L9-10 Depression Flashcards
What is the first-line treatment option for mild depression?
psychosocial treatments (watch your own thoughts, healthy coping mechanisms)
What are the treatment options for moderate and severe depression?
pharmacological and psychological treatments (down to molecules, receptors, anatomy)
What is the lifetime prevalence of MDD?
5.8%
Among persons with a mental illness,
50.6% also had a chronic physical illness
Suicide in general population - general risk factors:
A poor, elderly, lonely, man, with physical/mental comorbidities and previous attempts
Biological etiology and pathophysiology of depression
- hormonal influences: incr cortisol scretion (major stress hormone)
- monamine hypothesis: decr neurotransmitter in brain eg. NE, 5-HT, DA
What are the secondary causes for depression?
medical disorders:
- endocrine disorder eg hypothyroidism
- deficiency states
- infections
- metabolic disorders
- cv
- neurological
- malignancy
psychiatric disorders
drug-induced:
- alc/stimulants withdrawal
DSM-5 diagnostic criteria for MDD
- IN.SAD.CAGES, at least 5 sx during same 2 week period + change from previous functioning
^ one of the sx must be D - sx cause significant distress or impairment in social, occupational, or other important areas of functioning
- not caused by an underlying medical condition or substance ie. intoxication/withdrawal
Why is it important the evaluate for any history of maniac/hypomaniac episodes prior to diagnosis and treatment of MDD?
Antidepressants may cause ‘maniac switch’ in patients with underlying bipolar disorder
What is the MSE used for?
For accurate diagnosis: assess for suicidal/homicidal ideations and risks
- appearance, speech, mood, thought process, insight, judgement
- reassessed on every interview to evaluate efficacy and tolerability
What are the general evaluations required prior to diagnosis and treatment?
- hx of present illness
- psychiatric illness
- substance use hx
- complete medical hx and medication hx
- family, social, forensic, developmental and occupational hx
- physical and neurological exam
- MSE
- labs and other investigations
Why is it important to exclude general medical conditions or substance-induced sx eg psychosis//depression/mania/anxiety/insomnia ?
Before starting on antidepressants
- chronic commitment, >= 6 months
- comes with SE
Escitalopram
2C19 substrate
Sertraline
2C19 substrate
Paroxetine
2D6 substrate
What is the therapy goal for MDD tx?
remission, sx free
Difference between PHQ-2 and PHQ-9
2: screening instrument
- if patient has a positive response to either question (little interest or pleasure in doing things/feeling down, depressed or hopeless over the past 2 weeks),
a. consider administering the PHQ9 or asking the patient more questions about possible depression
- a negative response to both questions is considered a ‘negative’ result for depression screening
When are non-pharmacologicals used?
- monotherapy in mild depression
- in combination with antidepressants for moderate-severe depression
Examples of non-pharmacological tx of MDD
sleep hygiene, psychotherapy, neurostimulation ie ECT, rTMS
Dysthymia
milder, but persistent (over 2 years) form of depression
antidepressant effectiveness
all kinda have equal efficacy - select based on target sx, comorbid conditions, ddi, prior response, preference
first line antidepressant monotherapy
usually SSRI, SNRI, mirtazapine (subsidised)
- or bupropion (non-subsidised)
