psychotherapeutics ppt Flashcards
what is the prevalence of depression annually in Canada in %
from 5 to 8.2 percent of the Canadian population afflicted annually.
what is the estimated lifetime prevalence of depression in the US for adults
16.2% lifetime prevalence
what is remission like in relation to depression
what is the risk of relapse after 1 time? after 2nd and third?
At least 50% of people following their first episode of major depression will go on to have at least one more episode and after the second and third episodes, the risk of further relapse rises to 70% and 90% respectively.
if taking antidepressants and you are no longer having symptoms when can you stop taking the
how long do you need to take them the second time?
third time?
after the first depression to stay on antidep for at least 9 months after symptoms subside,
the second time at least 5yrs after symptoms subside
the fthird time basically for life (she wasnt positive on those timelines)
what are 2 great screening questions for depressed pt
Screening for depression is 2Q: have they lost pleasure or interest in things in their life or are there still things they enjoy? Have felt sad down low depressed or hopeless?
which age and ethnicities are at disproportionate risk of suicide
Elderly Caucasian and Asian men over the age of 65 years and Asian women over 80 years are at disproportionate risk.
t or f a large amount of those who died by suicide had lost touch with their drs
f
75 % of elderly suicide completers were seen by their doctor within one month of death
when a pt has high levels of the following what risks for suicide does it mean that risk is very high and hospitalization may be immediately necessary
- Internal emotional pain (e.g., feelings of shame, guilt, humiliation),
- External stress (e.g., loss of spouse, job, legal troubles),
- Agitation (e.g., from sleep loss, drug use, or excessive anger),
- Hopelessness
what re the 2 major theories of et of depression
Monoamine neurotransmitter dysfunction
Neuroendocrine factors
which addition factors are thought to play a role in et of depression. examples of each
Additional factors thought to play a role in etiology of depression
- Immune system-stress (going thru the hypothalamic pituitary renal system)
- Genetic factors (family hx, genetic cofactors like alcoholism and depression)
- Environmental factors (poverty, trauma in early childhood and beyond)
what is it called when a pt cant describe how they feel
alexithymia
which drugs may be associated with major depression
Reserpine, steroids, alpha-methyldopa, propranolol and hormonal therapy may be associated with major depression.
in class: Anticonvulsants, antimigraines, corticosteroids, hormonal drugs eg corticosteroids, GNRH, birth control, antiretrovirals, antimalarials
beyond the mentioned drugs what are other medical causes of depression
Active abuse or withdrawal from alcohol, cocaine, sedatives, opiates, cannabis, anxiolytics, hypnotics and amphetamines
Idiosyncratic reactions to other medications can occur
Medical conditions: hypothyroidism, cardio- vascular disease, etc.
depression has a **bidirectional relationship to which medical condition?
How does this work?
coronary artery disease can cause depression
and depression is an independent risk factor for coronary artery disease and its complications;
depression may contribute to sudden cardiac death and increase all causes of cardiac mortality;
and depression contributes to unhealthy lifestyle and poor adherence to treatment. “
in the graph she gave us how did depression following MI impact mortality
Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P=.0006).
what are the two larger…(classes?) of older antidepressants
Tricyclic antidepressants (TCAs) Monoamine oxidase (MAO) inhibitors
TCAs what other medical condition are these used for?
egs of these?
**(used for urinary retention as well due to this side effect)
imipramine and amitriptyline
TCAs: were they still used much after SSRIs
-how are these meds dangerous for pt
As soon as the new drugs came out these were mostly phased out. Theyre very cardiotoxic and can easily kill pt if takes OD. Gen only psychiatrists could provide
are there major restrictions with MAOI antidepressants? When are these used in r/t other antidepressants
**MAOI have many dietary and drug interactions. The only time they use these now is if someone doesnt have good result with other drugs. Theyd probably be tried after AAP and TCA
what were the two general classes of newer antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Serotonin/norepinephrine reuptake inhibitors (SNRIs)
how long must you take antidepressants before theyll begin working
why?
**Must be taken 2–4 weeks before depressive symptoms improve
-Why they take so long to work: some theories
Up-regulation of neurotransmitter
Hippocampus changes
Scientists believe the behavioral effects of antidepressants may be due to other changes that occur as a reaction to the changed serotonin levels. However, researchers don’t know what reactions include, and therefore cannot create medications that target them directly.
where are antidepressants in general absorbed and metabolized?
what route are they given through?
Given orally, absorbed from small bowel, metabolized extensively in the liver
do antidepressants interact with each other and other meds metb in the liver
yes
SSRIs are generally oxidatevely metabolized by CYP2D6 what are the different categories of this
ultrarapid metabolizer (UM); extensive, or normal, metabolizer (EM); intermediate metabolizer (IM); and poor metabolizer (PM). Between 5% and 10% of whites are classified as PM, ~5% are classified as UM, 20% to 30% are classified as IM, and the rest are EM Some people d/t genotype may metabolize SSRIs differently
which neurotransmitter do traditional antidepressants mostly work on and how are they acting on it
Traditional antidepressants go after serotonin transporter proteins. These regulatory proteins take serotonin back into the nerve cell after it has been released in the process of signaling other neurons. Antidepressants keep the transporters from performing this function.
which area of the brain is sometimes found to be smaller in depressed people?
Is there a cnclusion on why this is?
Researchers have noticed that the hippocampus of a depressed person’s brain tends to be smaller than average. Some researchers hypothesize that a problem with neurogenesis causes both the small hippocampus as well as depression; others caution that the causal arrow may be reversed, with a small hippocampus leading to problems with neurogenesis and depression.
does chronic or long term use of antidep cause and inc or dec in neurogenesis
increases neurogenesis
what are the indications for use of antidepressants
Depressive symptoms persist at least 2 weeks
Impair social relationships or work performance
Occur independently of life events
-Treatment of anxiety disorders
-Enuresis management
-Neuropathic pain management
