MDD Flashcards
What does a dualist say about mental?
Brain and mind are discrete entities
Wha does materialist (monist) say about mental?
Brain and mind are the same entity
What are the functional components of mental state?
Thinking
feeling
behavior
What are the 2 major primary depressive disorders?
MDD
Persistent depressive disorder
What are the 2’ depressive disorders?
Due to medical condition
- substance induced
- seasonal induced
What are some causes of 2’ DD due to medical conditions?
Nutrition
- b12
- folate
- vit D
Hematologic- anemia
Endocrinology
- hypothyroid
- adrenal insufficiency
- Cushing’s
- post partum
What kind of symptoms does a pt with 2’ DD due to medical conditions present with?
fatigue
lethargy
lack of motivation
+/- sadness
What are some neurological causes of 2’ dd?
Parkinson's stroke (left frontal) epilepsy - causes full blown depressive syndrome -Treat like MDD
What are some Rx drugs that can cause 2’ DD?
Acutane Beta-blockers Interferon Steroids Birth control
What are some epidemiology of MDD?
16.5% lifetime
7% 12 month
average age of onset is 32 years of age
-women are 70% more likely
What is a MDD genetic vulnerability?
5HTTLPR
- serotonin transporter
- lacking promoter
- short + short from both parents= low resilience and high depression
What is the sleep physiology involved with MDD?
Decreased in slow wave
- decreased REM onset
- increased REM in sleep cycle
- increased REM duration of 1st cycle and overall
- increased REM density
How can exercise help treat MDD?
Reverses Hippocampal atrophy
- releases endorphins
What are some psychotherapies for MDD?
CBT
- Psychodynamic psychotherapy
- interpersonal therapy
What are some somatic treatments for MDD?
Trepaning
- frontal lobotomy
- ant cingulotomy
- ECT
- Transcranial magnetic stimulation
- deep brain stimulation
What are the goals of somatic treatments, increase?
BDNF transcription
What the relevant neurotransmitters of MDD?
5ht
NE
DA
Glutamate
What is a multi-modal antidepressant?
Remeron (mirtazapine)
- increase Ne and 5HT, also block 5ht reuptake
- best used with MDD and anxiety
- every effective, even more with SNRI
- sedation and weight gain
- agranulocytosis
- special uses elderly
What are some MDD adjunctive meds?
Atypicals
- lithium
- thyroid hormone
- psychostimlants
With what other drugs and what indications make pyschostimulants good treatments for MDD?
SSRI/SNRI
- lethargy, trouble conc, and poor motivation
What is an emerging treatment for MDD?
NMDA receptor antagonist
- Ketamine
- Sedation, hallucinations and dissociation
What is the MOA of Ketamine and how it works for MDD?
Block NMDA receptor
- this increases BDNF
- this enhances neurogenesis
What are the antipsychotics and their MOA?
Haloperidol + -azines
- block DA d2 and increase cAMP
What are atypical antipsychotics used to treat?
Schitz- +/- symptoms
- BD
- Tourettes
- anxiety
- OCD
- Mania
- Depression
What atypical antipsychotic can be used as an adjunct for MDD?
Abilify (aripiprazol)
- with SSRI and SNRI
What are some common and dangerous SE of atypical antipsychotics?
prolonged QT interval
What is the MOA of atypical antipsychotics?
Block 5ht receptor postsynaptically
- partial DA agonist
