Depression

Question 1

major depressive disorder (MDD) criteria

Answer 1

A) must have at least 5 of SIGECAPS during a 2week period.
-at least 1 has to be depressed mood or anhedonia
B) cause social/occupational impairment
C) not due to a substance or other medical condition

Question 2

SIG E CAPS

Answer 2

Sleep
Interest (anhedonia)
Guilt
Energy
Concentration
Appetite
Psychomotor agitation
Suicidality

Must have 5. 1 must be depressed mood or anhedonia

Question 3

anhedonia

Answer 3

• inability to experience pleasure
• hallmark of MDD
• no sex drive

Question 4

terminal insomnia

Answer 4

-early morning awakenings

Question 5

sleep latency

Answer 5

takes longer to actually fall asleep

Question 6

things to screen for if suspect MDD

Answer 6

• endocrinopathies (Cushings, Addisons, diabetes, hypoglycemia, thyroid issues)
• stroke patients
• substance induced mood disorders
• pancreatic cancer
• carcinoid syndrome
• Parkinsons
• collagen vascular diseases
• viral illness (mono)
• heart disease

Question 7

MDD: peak age of onset

Answer 7

in the 20s

-can occur at any age

Question 8

MDD: lifetime prevalence

Answer 8

10-15% (worldwide)

Question 9

factors contributing to MDD

Answer 9

• decreased levels of serotonin in brain
• high cortisol levels
• genetics
• psychosocial events

Question 10

MDD vs bereavement

Answer 10

• same clinical presentation of SIGECAPS
• MDD has PERSISTENT symptoms, while bereavement symptoms wax and wane
• MDD can last more than a year, bereavement is usually less
• MDD more common feelings of guilt
• MDD tx includes support and meds, while bereavemtn is just support (no meds)
• MDD has suicidality, bereavement does not

Question 11

leaden paralysis

Answer 11

-heavy feelings in arms/legs

Question 12

non pharmacologic treatments for MDD

Answer 12

PSYCHOTHERAPY

• CBT
• supportive therapy
• interpersonal psychotherapy
• psychodynamic psychotherapy

Question 13

pharmacologic treatment of MDD

Answer 13

• SSRIs
• SNRIs
• TCAs
• MAOIs
• misc antidepressants
• second generation antipsychotics
• electroconvulsive therapy
• transcranial magnetic stimulation (TMS)

Question 14

SSRIs

Answer 14

• first line Tx for MDD
• take 4-6 WEEKS to achieve max efficacy
• most common side effect: GI disturbances
• most reported side effect: sexual dysfunction
• other side fx: headaches, rebound anxiety, weight gain, vivid dreams

Question 15

SNRIs

Answer 15

• 2nd line agents after ineffective Tx with SSRIs
• increased NE causes HYPERTENSION
• also used for neuropathic pain
• takes 4-6 weeks to reach max clinical efficacy

Question 16

TCAs

Answer 16

• original MDD Tx
• overdose: lethal cardiac arrythmias
• cause sedation, weight gain, QT prolongation, orthostatic hypertension, anticholinergic fx
• now used for neuropathic pain, migraines, enuresis, OCD

Question 17

MAOIs

Answer 17

• rarely used for MDD (old)
• risk of hypertensive crisis
• don’t take with tyramine
• risk of serotonin syndrome, orthostatic hypotension

Question 18

ECT

Answer 18

• controlled seizures to restart the brain
• given if pt cannot tolerate pharmacologic Tx
• can cause anterograde and retrograde amnesia (transient, resolves)

Question 19

Transcranial Magnetic Stimulation (TMS)

Answer 19

• new

- FDA approved for MDD

Question 20

dysthymia

Answer 20

Persistent Depressive Disorder
A) depressed mood for most days for at least 2 YEARS
B) 2+ of:
-poor appetite/overeating
-insomnia/hypersomnia
-low energy
-low self esteem
-poor concentration
-feelings of hopelessness
C) not been without symptoms for more than 2 months
D) not due to side fx of a substance/condition
E) social/occupational impairment or distress

Question 21

treatment of dysthymia

Answer 21

• same as MDD

- SSRIs not used as often