Depression

Question 1

Definition of Major depressive disorder

Answer 1

> 5 of the following nearly every day for >2 weeks
W at least 1 of *
* depressed need most of the day
Sleep - insomnia or hypersomnia
* Insterest - diminished in almost all activities most of the day
Guilt - feeling of worthlessness or inappropriate guilt
Energy - fatigue or loss of energy
Concentration - diminished ability to think/concentrate/ indecisiveness
Appetite - increased or decreased
Psychomotor agitation or retardation
Suicidal ideation

Question 2

When is a depression treatment resistant?

Answer 2

Inadequate response to >2 antidepressant

Question 3

Risk factors for depression

Answer 3

Family Hx
Negative childhood experience
Abuse
Stressors
Hormonal changes (post-partum)
Poor social support
Chronic medical conditions

Question 4

Differentials to depression

Answer 4

• Persistent depressive disorder
• Adjustment disorder (stressor <3 mo resolved <6 mo)
• grief reaction (loss, usually <3 mo)
• bipolar
• schizoaffective disorder
• organic ( substance abuse, DM, Thyroid, pituitary, decreased B12, anemia, dementia, Parkinson’s, MS, CVA, hepatitis, OCP, BZD, Betablokkere)

Question 5

Principals of management

Answer 5

Assessments w clinical scales
Comprehensive management plan incl safety
At visits do both symptoms w scales and assess functional impairment (occupation, social, educational) and QOL

Question 6

When is St. John’s worth CI

Answer 6

With other antidepressants and OCP (decreased effect of OCP)

Question 7

Treatment depression kids/adolescents

Answer 7

CBT
Fluoxetine (note SSRI <24 yo increased risk of suicide. Follow up every week x 4 week then q 2 weeks.
Escitalopram also safe and sertraline

Question 8

Postpartum or pregnancy: treat with

Answer 8

• CBT
• Citalopram and sertralibe both safe
  And escitalopram
• exercise, acupuncture, light therapy, bupropion
• ECT (for severe psychotic)

Question 9

Depression in perimenopause

Answer 9

CBT
Desvenlafaxine
Transdermal estradiol

Question 10

Prevention of depression in elderly

Answer 10

Decrease loneliness/ isolation
Physical exercise
Social groups

Question 11

Adverse effects med in elderly

Answer 11

Falls
Decreased Na
Prolonged QT (especially w escitalopram and citalopram!!)
Serotonin syndrome
Extrapyramidal
Neuroleptic malignant syndrome

Question 12

Risk factors for suicide

Answer 12

S.A.D.P.E.R.S.O.N