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Flashcards in Depression and Tx Deck (19)
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1
Q

Causes of depression

T/F: multiple episodes of untreated depression can cause physiologic changes to the brain?

A
  • genetics/epigenetics
  • early life adversity
  • social factors (isolation, poor social relationships, depression in social networks)
  • psychological factors (personality, psychodynamic = early losses, cognitive/behavioral = negative thinking)
  • 2ndry depression d/t medical disorders/meds/substance abuse

True, can alter brain structure and function.

2
Q

Neurobiology of depression

A
  • abnormal functioning of NT: serotonin, NE, dopamine, GABA, glutamate
  • excess excretion of glucocorticoids
  • abnormal neuronal networks
  • sleep/circadian rhythms, decreased REM latency and slow wave sleep
  • higher levels of inflammatory markers.
3
Q

Sx of Major Depression

A

Psychological:

  • numbness
  • anhedonia
  • irritability/anxiety
  • guilt
  • suicidal ideation

Neurovegatative:

  • appetite (anorexia)
  • sleep (wake up early)
  • low energy
  • concentration

Psychomotor:

  • retardation
  • agitation

physical:
-aches/pain
-weakness/malaise
-GI distress
“walking through mud”

4
Q

Criteria for Depression

A
  • sx occur in same two weeks most of the day nearly every day
  • distress or impairment (social, work functioning)
5
Q

What are the subtypes of depression?

What are the subcategories of depression?

A
  • anxious
  • atypical
  • catatonic
  • melancholic
  • mixed features
  • peripartum
  • psychotic
  • seasonal

Categories:

  • bipolar
  • 2ndry:
  • -medical illnesses
  • -medications
  • -drugs of abuse
6
Q

what is SIGECAPS

A
Sleep 
Interests 
Guilt/worthlessness 
Energy 
Concentration 
Appetite
Psychomotor disturbance
Suicidal ideation
7
Q

Depression evaluation

A

Complete Hx
+/- Physical and neuro exam

Mini- mental status exam

Toxicological screen

Labs: CBC, TSH, LFTs, Chem7/BMP, B12, folate, HIV

Brain imaging (psychosis or neuro findings)

+/- EEG, LP (psychosis or neuro findings)

8
Q

What are psychotic features?

A

delusions, hallucinations, disordered thought

*markedly higher risk of suicide.

9
Q

What is the pneumonic for suicide risk factors

A

SAD PERSONS

  • Sex (male)
  • Age (elderly or adolescent)
  • Depression
  • Previous suicide attempts
  • Ethanol abuse
  • rational thinking loss (psychosis)
  • social supports lacking
  • organized plan to commit suicide
  • no spouse (divorced, widowed, single)
  • sickness (physical illness)
10
Q

When do we hospitalize pts with depression?

A

when they are expressing suicidal ideations and have:
-plan, intent, means

*if less acute develop a safety plan

11
Q

What is all included in the safety treatment plan?

A

crisis numbers (family, friends, suicide hotline, ER, clinic number)

Release of information for family in chart

Commitment to adhere to medications, appointments, contact office with concerns

Agree to remove lethal means

12
Q

What is STAR*D

A

Sequenced Tx Alternative to Relieve Depression

S- switching classes does not improve remission

T- Tolerability similar between classes

A- augmentation may be better than switching*

R- Remission rates decreases with each failed medication trial

13
Q

What are some positive and negative predictors of remission?

A

Positive:
-Caucasian, female, employed, education

Negative:

  • longer index episodes
  • drug abuse
  • anxiety disorders
  • medical disorders
  • lower functioning
14
Q

Acute Tx of Depression

  • mild
  • moderate-severe
  • bipolar
  • psychotic
A

Mild: psychotherapy alone

Moderate/severe: medication +/- therapy

Bipolar: mood stabilizer +/- antidepressant

Psychotic: antipsychotic + antidepressant.

15
Q

What are the three phases of depression?

What is the lifetime recurrent rate of depression with:

  • one episode
  • two episodes
  • three episodes
A

Acute phase (1st 12wks)

Continuation phase (4-6mo following remission)

Maintenance phase (relapse prevention)

Recurrence rate:

  • 1 episode = 50%
  • 2 episodes = 70% (medications are lifelong at this stage)
  • 3 episodes = 90%
16
Q

What is important to educate your pts on about depression medications?

A
  • minimum of 2-4wks to be effective
  • need to continue taking every day even if feeling better
  • will need to take up to 1 year after resolution of depressive sx
  • be aware of the SE, they will occur right away it takes time to feel better.
17
Q

When are suicide attempt rates highest?

Tx for anxiety ? insomnia?

If pt presents with prominent agitation consider what disorder?

Which of the SSRIs has the least likelihood of drug interactions?

A

1 mo before treatment.

Tx anxiety:

  • benzos
  • Gabapentin
  • lyrica
  • buspirone
  • -therapy/meds/exercise

Tx Insomnia:

  • benzos
  • zolpidem
  • trazodone
  • -therapy/meds/exercise

BIPOLAR!!!

Excitalopram/Lexapro has least likelihood of drug interaction.

18
Q

SSRIs inhibit which liver enzyme ? Which meds are most likely to inhibit this enzyme?

A

2D6, this enzyme metabolizes drugs so if we inhibit this it may lead to build up of drug in the blood stream…toxic.

Concerend with Fluoxetine (Prozac), Fluvoxamine (luvox), Paroxetine (Paxil)

19
Q

Non-medication tx of depression

A
  • CBT
  • Interpersonal therapy
  • Bibliotherapy (workbooks)
  • mediation
  • exercis e
  • apps/support groups