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14 Cards in this Set

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Who are most likely to have depressive episode?
Women, during reproductive years. Increased incidence after you've already had a depressive episode.
What is the #1 risk for depression
SUICIDE! ALWAYS CHECK FOR THIS FIRST. HIGHEST PRIORITY!!
What are personal, permanent, pervasive versus impersonal, transient, specific?
P, P, P is depressive personality disorder. Internal misprocessing of stressors. I, T, S are more optimistic ways of handling stress.
What is depressive personality disorder?
Traits: Personal (they themselves are the root of the problem), Permanent (happens everytime), Pervasive (this ruins other aspects of their lives)
Common pathway of depression?
Dysregulation of prefrontal cortex hypoactivity
What are the diagnostic criteria for depression?
Suicidal thoughts, insomnia, lack of energy/interest, feelings of guilt/worthlessness, anhydonia
Diagnostic criteria for MDE (major depressive episode)
Marked social/occupational impairment. Not related to medical (hypothyroidism) or substance abuse. NOT MIXED EPISODE. THERE ARE SUBTYPES
What are the mood disorders?
Dysthymic, bipolar I, bipolar II, MDE, cyclothymic.
Goals of antidepressant treatment?
Acute (6-12 wks) = lower suicide risk, remission of depressive symptoms

Continuation (4-5 months) = adherence, setting goals, education.

ACUTE/CONTINUATION ARE HUGE FOR EACH EPISODE.

Maintenance (>1 yr) = Optimize adherence, restore psych. fxn
Treatment options for depression
SSRI = selective serotonin reuptake inhibitor (first-line)... can deal with anxiety as well

SNRI = serotonin nori reuptake inhibitors

NDRI = nori dopamine reuptake inhibitors

SARI = serotonin antagonism and reuptake inhibition

NASSA = alpha-2 antagonist and serotonin antagonist

MAOI = monoamine oxidase inhibitor

TCA = tricyclics
How long do you keep treating for depression?
First episode = ~12 mths

Second episode = maintenance treatment

Third episode = lifelong treatment

TAPER OFF...SAME DRUG DOSE ACUTE AS CONTINUATION
How is depression presented?
SOMATICALLY!! Especially in elderly. ~20% consults are primarily psychiatric
ALGORHYTHM of Depression treatment
Monotherapy (NOT TCA), then monotherapy (TCA ok), combination therapy (meds + psychotherapy), Somatic (VNS, ECT...)
Where is brain stimulated for treatment of depression?
PRIMARILY IN LEFT PREFRONTAL CORTEX!!!