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MDD Flashcards

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1
Q

What is MDD characterized by?

A

Persistent low mood
and
Lack of positive affect
Anhedonia (Loss of interest in usually pleasurable activities) that is different from patient’s usual self
and
Causes significant distress or impairment for 2+ weeks

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2
Q

Which sex is MDD more common in?

A

Women > men

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3
Q

What does MDD co-occur with?

A

Other psychiatric and medical conditions

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4
Q

What does MDD contribute to?

A

Suicide - must assess

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5
Q

What does MDD impact?

A

Functioning and ability to work

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6
Q

What is MDD partially due to?

A

Genetics
Stress
Environment (biopsychosical model)

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7
Q

What hypothesis does MDD therapy focus on?

A

“Monoamine hypothesis”
or
“Biogenic amine hypothesis”

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8
Q

What is the monoamine hypothesis?

A

Deficiency/underactivity in serotonin, NE, DA, GABA, tryptophan, somatostatin, and thyroid hormones have all been impacted in causing MDD or depression

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9
Q

What are the RFs for MDD?

A 
FH
Other psychiatric illness
Stress
Female
Meds
Illness
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10
Q

What meds cause MDD?

A 
Clonidine
Oral contraceptives
Corticosteroids
AEDs
Antipsychotics
Varenicline
Benzo
EtOH
Opioids
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11
Q

What is the first step in treating MDD?

A

Treating or removing underlying cause

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12
Q

How long will sx develop in MDD?

A

days-weeks

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13
Q

What is the onset of MDD?

A

Mid-20s

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14
Q

Is MDD recurrent or one time?

A

Recurrent

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15
Q

Are recurrent episodes of MDD variable or consistent?

A

Variable

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16
Q

When are longer periods of remission most common in MDD?

A

Early in course

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17
Q

What is a predictor or MDD persistence?

A

Severity of initial major depressive episode

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18
Q

Which assessments are used in MDD?

A

PHQ-9

HAM-D

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19
Q

What is PHQ-9 used for?

A

To screen for and diagnose depression

Can be completed in minutes

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20
Q

What is the HAM-D used for?

A

Monitoring

Decreasing score = improvement

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21
Q

How many sx must be present for how long in MDD?

A

5+ sx (at least one of the following: depressed mood or loss of interest/pleasure)
During the same 2 week period

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22
Q

What are the sx of MDD?

A 
SIG E CAPSL
Sleep (insomnia/hypersomnia)
Interest (loss of interest/pleasure)
Guilt (feelings of worthlessness or excessive/inappropriate guilt)
Energy (fatigue/loss of energy)
Concentration
Appetite (change in appetite/weight)
Psychomotor
Suicidal thoguhts
Low mood
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23
Q

What variation of MDD is experienced in elderly?

A

“pseudo-dementia”

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24
Q

What types of physical complaints are common?

A

Somatic - involves having a significant focus on physical sx to the point that it causes major distress and problems functioning

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25
Q

What is persistent depressive disorder?

A

2 years of impaired functioning secondary to MDD sx (5 or less)

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26
Q

What is considered a response to therapy of MDD?

A

50% reduction of sx

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27
Q

What is partial response to therapy of MDD?

A

Less than 50% reduction of sx

28
Q

What is considered MDD remission?

A

A period of 2 or more months w/no sx
1-2 sx of mild degree
Primary goal of treatment

29
Q

What is considered MDD recovery?

A

Sustained remission lasting > 6 months

30
Q

What is considered MDD relapse?

A

Return of manifestations of a disease

31
Q

What are common residual sx of MDD?

A 
Insomnia
Fatigue
Painful physical complaints
Difficulty concentrating 
Lack of interest
32
Q

What are the least common residual sx of MDD?

A

Depressed mood
Suicidal ideation
Psychomotor retardation

33
Q

What are key indicators of relapse of MDD?

A

Uncommon residual sx

34
Q

What is considered recurrence of MDD?

A

Return of sx

35
Q

What are the short term treatment goals of MDD?

A

Response
Decrease current sx
Limit SE/ADRs
Monitor SI

36
Q

What are the long term treatment goals for MDD?

A

Remission
Restore fxn and QOL
Limite relapse/recurrence

37
Q

What are the 1st line treatment options for MDD?

A

SSRI
SNRI
Mirtazapine
Bupropion

38
Q

What are the 2nd line treatment options for MDD?

A

Try a different first line therapy

39
Q

What are considerations when selecting therapy for MDD?

A

Patients tolerate and respond to medications differently

Clinically important differences exist between commonly prescribed antidepressants for both efficacy and acceptability

40
Q

How is CBT used in MDD?

A

CBT has good evidence for use in MDD, and is acceptable first line monotherapy or combination therapy

41
Q

How soon are physical sx improvement seen in MDD?

A

Sleep, and appetite in 1-2 weeks

42
Q

How soon are emotional sx improvement seen in MDD?

A

Reduced sadness, increase pleasure in 2-4 weeks

43
Q

How do we monitor efficacy of MDD treatment?

A

Adherence
Response
Functional status
QOL

44
Q

What do we monitor in MDD therapy?

A

Drug SEs and Serotonin syndrome

45
Q

What is important to remember about suicide risk and antidepressant use?

A

For most patients, antidepressant tx is better than no tx when considering SI and associated risk

46
Q

What do we do for patients to help with SI and use of antidepressants?

A

Patients must be educated, and closely monitored

47
Q

How long is considered an adequate trial for MDD therapy?

A

4-8 weeks at an appropriate dose

48
Q

Should we exceed FDA max dose recommendations?

A

Does not improve efficacy

49
Q

What do we do if non-response in MDD tx?

A

Re-evaluate patient and diagnosis

Change/switch to a different antidepressant (unless pt wishes to remain on therapy)

50
Q

What do we do if there is a partial response in MDD tx?

A

Ensure optimized dose
Can either switch/augment therapy (should target remaining sx)
Augmentation is a better strategy when response is seen

51
Q

What is the gold standard for MDD augmentation?

A

Lithium

52
Q

What does Li do in MDD?

A

Reduces SI or thoughts in MDD

53
Q

What augmentation agent for MDD is better in females?

A

T3 or T4

Can use in euthyroid

54
Q

If AAP are used for MDD augmentation, what must we do?

A

Weight risk/benefit with SEs

55
Q

Which AAPs are acceptable in MDD w/o psychosis?

A 
Low dose SGAs
Aripiprazole
Quetiapine
Olanzapine
Brexpiprazole
56
Q

How are stimulants used with augmentation/adjunct tx in MDD?

A

Controversial
May consider short course in severe depression (fatigue, not getting out of bed or if immediate response required)
May exacerbate anxiety
Abuse potential

57
Q

How are Mood stabilizers/AEDs used in augmentation/adjunct tx in MDD?

A

May offer some benefit

Often used as a hail Mary

58
Q

If mood stabilizers are effective at sx improvement, what is the next step in therapy?

A

Should screen patient for bipolar disorder

59
Q

What is the DOT for first episode of MDD?

A

At least 12 months with the first episode for most patients

60
Q

What is the DOT for patients with recurrent and/or severe MDD?

A

12-36 months

Indefinitely depending on severity

61
Q

How should d/c be managed in MDD therapy?

A

Must be tapered over several weeks to prevent WD (sx are severe)

62
Q

What are the sx of WD for antidepressants?

A 
GI disturbance
Flu like sx
Anxiety
Crying
MDD re-emergence
63
Q

Is it better or worse to treat pregnant women with MDD with antidepressants?

A

The risks of untreated psychiatric disorder to mother and child often outweigh the risks associated with antidepressants

64
Q

How is the decision to treat pregnant women with MDD determined?

A

Shared decision making (mother to be to provider) necessary to determine whether or not to treat (start, continue, adjust, or stop)

65
Q

What is 1st line treatment of MDD for pregnant women?

A

Zoloft
Celexa
Lexapro

Psych (9 decks)

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