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Behavioral Health II > Blades- Major Depression > Flashcards

Blades- Major Depression Flashcards

1
Q

What are the three types of secondary depressive disorders?

A
  1. General medical conditions
  2. Substance induced
  3. Seasonally mediated
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2
Q

What are general medical conditions that cause depressive symptoms?

A
  1. Nutritional: B12, Folate, Vit D
  2. Hematologic: Anemia
  3. Endocrinologic: Hypothyroidism, adrenal insufficiency
  4. Trauma: brain injury
  5. Neurologic: parkinson’s, stroke
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3
Q

What causes substance induced depression?

A

CNS depressants- alcohol and cannabis (slow brain activity)

DA depleters- cocaine, amphet, MDMA

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4
Q

What causes seasonal affective disorder?

A

Shortened photo period (decreased light exposure) causes circadian rhythmic disturbances leading to neurovegetative changes and a depressed mental state.

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5
Q

What is the etiology of MDD?

A

Vulnerability + stressor –> depression

  1. Biological- genetic, acute illness
  2. Psychological- neglect, bereavement
  3. Social- poverty, loss of status
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6
Q

What gene is linked to genetic vulnerability?

A

5HTTLPR

Causes a 5HT transporter linked promoter region polymorphism

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7
Q

How is the length of gene related to resilience and depression?

A

Long, long, high R, low depression
Long, short, avg R, avg depression
short, short, low R, low depression

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8
Q

What is the criteria for diagnosing depression?

A

At least 2 weeks of low mood OR anhedonia +:

-appetite change, sleep change, psychomotor change, fatigue, trouble concentrating, thoughts of death

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9
Q

What is the prevalence of depression? Age of onset? Who is it more likely to affect?

A

16.5%
Age of onset 32
F: 70% more likely than M

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10
Q

What are the comorbidities for MDD?

A 
Anxiety
Pain
Cardiovascular disease* (2x as likely to die after HA if you've have depression)
Metabolic Disease
Substance abuse
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11
Q

What is the tx for secondary depression?

A
  1. tx underlying medical conditions
  2. Neurologic- tx like MDD
  3. Substance induced- abstinence, +/- anti-depressant
  4. Seasonally mediated- phototherapy
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12
Q

What is the tx for SAD?

A

10,000 lucks for 30 mins daily in am

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13
Q

How does exercise affect MDD?

A

Reverses hippocampal atrophy

Releases endorphins

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14
Q

How does sleep affect MDD?

A

Sleep deprivation decreases resiliency

Circadian rhythm disturbance effect

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15
Q

How does diet affect MDD?

A

imp. general health

decreases biological vulnerability to depression

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16
Q

What psychotherapies are good for treating MDD?

A
  1. CBT: Identify chain of thinking that leads to neg thoughts
  2. Psychodynamic pscyhotherapy: resolution of intrapsychic conflicts
  3. Interpersonal therapy: relationships matter
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17
Q

What are somatic tx for MDD?

A
  1. Psychosurgery: trepanning, frontal lobotomy, anterior cingulotomy
  2. Neuromodulation: ECT, transcranial magnetic stimulation, deep brain stimulation
  3. Medications: manipulate neurotransmission
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18
Q

What is Prozac and how does it work? What is it used for? Efficacy?

A

SSRI
Increases 5HT in synapse
MDD and AD
50% of people get 50% better

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19
Q

What are the side effects of prozac?

A

common: GI, sexual
dangerous: platelet dysfxn, seizure, CYP2D6, 5HT syndrome, suicide

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20
Q

What is Effexor and how does it work? What is it used for? Efficacy?

A

SNRI
Increases synaptic 5HT and NE
MDD and AD
50% of people get 50% better

21
Q

What are the side effects of effexor?

A

Common: GI, sexual, tachycardia, hypertension, discontinuation syndrome
Dangerous: CYP2D6, seizure, suicide, 5HT syndrome

22
Q

What is Wellbutrin (bupropion) and how does it work? What is it used for? Efficacy?

A

DNRI
Increases synaptic DA and NE
MDD
Adjunct for residual sx

23
Q

What are the side effects of wellbutrin?

A

common: HA, hypertension, irritability, increased anxiety
dangerous: CYP2D6, seizure

24
Q

What are the special uses for wellbutrin?

A

Reverse sexual SE

ADHD

25
Q

What is Remeron (Mirtazipine) and how does it work? What is it used for? Efficiacy?

A

Multi-modal AD
Increase synaptic NE and 5HT, block post synaptic 5HT receptor
MDD, Anxiety Disorders
Very effective in combination w/ an SNRI

26
Q

What are the side effects of Remeron (Mirtazipine)?

A

Common: sedation, weight gain
dangerous: agraulyocytosis

27
Q

What are the special uses of remeron (Mirtazipine)?

A

Elderly- good if elderly pt isn’t sleeping or eating

28
Q

What is Imipramine and how does it work? What is it used for? Efficacy?

A

TCA
Increases synaptic 5HT and NE
MDD, Anxiety disorders, chronic pain
More effective than SSRI and SNRI

29
Q

What are the side effects of Imipramine?

A

common: dry mouth , sedation, chronic pain
dangerous: CYP2D6, seizure, arrhythmia, lethal in overdose

30
Q

What are special uses of imipramine?

A

fibromyalgia
neuropathy
insomnia

31
Q

What is Nardil (phenelzine) and how does it work? What is it used for? Efficacy?

A

MAOIs
Increase synaptic 5HT, NE and DA
MDD, Anxiety Disorders
More effective than SSRIs, SNRIs, or TCAs

32
Q

What are the side effects of Nardil (phenelzine)?

A

common: sedation, weight gain
dangerous: medication interactions, food interactions (tyramine), hypertensive crisis, 5HT syndrome

33
Q

What are the special uses of Nardil (phenelzine)?

A

Treatment resistant depression

34
Q

What is Abilify (Aripiprazole) and how does it work? What is it used for? Efficacy?

A

Atypical antipsychotic
Block post-synaptic 5HT receptor, post-synaptic DA receptor partial agonist
Schizophrenia, Bipolar, MDD
Useful in combination w/ SSRI/SNRI

35
Q

What are the side effects of Abilify (Aripiprazole)?

A

cmmon: sedation, weight gain, parkinsonian side effects
dangerous: tardive dyskinesia

36
Q

What are the special uses for Abilify (Aripiprazole)?

A

Treatment resistant depression

37
Q

What is Lithium and how does it work? What is it used for? Efficacy?

A

Adjunct tx
Enhance serotonergic neurotransmission
Bipolar disorder, MDD (adjunct)
Useful in combination w/ SSRI/SNRI

38
Q

What are the side effects of Lithium?

A

common: sedation, weight gain, tremor (propanolol to tx tremor)
dangerous: toxicity

39
Q

What are the special uses for Lithium?

A

Treatment resistant depression

Mood instability

40
Q

What is Cytomel and how does it work? What is it used for? Efficacy?

A

Thyroid hormone (T3)
Stimulate gene transcription
MDD (adjunct)
Useful in combination w/ SSRI/SNRI

41
Q

What are the side effects of cytomel?

A

common: activation
dangerous: hyperthyroidism

42
Q

What are the special uses of cytomel?

A

Treatment resistant depression

Mood instability

43
Q

What is adderall (amphetamine/dextroamphetamine) and how does it work? What is it used for? Efficacy?

A

Psychostimulant
Stim release of DA, block DA reuptake
MDD (adjunct)
Useful inc ombination w/ SSRI/SNRI

44
Q

What are the side effects of adderall?

A

common: activation, anxiety
dangerous: dependence, arrhythmia

45
Q

What are the special uses for adderall?

A

lethargy, trouble concentration, poor motivation

46
Q

What is ketamine and how does it work? What is it used for? Efficacy?

A

Emerging tx
NMDA receptor antagonist
Block NMDA receptor–> increase BDNF–> enhance neurogenesis
MDD (experimental)

47
Q

What are the side effects of ketamine?

A

common: sedation
dangerous: hallucinations, dissociations

48
Q

What are special uses of ketamine?

A

Treatment of resistant severe depression

Behavioral Health II (20 decks)

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