Depression Flashcards
What is the treatment for major depression with psychotic features?
- SSRI and an atypical antipsychotic medication
How might depression in pediatric patients present?
Depression in younger patients can present as:
- Sudden onset of anger and irritability
- Lack of interest in fun activities
- Decreased energy
- Sudden poor grades
What is the differential diagnosis for major depressive episodes?
- Major Depressive Disorder
- Bipolar I/II
What is SIG E CAPS?
Symptoms of Major Depression => need 5 of the below 9 for at least 2 weeks Sleep Interest Guilt Energy Concentration Appetite Psychomotor activity (restlessness or slowness) Suicidal ideation
*Don’t forget DEPRESSED MOOD
What substances can cause a secondary depressive episode?
- EtOH
- Antihypertensives
- Barbiturates
- Corticosteroids
- Levodopa
- Sedative hypnotics
- Anticonvulsants
- Antipsychotics
- Diuretics
- Sulfonamides
- Withdrawal from psychostimulants
What type of medical patient is at very high risk for developing depression?
Stroke patients
pancreatic cancer also has a high association
Which psychiatric disorder has the highest rate of suicide?
Major Depressive Disorder
What types of sleep disturbances are often seen in major depression?
- Multiple awakenings
- Initial and terminal insomnia (difficulty falling asleep and staying asleep)
- Hypersomnia
- Rapid eye movement earlier in the night and decreased time in stages 3 and 4
What brain/neurotransmitter/hormonal differences are seen in patients with depression?
- Decreased CSF levels of serotonin and its metabolite 5-HIAA
- High cortisol
- Abnormal thyroid
If left untreated how long do most depressive episodes last?
6-13months
Which type of depression generally resolves without treatment?
Post partem depression
What type of depression is best treated with MAOIs?
Atypical depression
What drugs may be added to an antidepressant to turn non-responders into responders?
- T3/T4 (liothyronine or levothyroxine)
- Li+
- L-tryptophan (serotonin precursor)
What is the primary indication for ECT?
- Unresponsive to pharmacotherapy ( but can be used along with pharmacotherapy)
- Pregnancy
- Rapid reduction of symptoms is required (serious suicide risk)
- Given 8 treatments over 2-3 weeks
What pre-medications are generally employed before ECT administration?
- Atropine
- General anesthesia
- Muscle relaxant
