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major depressive episode criteria

5/9 for 2 weeks:
1-Depressed Mood (feel sad or blue)
2-Anhedonia (don’t like things)
3-Change in appetite/body weight (eating)
4-Change in sleep habits (sleeping)
5-Feelings of worthlessness or guilt (guilt)
6-Unable to concentrate on things (concentration)
7-Psychomotor agitation (restlessness or slowness)
8-Fatigue or Loss of energy (no energy)
9-Recurrent thoughts of death or suicide (SI)


What medical conditions could cause depressive episode?

Endocrine (thyroid, cortisol, calcium)

Neuro diseases (parkinson’s, mononucleosis)

Cancer (lymphoma, pancreatic)

SLE (lupus)


What is the DSM criteria for Major Depressive Disorder?

1-at least one major depressive episode

2-no signs of manic or hypomanic episode


What sleep problems are associated with MDD?

Multiple awakenings

Initial and terminal insomnia

REM (rapid eye movement) sleep earlier in night


What is seasonal affective disorder (SAD?)

Subtype of MDD where the episodes only occur during the winter months.
Pts are classically IRRITABLE, HYPERSOMNIC and have CARBOHYDRATE cravings.


What is dysthymic disorder?

Depressed mood for most days for at least two years

Two of the following:
Poor appetite or overeating (eating)
Poor sleep (sleep)
Feelings of hopelessness/guilt
Feelings of low self esteem
Difficulty concentrating or making decisions
Fatigue or loss of energy
-doesn’t list anhedonia or SI, adds low self-esteem

During the period pts have not been w/o above symptoms for >2 mo at a time and do not meet criteria for Major Depressive Episode.


What is double depression?

Patients with MDD who have dysthymic disorder in residual periods (Dysthymic disorder in betw episodes)


What is cyclothymic disorder?

Alternating periods of hypomania and mild/mod dep
-no actual major depressive or manic episodes
-associated with borderline personality disorder
-1/3 of these patients advance to BPADII
-treat with antimanic agents

-males=females and onset usually 15-25 years (young)


Is MDD more common in women or in men? Avg age? Risks?

2x more common in women
Can occur in any age, average onset is 40

No ethnic or socioeconomic differences

Very prevalent in elderly (1/4 to ½ by some estimates)

2-3x greater risk if + family hx


What % of depressed patients have SI? What % commit suicide?

About 2/3 have SI

About 10-15% commit suicide


What is the kindling theory of depression?

With each episode of depression (may last mos to yrs) pts are more prone to have further depressive episodes triggered with weaker stimuli or stressors.


What are the five possible outcomes during depression?

Response, Remission, Relapse, Recovery and Recurrence


What are the risks of recurrent episodes?

50% after 1, 70% after 2 and 90% after 3 episodes


What is cognitive therapy (CBT) for depression?

Focuses on the here & now, very little exploration of person, focuses on correction of abnormal thought connections based on person’s experience.


What is interpersonal therapy (IPT) for depression?

Focuses on the Here & Now, uses the relationship with therapist as a vehicle, helps to redefine one’s relationships w/others
-good for bulimia patients


What is behavioral therapy for depression?

Focused on learning models, healthy eating, relaxation models, exercise.
-very effective for anxiety disorders and “stress”


How often do patients with MDD have another co-morbid psych condition?

About 60% of the time.

25% of the time there are 3 or MORE disorders

-like Substance abuse, Anxiety disorders (panic, GAD, social), Somatoform disorders, OCD, Eating Disorders and Personality disorders (Axis II).


Which patients with MDD need maintenance-phase therapy?

Pts who have had 3 or more episodes
Pt had 2 episodes and a risk factor:
-FHx of BPAD or recurrent MDD
-episodes were closely-spaced (in less than 3 years)
-Onset of first episode at less than 21y or over 60y
-They have very long episodes lasting >2 years


What organ system is most strongly affected by depression?

-moderate risk for developing MI/CAD/CHF
-pts have inc plt aggregation, HR variability, inc cytokines
-pts exercise less, are fatter, smoke