Depression

Question 1

3 core sx domains of depression

Answer 1

• mood (depressed mood, anhedonia)
• cognitive (conc impairment, guilt/worthlessness, suicidal thoughts)
• neurovegetative (sleep disturbances, appetite change, psychomotor slowing or agitation, fatigue)

Question 2

Major Depressive Disorder Dx

Answer 2

o At least 5 of 9 core depressive symptoms from SIG E CAPS (must include depressed mood or loss of interest/pleasure) for at least 2 weeks, most of the day, nearly every day

Question 3

SIG E CAPS

Answer 3

• Sleep disturbance
• Interest loss (anhedonia)
• Guilt/feelings of worthlessness
• Energy loss
• Concentration loss
• Appetite loss
• Psychomotor retardation or agitation
• Suicidal ideations
  + Depressed mood

Question 4

Differential Diagnosis

Answer 4

o Other Psychiatric: Bipolar, Substance Use, Personality Disorders, PTSD, Dementia, ADHD, Schizophrenia, Adjustment Disorder, Premenstrual Dysphoric Disorder (PMDD), CNS Lesions
o Metabolic: hypothyroidism, hypercalcemia, hypercortisolemia
o Sleep Disorders
o Autoimmune, Infectious, Nutritional, or Rheumatologic
o Medications: steroids, OCPs, immunosuppressants, CCB, BB, anticonvulsants, statins, isoretinoin, varenicline, reserpine, antimicrobials

Question 5

Depression risk factors

Answer 5

o Genetics: 3-fold higher risk in 1st degree relative, 60% concordance in MZ twins, genetic factors account for 30-40% of risk for MDD (even higher for bipolar)
o Gender: 2 to 1 ratio in women to men
o Neuroticism: predisposition to develop emotional upset under stress
o Negative cognitive bias: enhanced attention and difficulty disengaging from negative info
o Stressful life events: job loss, low income, health problems, disruption of relationships
o Adverse childhood experiences: abuse or neglect, parental divorce, sibling illness

Question 6

Risk factors for completed suicide

Answer 6

o Static: previous attempts, male, single, older age, Caucasian, unemployed, major medical illness, abuse or trauma, family history of suicide
o Dynamic: access to firearms, substance abuse, severe anxiety or insomnia, impulsivity, psychosis, hopelessness, physical pain, polarized thinking, lack of social supports

Question 7

Neurobio of MDD

Answer 7

• The Catecholamine Hypothesis
• HPA Axis Changes (excess activation)
• Neurotrophic and other growth factors: BDNF, VEFG, ILGF-1
• Glutamatergic mechanisms
• Bioenergetics (mitochondrial ATP)