Depression

Question 1

Recurrence rates

Answer 1

56% 1 MDE, 28% 2 MDEs (70% chance relapse), 15% 3 MDEs (90% chance)

Question 2

RF for recurrence/chronic course

Answer 2

RF for recurrence/chronic course
- FHx
- ss allele 5HTTLPR (2x short alleles of serotonin transporter)
- Early onset, high severe 1st episode, # episodes
- Neuroticism
- Partial remission, ongoing sleep Sx, negative cognitions
- Comorb: PDD, anxiety
- Lack of support

Question 3

neuromod indications

Answer 3

Neuromodulation
Indications
ECT 1st line: TRD, psychosis, SI
2nd line: deteriorating phys status, catatonia, Rx intol, prior response, preference, pregnancy + 1

rTMS 1st line MDD w/out psychosis, 1 failed Rx trial

VNS (L) 3rd line

DBS Investigational : Sub-callosal cingulate gyrus