Term
| How do diagnose a major depressive episode? |
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Definition
| five or more of the following symptoms during the same 2 week period at least one being depressed mood or loss of interest or pleasure 1) derpessed 2) decreased interest 3) weight/appetite abnormalities 4) imsomnia or hypersomnia 5) psychomotor agitation or retardation 6) fatigue or loss of energy nearly every day 7) feelings of worthlessness or inappropriate guilt 8) diminished ability to concentrate 9) recurrent thoughts of death or suicidal ideation. Symptoms can not be d/t GMC or bereavement |
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Term
| What are the two types of features of depression? |
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Definition
| melancholic features or atypical features |
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Term
| What are melancholic features of depression? |
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Definition
| either loss of pleasure or reactivity + three or more of: depressed mood, worse in morning, early morning awakening, marked retardation or agitation, weight loss, excessive guilt |
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Term
| What are the atypical features of depression? |
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Definition
| mood reactivity + weight gain, hypersomnia, leaden paralysis, interpresonal rejection sensitivity |
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Term
| How do you diagnose dysthymic d/o? |
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Definition
| 2 years of have depressed mood on monst days + at least 2 of [hoplessness, impaired cognition, appetite change, los energy, low self-esteem, hypersomnia or insomnia) No symptom free period lasting greater than 2 months in the past 2 years |
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Term
| How many people with depression commit suicide? |
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Definition
| 1/7 with recurrent illness |
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Term
| What rank is suicide as a cause of death? |
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Definition
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Term
| What degenerative neurologic disorders are associated with depression? |
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Definition
| parkinson's, huntintons, progressive supranuclear palsy, alzhiemers, MS |
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Term
| What are the endocrine abnormalities of depressed people? |
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Definition
| blunted release of TSH in response to TRH; increased cortisol levels (abnormal dexamethasone suppression test) |
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Term
| What are the sleep abnormalities of people with depression? |
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Definition
| longer to get to sleep, shorter REM latency, increased length of first REM |
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Term
| How much does your risk of depression increase if you have a family member with depression? |
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Definition
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Term
| What is the monamine hypothesis? |
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Definition
| decreased NE, 5HT or DA causes depression (dopamine is involved in the mesolimbic tract which gives you pleasure and in the mesocortical tract which is involved in concentration) |
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Term
|
Definition
| brain derived neurotropic factor; thought to be decreased in depression |
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Term
| What is the receptor hypothesis? |
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Definition
| there is an increased density of 5HT receptors in suicide victims suggesting that this can lead to depresion |
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Term
| How do you treat premenstrual dysphoric disorder? |
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Definition
| lower dose of antidepressants or OC |
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Term
| What percent of the population ultimately commits suicide? |
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Definition
|
|
Term
| What is the typical age of the person that commits suicide? |
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Definition
males= peaks after age 75
females= late 40s and 50s |
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Term
| What factors do you use to assess suicide? |
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Definition
| lack of physical health, stressful life events, previous attempts, access to firearms, pervious attemps, family history (anniversaries), substance abuse, active vs. passive thoughts, hallucinations (commands) |
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Term
| How old are pts when they are diagnosed with depression? |
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Definition
| mean age= 40 years; 50% have onset between age 20 and 50 |
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Term
| Depression can be induced by abuse of what substances? |
|
Definition
| ETOH/benzodiazepine, cociane, cannabis, opiate |
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Term
| What endocrine disorders can cause depression? |
|
Definition
| hypothyroidism, adrenal disease (cushings/addisons), parathyroid |
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Term
| What inflammatory/infectious diseases can look like depression? |
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Definition
| SLE, neurosyphilis, AIDS, TB, chronic fatigue syndrome |
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Term
| What metabolic abnormalities can look like depression? |
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Definition
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Term
| What is the monamine hypothesis of gene expression? |
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Definition
| depression is d/t dysfunction in 2nd messenger systems causing decreased BDNF which leads to apoptosis of vulnerable neurons with stress |
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Term
| How do you diagnose PMDD? |
|
Definition
in most menstrual cycles,>=5 of the following present before menses and absent after menses: 1) depressed 2) anxiety 3)affective lability 4) anger, irritability 5) decreased interest 6) difficulty in concentration 7) lethargy 8) marked change in appetite 9) hypersomnia or insomnia 10) overwhelmed/out of control 11) breast tenderness, headaches, joint or muscle pain, sensation of bloating.
INTERFERES WITH FUNCTIONING |
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Term
| If your depression comes back after a remission it is called a ____. |
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Definition
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|
Term
| If your depression comes back after a recovery it is called a ____. |
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Definition
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|
Term
| It is a common belief that what drug is better for depressed pts with comorbid anxiety? |
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Definition
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|
Term
| What antidepressants work the same among family members? |
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Definition
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|
Term
| Where is MAO found and what does it do? |
|
Definition
| intracellulary on outer mitochondrial membrane; degrades cytoplasmic monoamines (NE, 5HT, DA, tyramine) |
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Term
| What are the two types of MAO? |
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Definition
|
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Term
| Where is type A MAO located and what does it primarily metabolize? |
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Definition
| CNS, sympathetic terminals, liver, gut, skin (primarily metabolizes NE, 5HT, EPI |
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|
Term
| Where is type B located and what does it metabolize? |
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Definition
| CNS, liver, platelets; DA and tyramine |
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Term
|
Definition
| pheelzine, tranylcypramine, isocarboxazide, selegiline |
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|
Term
|
Definition
| a single dose can persist for two weeks. Side effects are hypotension, insomnia |
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|
Term
| Which MAOIs are associated with an increased risk of hepatotoxicity? |
|
Definition
| phenelzine and isocarboxazide |
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|
Term
| People on MAOIs must avoid what foods? |
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Definition
| cheese, fish, cured meats, sausage, salami, pate, organs, alcoholic beverages (red wine, scotch), sauerkraut |
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|
Term
| How long do you have to continue restricted diet after you stop a MAOI? |
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Definition
|
|
Term
| How do tricyclic antidepresents work? |
|
Definition
| block reuptake pumps for NE and 5HT |
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|
Term
| Which TCA is serotonergic? |
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Definition
|
|
Term
| Which TCAs are noradrenergic? |
|
Definition
| desipramine, nortriptyline, protriptyline |
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|
Term
| Which TCAs are both noradrenergic and serotonergic? |
|
Definition
| amitriptyline, imipramine, doxepin |
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|
Term
| At what levels do TCAs start to affect cardiac functioning? |
|
Definition
| 200 mg (slowing of His bundle ventricular system); arrhythmia at 1275; cardiac arrest at 1700 |
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|
Term
| Fluoxetine, fluvoxamine, paroxetine, sertraline, citalopram, and excitalopram are all examples of... |
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Definition
|
|
Term
| What are the cons of using SSRIs? |
|
Definition
| suicide risk in peds, prozac poop out, vivid dreams, increased GI and sexual side effects |
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|
Term
| Libido is controlled by what NTs? |
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Definition
|
|
Term
| Arousal is controlled by what NTs? |
|
Definition
|
|
Term
| Orgasm is controlled by what NTs? |
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Definition
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|
Term
| What is serotonin syndrome? |
|
Definition
autonomic= diaphoresis, hyperthermia, hypertension, tachycardia, pupillary dilatation, nausea, diarrhea
Neuromotor= hyperreflexia, myoclonus, tremor, clonus seziures
cognitive/behavioral= confusion, agitation, insomnia |
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Term
| How long does it take for serotonin syndrome to develop? |
|
Definition
| 50% within 2 hrs of change in meds |
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Term
| What is the treatment for serotonin syndrome? |
|
Definition
| stop serotonergic meds, supportive care (dantroline, benzodiazepines for muscle relaxation and cooling measures/fluids), consider antiserotonergic medication (cyproheptadine) |
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Term
| What are the symptoms of SSRI withdrawal syndrome? |
|
Definition
| dizziness, paresthesia, lethargy, nausea (onset within 5 days and lasts up to 3 weeks) |
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Term
|
Definition
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Term
| What are teh side effects of bupropion (wellbutrin)/ |
|
Definition
| worsen comorbid anxiety, h/a, insomnia, seizure risk, less weight gain and sexual side effects, smoking cessation |
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Term
|
Definition
| venlafaxine, desvenlafaxine, duloxetine, nefazodone, trazodone |
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Term
| What ae the side effects of culoxetine (cymbalta)? |
|
Definition
| chronic pain, diabetic peripheral neuropathy |
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|
Term
| What rae the side effects of nefazodone? |
|
Definition
| decreased sexual side effects, inhibitor of CYP 3A4 (liver failure) |
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|
Term
| What are teh side effects of trazodone? |
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Definition
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|
Term
| Name an alpha 2 antagonist used for depression? how does it work/what are side effects? |
|
Definition
| mirtazapine; increased NE and 5HT via heteroreceptors on serotonergic neurons in the raphe nuclei; antagonist of 5HT2 (low sexual SE) and 5HT3 (low GI SE); sedating; weightgain |
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|
Term
| What are the uses of ECT? |
|
Definition
| refractory depression, mania, catatonia |
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