MDD

Question 1

What does a dualist say about mental?

Answer 1

Brain and mind are discrete entities

Question 2

Wha does materialist (monist) say about mental?

Answer 2

Brain and mind are the same entity

Question 3

What are the functional components of mental state?

Answer 3

Thinking
feeling
behavior

Question 4

What are the 2 major primary depressive disorders?

Answer 4

MDD

Persistent depressive disorder

Question 5

What are the 2’ depressive disorders?

Answer 5

Due to medical condition

• substance induced
• seasonal induced

Question 6

What are some causes of 2’ DD due to medical conditions?

Answer 6

Nutrition

• b12
• folate
• vit D

Hematologic- anemia

Endocrinology

• hypothyroid
• adrenal insufficiency
• Cushing’s
• post partum

Question 7

What kind of symptoms does a pt with 2’ DD due to medical conditions present with?

Answer 7

fatigue
lethargy
lack of motivation
+/- sadness

Question 8

What are some neurological causes of 2’ dd?

Answer 8

Parkinson's
stroke (left frontal)
epilepsy 
- causes full blown depressive syndrome 
-Treat like MDD

Question 9

What are some Rx drugs that can cause 2’ DD?

Answer 9

Acutane 
Beta-blockers
Interferon
Steroids
Birth control

Question 10

What are some epidemiology of MDD?

Answer 10

16.5% lifetime
7% 12 month
average age of onset is 32 years of age
-women are 70% more likely

Question 11

What is a MDD genetic vulnerability?

Answer 11

5HTTLPR

• serotonin transporter
• lacking promoter
• short + short from both parents= low resilience and high depression

Question 12

What is the sleep physiology involved with MDD?

Answer 12

Decreased in slow wave

• decreased REM onset
• increased REM in sleep cycle
• increased REM duration of 1st cycle and overall
• increased REM density

Question 13

How can exercise help treat MDD?

Answer 13

Reverses Hippocampal atrophy

- releases endorphins

Question 14

What are some psychotherapies for MDD?

Answer 14

CBT

• Psychodynamic psychotherapy
• interpersonal therapy

Question 15

What are some somatic treatments for MDD?

Answer 15

Trepaning

• frontal lobotomy
• ant cingulotomy
• ECT
• Transcranial magnetic stimulation
• deep brain stimulation

Question 16

What are the goals of somatic treatments, increase?

Answer 16

BDNF transcription

Question 17

What the relevant neurotransmitters of MDD?

Answer 17

5ht
NE
DA
Glutamate

Question 18

What is a multi-modal antidepressant?

Answer 18

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

Question 19

What are some MDD adjunctive meds?

Answer 19

Atypicals

• lithium
• thyroid hormone
• psychostimlants

Question 20

With what other drugs and what indications make pyschostimulants good treatments for MDD?

Answer 20

SSRI/SNRI

- lethargy, trouble conc, and poor motivation

Question 21

What is an emerging treatment for MDD?

Answer 21

NMDA receptor antagonist

• Ketamine
• Sedation, hallucinations and dissociation

Question 22

What is the MOA of Ketamine and how it works for MDD?

Answer 22

Block NMDA receptor

• this increases BDNF
• this enhances neurogenesis

Question 23

What are the antipsychotics and their MOA?

Answer 23

Haloperidol + -azines

- block DA d2 and increase cAMP

Question 24

What are atypical antipsychotics used to treat?

Answer 24

Schitz- +/- symptoms

• BD
• Tourettes
• anxiety
• OCD
• Mania
• Depression

Question 25

What atypical antipsychotic can be used as an adjunct for MDD?

Answer 25

Abilify (aripiprazol)

- with SSRI and SNRI

Question 26

What are some common and dangerous SE of atypical antipsychotics?

Answer 26

prolonged QT interval

Question 27

What is the MOA of atypical antipsychotics?

Answer 27

Block 5ht receptor postsynaptically

- partial DA agonist