Major Depressive Disorder

Question 1

what is the definition of MDD?

Answer 1

> 5 of 9 symptoms present during same 2-week period and represent a change from previous functioning

• at least 1 is either depressed mood or anhedonia
  1. depressed mood most of day nearly every day (subjective)
  2. anhedonia
  3. significant weight loss or weight gain (>5% change), or failure to thrive
  4. insomnia or hypersomnia nearly every day
  5. psychomotor agitation or retardation nearly every day
  6. fatigue or loss of energy nearly every day
  7. worthlessness or guilt
  8. diminished ability to concentrate or think
  9. recurrent thoughts of death

Question 2

what is SIGECAPS?

Answer 2

DSM criteria for depression (need at least 5 of them)

Sleep disturbance
Interest/pleasure reduction
Guilt, worthlessness
Energy loss, fatigue
Concentration/attention impairment
Appetite changes
Psychomotor symptoms
Suicidal ideation

Question 3

what is SWAG?

Answer 3

differentiation between sadness and depression (need only 1)

Suicidal thoughts
Weight loss/gain
Anhedonia
Guilt

Question 4

what is atypical depression?

Answer 4

more likely to have weight gain and hypersomnia

-also leaden paralysis, carb craving, rejection sensitivity (self-esteem problem)

Question 5

what is pseudodementia?

Answer 5

cognitive symptoms in depressed elderly

-often misdiagnosed as dementia, but these problems are reversible

Question 6

what is diurnal variation?

Answer 6

more depressed in AM, better in PM

-melancholic-type depression

Question 7

what are psychomotor symptoms?

Answer 7

physical complaints like body aches and headaches

• agitation VS retardation
• vegetative depression

Question 8

what is seasonal affective disorder?

Answer 8

MDD usually associated with shroter days in winter

• usually with atypical symptoms
• treat with full-spectrum light exposure, psychotherapy, antidepressants

Question 9

what is masked depression?

Answer 9

depressed patients presenting with vague physical ailments but unaware/in denial of depression

• seem stoic
• seek primary care for psychomotor or somatic symptoms instead
• consider diagnosis only when no organic medical cause is identified and patient has other MDD symptoms
• more typically seen in elderly patients, OCD/narcissistic patients

Question 10

what are possible medical causes of depression?

Answer 10

• hypothyroidism
• Cushing syndrome
• anemia
• brain injury, stroke
• vitamin deficiency (B12, folate, D)
• obstructive sleep apnea

Question 11

what are biological factor etiology of MDD?

Answer 11

1. monoamine deficiency
   - low DA, SR, NE
2. monoamine receptor exccess theory
3. loss of neutrophic factors and degeneration
4. genetics (serotonin transporter gene)

Question 12

what are psychosocial factor etiology of MDD?

Answer 12

1. ability to cope with stressors - resilience
2. low self-esteem, negative outlook
3. personality traits
4. addiction
5. learned helplessness and automatic thoughts
6. catastrophic loss
7. anger turned inward (take anger out on self)
8. incapacity via hibernating (dropping out makes you happier)
9. social disconnect

Question 13

what proportion of depression is genetic VS environmental?

Answer 13

65% environmental

35% genetic

Question 14

explain interactions among risk factors on depressive vulnerability?

Answer 14

the monthly risk of depressive onset increases with the number of depressive episodes
-this is worsened by genetic risk

Question 15

explain stress-cortisol-depression-treatment?

Answer 15

1. stress causes increased glucocorticoids, which decreases BDNF (brain-derived neurotropic factor)
2. dendritic branching decreases, causing atrophy and death of neurons
3. pharmacotherapy, ECT, and psychotherapy will increase 5-HT and NE, thus decreasing glucocorticoids, and increasing BDNF
4. this may cause increased survival and growth

Question 16

what is the dysfunctional neuroanatomy in a depressed brain?

Answer 16

hypoactive DLPFC

hyperactive amygdala

Question 17

what is the occurrence of MDD?

Answer 17

• lifetime prevalence: women > men
• -women also more likely to seek help/treatment
• higher risk for elderly who are widowed or chronically ill
• co-morbidity of substance abuse, generalized anxiety

Question 18

what are the frontline antidepressants? why are they so?

Answer 18

1. SSRIs
2. SNRIs
3. NDRIs

they have less severe side effects

Question 19

what are second-line antidepressants?

Answer 19

1. MAOi
2. TCA
3. sedating antidepressants

Question 20

how do sedating antidepressants work? examples?

Answer 20

Trazodone, mirtazapine

• block 5HT2 receptors and H1 receptors instead of SSRI mechanism
• mirtazapine increases NE by blocking a2a NE receptor

Question 21

what should you do when antidepressants aren’t enough?

Answer 21

use augmenting strategies together

• lithium
• thyroid hormone
• atypical antipsychotics

Question 22

how long do antidepressants take to work?

Answer 22

from 6 to 8 weeks, and only 1/3 of patients respond

Question 23

what are faster-acting pharmaceuticals? downside?

Answer 23

psychostimulants, ketamine IV (lasts 7 days)

-may cause addiction

Question 24

what is ECT?

Answer 24

electroconvulsive therapy (shock treatment)

• effective for severe depression, especially if non-responsive to meds
• used when antidepressants cannot be used due to toxicity/side effects, or when antidepressants fail
• also used when immediate resolution of symptoms is needed (acute suicidal or psychotic)

Question 25

what are other neurostimulation techniques?

Answer 25

1. vagus nerve stimulation (VNS) 2. transcranial magnetic stimulation (TMS) 3. deep brain stimulation (DBS) 4. transcranial direct current stimulation (TDCS)

Question 26

what are psychological treatments?

Answer 26

family, interpersonal, psychoanalytic/psychodynamic, behavioral, and cognitive therapies - psychological treatment + medication is more effective than either alone - new functional brain studies may suggest which patients respond to which treatment