wamss notes depressive mood disorders Flashcards
major depressive disorder (MDD)
Condition in which at least 2 weeks of low mood predominates resulting in significant distress or impairment in functioning
male to female ratio of major depressive disorder
M:F 1:2
classification of major depressive disorder (MDD)
A) 5 or more of the symptoms present in the same 2 week period, at least one symptom must be symptom 1 or 2
B). The Sx cause significant distress or impairment of functioning
C) Is not attributable to another medical condition
D) Not better explained by another psychiatric disorder
E) No episodes of mania or hypomania
what is the acronym used to remember the symptoms of major depressive disorder
SIGECAPS
what are the symptoms of major depressive disorder
- Depressed mood most of the day nearly every day
- Sleep Disorder
- Interest Deficit
- Guilt, worthlessness, hopelessness
- Energy deficit
- Concentration deficit
- Appetite disorder (↑↓)
- Psychomotor retardation/agitation
- Suicidality or recurrent thoughts of death
what might FBC show that would indicate a cause other than major depressive disorder
anaemia or infection
what might U&Es show that would indicate a cause other than major depressive disorder
electrolyte imbalances, hyponatraemia
what might LFTs show that would indicate a cause other than major depressive disorder
liver damage, ETOH, hepatic encephalopathy
severity of major depressive disorder
Mild: 2 symptoms
Moderate: 3 symptoms
Moderate-Severe: 4-5 symptoms
Severe: 2-5 Symptoms + psychomotor agitation
Ddx of major depressive disorder
Other psychiatric disorders: dysthymia, bipolar, stress related disorders adjustment/bereavement disorders, PTSD, anxiety disorders…
non psychiatric disorders
non-psychiatric Ddx of major depressive disorder
Neurological Disorders (dementia, Parkinson, MS, CVA, tumour)
Endocrine- (Addison’s, Cushing’s, hypothyroidism, menopausal, hypopituitarism)
Metabolic Disorder (hypoglycaemia, hypocalcaemia)
Substance misuse & medication related
treatment for mild major depressive disorder
psychological therapies are generally more effective
treatment of severe major depressive disorder
antidepressants and generally more effective although concurrent psychological therapies may be helpful If the pt engages
treatment of moderate major depressive disorder
psychological therapies and pharmacological are equally effective
non pharmacological intervention for major depressive disorder
Psychoeducation
Psychotherapy:
- CBT
- Interpersonal Psychotherapy (IPT)
Group therapy
Social work
Diet, exercise, lifestyle…
Psychologist
first line medication for major depressive disorder
SSRI, SNRI, NaSSA
SSRI options
Sertraline (zoloft)
Citalopram (celexa)
Escitalopram (Lexapro)
Paroxetine (paxil)
Fluoxetine (Prozac)
SNRI options
Venlafaxine (Effexor)
Desvenlafaxine
(Pristique)
Duloxetine
NaSSA options
Mirtazapine
how long might it take for medication to take effect in major depressive disorder
It may take 2-6 weeks to see a clinical response
If there is no initial or only a partial response then consider ↑ the dose: note relatively flat dose
response curve with SSRIs
If there is still no or partial response consider switching to a different first line medication
second line choices for major depressive disorder
RIMA eg. Moclobemide
NRI eg. reboxetine
NDRI eg. bupropion
third line choices for major depressive disorder
MAOI or TCA
MAOI options
Selegiline Zelpar
Phenelzine Nardil
Tranylcypromine Parnate
TCA options
Amitriptyline (endep)
Nortriptyline (allegron, noritren)
Imipramine (tofranil)
Clomipramine (anafrandil)
mood stabilisation augmentation for major depressive disorder
Lithium, Sodium Valproate, Lamotrigine
+ SSRI + TCA
if there is comorbid psychosis in major depressive disorder
antipsychotics should be added to Tx
if there is comorbid psychosis in major depressive disorder
antipsychotics should be added to Tx
prognosis for major depressive disorder
80% relapse at least once
15% chronic reoccurrence
Tx reduces chance of reoccurrence by 70%
Tx for major depressive disorder reduces chance of reoccurrence by
70%
life expectancy of major depressive disorder
shorter life expectancy (suicide and other)
persistant depressive disorder (dysthymia)
Symptoms of depression lasting at least 2 years, less severe than MDD.
criteria of persistent depressive disorder (PDD)
A. Depressed mood for most of the day, more days than not for >2 years
B. Presence, while depressed of 2 or more of the following:
- Appetite disorder
- Concentration deficit
- Hopelessness
- Energy Deficit
- Worthlessness ↓ self esteem
- Sleep Disorder (↑↓)
C. During the 2 years pt has net been without symptoms in criteria A&B for more than 2
months at a time
while depressed, an individual with persistent depressive disorder may also experience
- Appetite disorder
- Concentration deficit
- Hopelessness
- Energy Deficit
- Worthlessness ↓ self esteem
- Sleep Disorder (↑↓)
if a person meets the criteria of MDD during PDD
If full criteria for a major depressive episode have been met at some point during the
current episode of illness then they should be given a Dx of major depressive disorder at
that time as a specifier within the Dx of dysthymia
melancholic depression
A subtype of MDD characterised by persistent & severe depression
criteria of melancholic depression
One of the following is present during the most severe period of the current episode:
- Loss of pleasure in all or almost all activities
- Lack of reactivity to usual pleasurable stimuli (doesn’t feel good even temporarily
when something good happens)
3 or more of the following - Distinct quantity of depressed moon characterised by profound despondency, despair
- Depression regularly worse in the morning
- Early-morning awakening
- Marked psychomotor agitation
- Significant anorexia or weight loss
- Excessive or inappropriate guilt
atypical depression
Shares the criteria of MDD or dysthymia but is characterised by improvement in mood in response to positive events
epidemiology of atypical depression
M:F 1:3
Tends to be more chronic
adjustment disorder
Also called reactive or situational depression occurs when a pt is unable to cope with a particular stress or major life event
criteria of adjustment disorder
Development of emotional or behavioural Sx to an identifiable stressor occurring within 3 months
Sx cause significant functional impairment or distress that is out of proportion to the severity
of the stressor
Does not meet the criteria of other mental disorders & is not an exacerbation
Once the stressor has ended the Sx do not persist for >6months
once the stressor causing adjustment disorder has ended
the Sx do not persist for >6months
after the identifiable stressor, adjustment disorder occurs within
3 months
substance/medication induced depressive disorder
Prominent & persisted disturbance in mood characterised by depressed mood or markedly
diminished interest or pleasure in almost all activities
Evidence that that the symptoms developed soon after substance intoxication or withdrawal
The substance is capable of producing the symptoms
Is not better explained by a mood disorder
depressive disorder due to another medical condition
Prominent & persisted disturbance in mood characterised by depressed mood or markedly diminished interest or pleasure in almost all activities
There is evidence that the Sx are a direct consequence of a medical condition
Disturbance is not better explained by another mental condition
recurrent brief depression
Depressed mood & 4 other Sx of depression for 2-13 days at least once per month for at least
a year, but does not meet the criteria for MDD or other MD
short-duration depression
Depressed mood & 4 other Sx of depression with clinically significant distress for 4-13 days, in
a pt who does not meet criteria for MDD or other MD
depressive episode with insufficient Sx
Depressed affect with at least 1 Sx of depression associated with clinically significant distress
or impairment for at least 2 weeks in a pt who does not meet the criteria for MDD or other
MD
unspecified depressive disorder
Sx characteristic of a depressive disorder that cause significant distress or impairment but do not meet the full
criteria for any of the disorders. Often used when there is insufficient information to make a more specific
diagnosis eg ; ED
