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29 Cards in this Set

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Depression
BIOLOGICAL ILLNESS

dec in NE and/or Serotonin

dec CSF levels of NE/Serotonin
Norepi
made in Locus Ceruleus

at angle of 4th Ventricle at mid pons up to mid-brain
Serotonin
made in Dorsal raphe Nucleus

at level of inf colliculus and rostral pons
Depression Types
1. w/o psychotic features

2. w/ psychotic features
paranoid, delusional, halluc,
etc.
3 Vegetative Signs of Depression
1. dec sleep

2. dec appetitite

3. dec libido
Time Limited
young: 1-1.5 years recovery

old (65+): ~5 years recovery
Depression Facts
-15% off all patients admitted for depression will commit suicide
-external environment influences our internal neurochem
Depression effects on CNS
inc stress--> inc ACTH--> inc Cortisol--> dec Hippocampus vol
Chronic Cortisol Rel
side effect of major depression
dec Hippocampus vol
SSRIs
selective serotonin reuptake inhibitors
developed in 1990s

Prozac, Celexa, Lexapro, Zoloft, Paxil
Prozac
Fluoxetine
came out 1st
long half life (5week wash out)
binds to serum albumin
significant sexual side effects
ED, anorgasmia in men/women
Celexa
Citalopram

quick-2 weeks
LEAST amount of sexual side effects
Lexapro
Escitalopram (similar to celexa)

quick acting with few sexual side effects
Zoloft
Sertraline

diarrhea
same sexual side effects as prozac
Paxil
Paroxetine

same sexual side effects as prozac
Wellbutrin
Buproprion
inc NE and Dopamine

counter side effects of SSRIs
Substantia Nigra
creates domamine
gives it to Nucleus Accumbens for addiction/reward pathways
Serotonin+NE reuptake blockers
recent, w/i last 4 years
used if SSRIs fail

Remeron-mirtazepine
effexor-venlafaxine
cymbalta-duloxetine
Suicide Prevention
Lithium (for biopolars as well)
also help with severe
depression
Electroconvulsive Therapy
used with severe depression and depressive psychotics (very benificial)

Treatment of choice for geriatric patients
-always assess cognitive abilities
Contraindications to ECT
1. intracranial mass (CT or MRI)
2. recent stroke or CVA
3. Recent MI
4. compression fractures of spine

test with MRI and 2D-echo for LV eject fract
Edema
severely depressed patients do not eat. Albumin < 3.0 will cause edema
ECT Procedure
1. General Anesthetic
2. Left Arm Cuff to prevent meds
3. 100% O2 and Succinylcholine
NMJ block with
Fasiculations
4. bite block
5. induce Grand Mal seizure
30-40 seconds, wake up
5-10min later
Cardiovascular Effects of ECT
1. PNS discharge dec HR and BP
2. SNS compensation inc HR and Bp
-use B-blockers to counteract
Risks of Death in ECT
same as general anesthesia
1 in 10000 to 1 in 50000
almost always a cardiac complication
Predictors of Success for ECT
no relapse in 6months
1. total seizure of 226 seconds
2. improved score on Folstein mini mental exam
ECT Results
90% get better
50% relapse in 1st year
maintenence treatment
1. Substantia Nigra
2. Locus Ceruleus
3. Dorsal Raphe Nucleus
1. Dopamine (and assoc with NAS)
2. Norepinephrine
3. Serotonin
Epilepsy and depression
people with poorly controlled epilepsy dont get depressed