exam ii: ch14 - depressive disorders Flashcards
what is the “single most disabling disease in the world”
depression
type of disorder; constant and severe irritability and anger
- dx: 6-18 yrs
- s/s in 2/3 (home, school, peers)
- onset: before 10yrs
- temper tantrums
- males > females
disruptive mood dysregulation disorder
how many s/s from dsm-5 to be dx with depression
at least 6 s/s for at least 2 weeks
type of depression; Low-level depressive feelings through most of each day, for majority of days
>2yrs adults
>1yr children/adolescents
persistent depressive disorder “dysthymia”
must have 2+ of the following s/s:
Dec appetite OR overeating
Insomnia/hypersomnia
Low energy, hopelessness
Low self-esteem
Difficulty thinking
dx of persistent depressive disorder
type of depression; Symptom cluster in last week prior to onset of women’s period
premenstrual dysphoric disorder
FDA approved meds for premenstrual dysphoric disorder?
fluoxetine, sertraline, paroxetine
s/s of the following:
Mood swings
Irritability, difficulty concentrating
Depression anxiety, feeling overwhelmed
premenstrual dysphoric disorder
tx for premenstrual dysphoric disorder
aerobic exercise, complex carbs, sufficient sleep
caused by long term illness that causes ongoing pain
depressive disorder d/t medical condition
full-blown depression during/after delivery, more serious than “baby blues”
postpartum depression
s/s of the following:
Exhaustion
Extreme sadness, anxiety
SI
postpartum depression
what is the first and only FDA approv med for postpartum depression
brexanolone (Zulresso)
type of depression; onset during winter, lack of sunlight contributing factor returns every year
seasonal affective disorder
s/s of the following:
Social withdrawal
Increased sleep
Weight gain
seasonal affective disorder
what are some risk factors of seasonal depressive disorder (5)
- female
- far from equator
- fam hx
- depression + bipolar
- younger
what is the main reason for inpatient psych admission
major depressive disorder
type of depression; no manic or hypomanic episode, continued feelings of depressed mood or loss of interest or pleasure
- 18-25 yrs common
- chronic = lasts more than 2 years
major depressive disorders
5+ of the following s/s for 2wks-6mo:
Weight loss/appetite change
Sleep disturbances
Fatigue
Loss of ability to concentrate, impaired fxn
Recurrent thoughts of death
major depressive disorder
type of depression; prolonged use/withdrawal from drugs and alc, s/s longer than expected effects of substance
substance induced/med induced depression
what are meds that can lead to substance induced depression
- antivirals
- cardiovascular drugs
- antidepressants
- anticonvulsants
- antipsychotics
- smoking cessation meds
different from depression, someone CAN experience low moods that meet the criteria of major depression with manic episodes
bipolar disorder
difference between bipolar and depression
bipolar = manic and depressive states
depression = emphasis on the “lows” of depressed mood
what are co-curring medical problems that inc risk of depression
HTN, diabetes, cardiac issues, arthritis, backaches
model that states life events + biological predisposition affect the way we respond to stress
diathesis stress model
how does the HPA axis lead to depression?
inc cortisol and CRH = depression
questionnaire used to grade mood improvement (given before and after TMS) and assess suicide potential
PHQ-9 questionnaire
inability to experience pleasure
anhedonia
lack of energy
anergia
what are vegetative signs and list examples
alterations in activities needed to support life and growth
- loss of appetite
- change in sleep pattern
- change in bowel/bladder habits
- neglected grooming
- libido decline
t/f: pharm therapy for depression aims to cure the disease
f: targets the symptoms rather than being an actual cure
what is the black box warning for all anti-depressants
inc in suicidal behavior + depressive thoughts
how long to observe pt after first admin of antidepressant
first 7-14 days of tx
class of the following meds:
paroxetine (Paxil)
fluoxetine (Prozac)
sertraline (Zoloft)
escitalopram (Lexapro)
citalopram (Celexa)
Fluvoxamine (Luvox)
selective serotonin reuptake inhibitors (SSRIs)
what is the only FDA approved med for OCD
Luvox
name that med class:
- good for depression + anxiety
- first line therapy, dec SE compared to other classes
- SE: agitation, sexual dysfunction, HA, serotonin syndrome, discontinuation syndrome
SSRIs
s/s of the following:
Abd pain, diarrhea, sweating, fever, tachycardia, HTN, altered mental status, myoclonus, irritability, hositility
serotonin syndrome
s/s of the following:
dizziness, insomnia, nervousness, irritability, nausea, agitation
discontinuation syndrome
class of the following meds:
venlafaxine (Effexor)
desvenlafaxine (Pristiq)
duloxetine (Cymbalta):
serotonin norepinephrine reuptake inhibitors (SNRIs)
name that med class:
- inhib serotonin and norepinephrine reuptake
- SE: HA, dizziness, insomnia, dry mouth
SNRIs
med class of the following:
mirtazapine (Remeron)
serotonin norepinephrine DISinhibitor
what is mirtazapine (Remeron) used for
antiemetic
med class of the following:
Nortriptyline (Pamelor)
Amitriptyline (Elavil)
Imipramine (Tofranil)
Desipramine (Nopramin)
tricyclic antidepressants (TCA)
name that med class:
- good for melancholic depression
- NOT first line d/t high risk OD
- SE: anticholinergic rxns, cardiovascular rxns
- Toxicity: dysrhythmias, MI, heart block
- DO NOT GIVE: heart issues, pregnant, seizures
tricyclic antidepressants (TCAs)
s/s of the following:
dysrythmias, MI, heart block
TCA toxicity
med class of the following:
Isocarboxazid (Marplan)
Phenelzine (Nardil)
Selegiline (EMSAM)
Tranylcypromine (Parnate)
monoamine oxidase inhibitors (MAOIs)
name that med class:
- give when failed SSRI/TCA
- needs dietary restriction from tyramine
- stop taking SSRI, wait 2-5wks before starting
- SE: orthostatic hypotension
MAOIs
t/f: need to maintain tyramine restriction for 2 weeks after MAOI stop
true
med class of the following
bupropion (Wellbutrin)
norepinephrine dopamine reuptake inhibitor (NDRI)
name that med class:
- inhib acetylcholine receptors to dec addictive aspect of nicotine, blocks reuptake of norepinephrine and dopamine
- benefits: NO sexual dysfxn, NO weight gain
- DO NOT GIVE: seizure, eating disorder, with benzos
SE: insomnia, tremors, weight loss, seizures, vomiting
NDRIs
foods to avoid that have tyramine
avocados
figs
bananas
fermented/smoked meats
deli meats
fish
ALL cheese
soy sauce
what treatment to opt for if pharm tx does not work
somatic treatments
somatic tx:
- most effect tx for depression, helps with catatonia
- works quickly and better than bed BUT use of anesthesia = less common
- SE: confusion + memory loss
electroconvulsive therapy (ECT)
where to place ECT leads for more dramatic results
bilaterally
what criteria need to be met for ECT
- suicidal and needs RRT
- can’t take med
- multiple med classes don’t work
- okay for elderly even >85
somatic tx;
- noninvasive, uses magnetic pulses to stimulate focal areas of cerebral cortex
- 30 tx sessions, 5 days/wk for 6 wks
- need to remove all metal from body
transcranial magnetic stimulation (TMS) or (rTMS)
somatic tx;
- used for epilepsy
- electrode stim nerve to noost NMs, improve mood
- SE: voice alteration, hoarseness, neck pain, cough, parathesia, dyspnea
vagus nerve stimulation (VNS)
somatic tx for seasonal affective depression
light therapy
somatic tx;
- electrodes are surgically implanted into specific areas of the brain to stimulate regions ID’d to be underactive in depression
deep brain stimulation
how does exercise help with depression
inc availability of serotonin
release of endorphins
benefit: no antidepressant SE
in order to dx dysthymia, it needs to be occuring for at least how long?
2 years (adults)
