum Psychosis

Incidence, duration, symptoms and treatment

Answer 12

0.1-0.2%

Variable development - days to 4-6 weeks postpartum

Delusions, confusion, sleep disturbed, unusual behavior, emotional liability

Antipsychotics, antidepressants, hospitalize

Electroconvulsive therapy if meds fail

They are a danger to themselves and the baby