Major Depressive Disorder (MDD)

Question 0

Who is most likely to be affected?

Answer 0

Female to male ration is 2:1. Highest risk from age 20 to 40.

Question 1

Abnormal levels of what Neurotransmitter are believed to contribute to depression?

Answer 1

Serotonin

Question 2

What is the risk of completed suicide in MDD?

Answer 2

15% over the course of a patient’s lifetime.

Question 3

Dysfunction of what neuroendocrine axis is thought to be in involved in depression?

Answer 3

Hypothalamic-pituitary-adrenal axis.

Question 4

What medications are thought to trigger depressive symptoms?

Answer 4

Beta-blockers, corticosteroids, benzodiazepines, and interferon.

Question 5

What are some common medical causes of depressive symptoms?

Answer 5

Endocrine (hypothyroidism, adrenal dysfunction), neurologic (parkinson disease, strokes, dementia), metabolic disorders (vitamin b12 deficiency), cancer (pancreatic), and infections (HIV, hepatitis).

Question 6

Diagnosis for MDD

Answer 6

Requires 5 or more of the following symptoms to be present for at least 2 weeks as well as depressed mood or anhedonia. Sleep changes, decreased interest, guilt, low energy, decreased concentration, appetite changes, psychomotor agitation or retardation, suicidality.

Question 7

What about the symptoms for diagnosing MDD?

Answer 7

They cannot be due to substance use or medical condition. They must cause social/occupational impairment.

Question 8

What is anhedonia?

Answer 8

Loss of interest in normally pleasurable activities.

Question 9

What is the typical course of a depressive episode?

Answer 9

Depressive episodes last about 6-9 months if left untreated. 50% of individuals who develop a single depressive episode will have more. The majority of those who suffer from a 2nd episode will subsequently have a 3rd.

Question 10

What are the subtypes of depression?

Answer 10

Melancholic, Atypical, Catatonic, Psychotic. They describe patient’s diagnosis, for example, MDD with psychotic features.

Question 11

Melancholic

Answer 11

Anhedonia, early morning awakenings, psychomotor disturbance, excessive guilt, and anorexia. 40-60% of hospitalized patients with depression.

Question 12

Atypical

Answer 12

Hypersomnia, hyperphagia, reactive mood, leaden paralysis, and hypersensitivity to interpersonal rejection.

Question 13

Catatonic

Answer 13

Purposeless motor activity, extreme negativism or mutism, bizarre postures, and echolalia. Can be applied to BD.

Question 14

Psychotic

Answer 14

Presence of hallucinations or delusions; 10-25% of hospitalized patients with depression.

Question 15

What are the main classes of antidepressants used to treat depression?

Answer 15

Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective noradrenaline reuptake inhibitors (SNRIs), and dopamine reuptake inhibitors.