Major Depressive Disorder Flashcards
what is the definition of MDD?
> 5 of 9 symptoms present during same 2-week period and represent a change from previous functioning
- at least 1 is either depressed mood or anhedonia
1. depressed mood most of day nearly every day (subjective)
2. anhedonia
3. significant weight loss or weight gain (>5% change), or failure to thrive
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day
6. fatigue or loss of energy nearly every day
7. worthlessness or guilt
8. diminished ability to concentrate or think
9. recurrent thoughts of death
what is SIGECAPS?
DSM criteria for depression (need at least 5 of them)
Sleep disturbance Interest/pleasure reduction Guilt, worthlessness Energy loss, fatigue Concentration/attention impairment Appetite changes Psychomotor symptoms Suicidal ideation
what is SWAG?
differentiation between sadness and depression (need only 1)
Suicidal thoughts
Weight loss/gain
Anhedonia
Guilt
what is atypical depression?
more likely to have weight gain and hypersomnia
-also leaden paralysis, carb craving, rejection sensitivity (self-esteem problem)
what is pseudodementia?
cognitive symptoms in depressed elderly
-often misdiagnosed as dementia, but these problems are reversible
what is diurnal variation?
more depressed in AM, better in PM
-melancholic-type depression
what are psychomotor symptoms?
physical complaints like body aches and headaches
- agitation VS retardation
- vegetative depression
what is seasonal affective disorder?
MDD usually associated with shroter days in winter
- usually with atypical symptoms
- treat with full-spectrum light exposure, psychotherapy, antidepressants
what is masked depression?
depressed patients presenting with vague physical ailments but unaware/in denial of depression
- seem stoic
- seek primary care for psychomotor or somatic symptoms instead
- consider diagnosis only when no organic medical cause is identified and patient has other MDD symptoms
- more typically seen in elderly patients, OCD/narcissistic patients
what are possible medical causes of depression?
- hypothyroidism
- Cushing syndrome
- anemia
- brain injury, stroke
- vitamin deficiency (B12, folate, D)
- obstructive sleep apnea
what are biological factor etiology of MDD?
- monoamine deficiency
- low DA, SR, NE - monoamine receptor exccess theory
- loss of neutrophic factors and degeneration
- genetics (serotonin transporter gene)
what are psychosocial factor etiology of MDD?
- ability to cope with stressors - resilience
- low self-esteem, negative outlook
- personality traits
- addiction
- learned helplessness and automatic thoughts
- catastrophic loss
- anger turned inward (take anger out on self)
- incapacity via hibernating (dropping out makes you happier)
- social disconnect
what proportion of depression is genetic VS environmental?
65% environmental
35% genetic
explain interactions among risk factors on depressive vulnerability?
the monthly risk of depressive onset increases with the number of depressive episodes
-this is worsened by genetic risk
explain stress-cortisol-depression-treatment?
- stress causes increased glucocorticoids, which decreases BDNF (brain-derived neurotropic factor)
- dendritic branching decreases, causing atrophy and death of neurons
- pharmacotherapy, ECT, and psychotherapy will increase 5-HT and NE, thus decreasing glucocorticoids, and increasing BDNF
- this may cause increased survival and growth
