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48 Cards in this Set
- Front
- Back
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What is the goal of treatment of depression?
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resolution of current symptoms (remission) and prevention of further epidsodes of depression (relapse)
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What should pt be counseled on when starting depression medication?
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adverse effects might occur immediately, but resolution of symptoms may take 2-4 weeks or longer. Adherence is essential to successful outcome, and tools to help increase medication adherence should be discussed with each patient.
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How is major depressive disorder diagnosed?
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an individual experiences one or more major depressive episodes without a history of manic, mixed, or hypomanic episodes.
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What is depression associated with?
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significant functional disability, morbidity, and mortality
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Who are at an increased risk of depression men or women?
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women
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What age group has highest rate of depression?
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18-29 years of age
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Is someone that has a family member with depression more likely to have depression?
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yes, 1.5-3x more likely
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What causes depression?
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changes in brain monoamine NT (NE, 5-HT, DA)
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What drug led to the first theory of depression that depression was caused by decreased brain levels of NE, 5-HT, and DA?
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reserpine
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Why is the theory that the depression is caused by decreased brain levels of NE, 5-HT, and DA not true?
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antidepressants block the reuptake of monamines immediately but effects are not observed for 4 weeks
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How is the delayed response when taking antidepressants explained?
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changes in receptor sensitivity
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What is the dysregulation hypothesis for depression?
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emphasis is placed on failure of homeostatic regulation of neurotransmitter systems rather than absolute increases or decreases in their activities. Antidepressants restore efficient regulation to the dysregulated neurotransmitter system
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Is a single NT involved in depression?
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no, serotonergic and noradrenergic systems are involved in antidepressant response. B-adrenergic receptor downregulation is important for achieving antidepressant effect
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What is the role of DA in depression?
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DA transmission is decreased in depression, and agents that increase daopaminergic transmission (specifically in the mesolimbic pathway) are effective antidepressants
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What kind of neuroendocrine abnormalities are present in depression?
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hypersecretion of cortisol, lack of cortisol suppression after dexamethasone administration, abnormal or diminished TSH
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How do you test for hypothalamic pituitary adrenal axis overactivity?
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dexamethasone administration suppresses adrenal corticosteroid production in normal subjects for 24 hours, but doesn't in overactive pts. Not a good test, lots of false positive/negatives
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What type of sleep abnormalities might a depressed person have?
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onset of REM sleep occurs earlier during sleep (decreased REM latency), shift of REM sleep to first half of the night, decrease in number of minutes in slow-wave sleep, increased awakenings and early morning awakening
not diagnositic |
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How is depression diagnosed by DSM-IV-TR?
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5 or more symptoms during 2 week period and represent a change from previous functioning. One symptom must be depressed mood or loss of interest or pleasure.
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What tests should every depressed person have to identify any medical problems?
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physical, mental status exam, CBC with diff, thyroid function test, electrolyte determination, and a complete medical review to identify any meds that could cause depression
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What medications can cause depression?
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HTN: clonidine, diuretics, guanethidine sulfate, hydralazine hydrochloride, methyldopa, propranolol, reserpine,
OC, steroids/adrenocortocotropic hormone, isotretinoin, interferon B1a |
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Are males or females more likely to commit suicide?
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males, females attempt 2-3x more, men succeed 2-3x more
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What age group are more likely to commit suicide?
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elderly
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What is the goal of tx for depression?
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reduce symptoms, return to level of functioning before illness, prevent further episodes
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What are the 3 phases of tx for major depressive disorder?
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acute, continuation, and maintenance
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What is acute phase of tx?
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6-10 weeks, goal is remission (absence of symptoms)
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What is continuation phase?
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4-9 months after remission, eliminate risidual symptoms and prevent relapse
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What is relapse?
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return of symptoms within 6 months of remission
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What is maintenance phase?
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12-36 months, prevent recurrence (separate episode of depression)
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What does the duration of antidepressant therapy depend on?
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risk of recurrence
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When is lifelong maintenancy therapy recommended?
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persons at greatest risk of recurrence
<40 years with 2 or more prior episodes and any person with 3 or more episodes |
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When is psychotherapy first line?
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mild to moderate depressive episode
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What kind of effect does psychotherapy and antidepressant have?
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additive
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When might combined tx not offer and advantage?
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uncomplicated nonchronic major depressive disorder
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Which is more effective: cognitive therapy, behavioral therapy, and interpersonal psychotherapy?
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equally effective
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Is psychotherapy recommended for maintenance therapy alone to prevent recurrence?
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no
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When is electoconvulsive therapy (ECT) recommended for depression?
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rapid response needed, risk of other tx outweigh benefits, history of poor response to antidepressant and history of good response to ECT, pt prefer ECT
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How is ECT given?
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unilateral or bilateral, 2-3x/week for 6-12 tx
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How long for response to ECT?
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rapid, 10-14 days
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What are CI for ECT?
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none
increased risk: increased intracranial pressure, cerebral lesions, recent MI, recent intracerebral hemorrhage, bleed, unstable vascular condition |
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How do you decrease morbidity with ECT?
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use anesthetic and nondepolarizing neuromuscular blocker
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What are AE of ECT?
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cognitive dysfunction (usually not permanent), CV dysfunction, prolonged apnea, tx emergent mania, HA, nausea, muscle aches
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How are relapse rates for ECT?
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high unless maintenance antidepressant med used
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What is bright light therapy?
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pt gazing into a 10,000 lux intensity light box that is slanted downward toward pt face for 30 minutes/day
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When has bright light therapy show effectiveness?
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winter "blues" (seasonal affective disorder), and djunctive use in major depressive disorder with seasonal exacerbations
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What is most common complaint of bright light therapy?
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visual complaints
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What tests for bright light therapy?
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baseline and periodic eye exams
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Is combo bright light therapy and medication additive?
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yes
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What factors influence the choice of antidepressant response?
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medical history, symptoms, drug-drug interactions, AE, preference, cost
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