Major Depressive Disorder Flashcards
1
Q
What is MDD?
A
- Depressed mood or loss of interest or pleasure in activities for at least 2 weeks
- Evidence of impaired social and occupational functions
- No history of manic behavior
- Symptoms cannot be attributed to substances or a medical condition
2
Q
Symptoms of MDD
A
- Depressed Mood (Irritability in children and adolescents)
- Marked diminished interest or pleasure in activities
- Significant weight gain or loss (change of 5% body weight in 1 month)
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue
- Feelings of worthlessness or excessive/inappropriate guilt
- Diminished ability to concentrate
- Indecisiveness
- Recurring thoughts of death, suicidal ideation
- Symptoms must cause significant distress or impairment
3
Q
Severity of MDD
A
- Mild
- Moderate
- Severe
- with psychotic features
- in full remission
- in partial remission
4
Q
Comorbidity
A
At risk for having 1 or more additional disorders
- Most common ETOH abuse or dependence
- OCD
- Panic disorder
- Social anxiety disorder
Comorbid substance abuse disorders and anxiety disorders worsen prognosis and markedly increase risk of suicide
5
Q
Predisposing Factors: Biological
A
- Genetic
- Biochemical: decrease in dopamine, norepinephrine, serotonin, increase in acetylcholine
- Neuroendocrine
- Neurological: CVA, AD, Parkinsons, huntingtons, multiple sclerosis, TBI
- Electrolyte imbalances
- Nutritional deficiencies
6
Q
Predisposing Factors: Medication
A
Medication side effects:
- Steroids
- Hormones
- Sedatives
- Antibiotics and antibacterials
- antineoplastics
- analgesics
7
Q
Predisposing factors: Psychosocial
A
- Loss of a parent to death or divorce
- Perinatal/Postpartum women
- Elderly
- Neurologic disorders
- Divorce and separated individuals
- Comorbid systemic physical illnesses
8
Q
Treatment
A
- Psychopharmacology
- Psychotherapy
- ECT
- Brain stimulation: TMS
- Light Therapy
9
Q
Psychotherapy
A
Individual:
- Cognitive Behavioral Therapy (CBT)
- Psychodynamic psychotherapy
Group
Family
10
Q
Pharmacotherapy
A
- Mild to Moderate depression medication or psychotherapy
- Combination treatment for severe, recurrent, chronic depression
- Most commonly prescribed - SSRIs and SNRIs
- Carry black box warning for increase risk of suicidality in children and adolescents
- Objective is suicide remission
- Use of antidepressants double the chance that the patient will recover in 1 month
- Medication choice determined by side effect profile
- treatment should be maintained for 6 months - 1 year
- Drugs should be tapered gradually
- Patients with chronic or recurrent depression are candidates for maintenance treatment
11
Q
Antidepressants
A
- SSRIs
- SNRIs
- MNOI
- Heterocyclics
- Tricyclics
12
Q
SSRIs (2) - Selective Serotonin Reuptake Inhibitors
A
- Sertraine (Zoloft)
- Fluoxetine (Prozac)
13
Q
Side Effects of SSRIs
A
- Headache
- Nausea
- Insomnia/Anxiety
- Weight gain
- Sexual dysfunction
- Serotonin syndrome; life threatening. drug drug interaction
14
Q
What is Serotonin Syndrome?
A
- Most often a drug drug interaction
- Symptoms: diarrhea, restlessness, agitation, hyperreflexia, autonomic instability, myoclonus, seizures, delirium, coma, cardiovascular collapse
- Treatment: removal of agents, medications to block serotonin receptors
15
Q
Timeline for Treatment
A
- 6 months to 1 year
- Take 4-6 weeks for effect
- Recurrence in common
