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Flashcards in Depression Deck (34):
1

What is the frequency which depression is dx and treated

Recognized half the time but then treated only half the time

2

Etiology of Depression

Most common pysch symptom
1 year prevelance:
5% have major depression
5.4% have dysthymic disorder
in a given year see 11 million people w/ depression

3

How efficacious is tx for depression

80%

4

What are the variety of ways depression can present

• Multiple Somatic Complaints
• Anxiety
• Cultural influences
– “Nerves” “Headaches”-Latino, Mediterranean
– Weakness, Tiredness, “Imbalance”-Chinese, Asian cultures
– “Heartbroken” - Hopi

5

What are common somatic complaints in pts with depression

tire, blahs, headache, malaise, poor sleep, abdominal/joint aches, stressed out, GI issues, loss sexual interest

6

What are the more common positive predictive somatic sypmtoms for depression

sleep issues, fatigue, non specific skeletal compliant, back pain, SOB

7

There is a strong correlation between number of physcial symptoms and

prevalence of pyschiatric disorder: anxiety, mood or other

8

We see high prevalance of depression in certain medical illnesses

cancer, stroke, diabetes, Parkinsons, MI

9

Depressive Disorder, Dysthymic Disorder and MDD are all nesteled under

Depressive Disorders (type of mood disorder)

10

What are the criteria for Major Depressive Episode

Minimum 5 symptoms for at least two weeks (at least one of the follow two)
– Depressed mood (irritable in kids)
– Loss of interest or pleasure
AND
4 of the following
– Weight loss or gain
– Insomnia or hypersomnia
– Psychomotor retardation or agitation
– Fatigue or energy loss
– Worthlessness or guilt
– Decreased concentration
– Death thoughts; suicidal thoughts, plans, acts

11

What things are NOT major depressive episode when present

• B. Not Mixed Episode
• C. Clinically significant distress or impairment
• D. Not due to substance or general medical condition
• E. Not Bereavement

12

SIGE CAPS is way to remember MDD

*5 or more in 2 week period
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Pyschomotor
Suicidality

13

What is the 2 question depression screen?

2-question depression screen
– Over the past 2 weeks, have you felt down or hopeless?
– Over the past 2 weeks, have you felt little interest in doing things?
A “yes” to either question is a positive screen for depression

14

How does the PHQ-9 work?

Patient Health Questionaire (PHQ-9)
Over the last 2 weeks, how often have you been bothered by the following problems?
Ranked 0-3 for not at all through every day

15

How does the scoring work for PHQ-9 screen?
5-9
10-14

5-9; minimal symptoms, support and educate to call if worse, follow up in 1 month
10-14: minor depression, dysthimia or mild major depression... antidepressant OR psychotherapy

16

PHQ-9 score of 15-19

Major depressive: antidepressant or psychotherapy

17

Score of over 20 on PHQ-9

psychotherapy and antidepressants

18

What are some suidice myths

• Suicide is a crazy act/rational act
• Those who talk, won’t do it; those who act don’t talk
• Broaching the subject plants the seed
• Marriage protects
• It doesn’t matter how much meds I prescribe, pts will stockpile
• If depression explainable, no need for tx
• A suicide attempt is simply a failed suicide

19

What questions do we ask when assessing pts risk for suicide?

• “Have things gotten to the point where you
have felt like ending it all?”
• Specific plans?
• How available is the method? • How lethal is the method?

20

Red flags for suicide


Red Flags: IS PATH WARM
Ideation/threatened or communicated
Substance Abuse/excessive or increased
Purposeless/no reasons for living Anxiety, Agitation/Insomnia Trapped/feeling no way out Hopelessness
Withdrawal from friends, family, society
Anger (uncontrolled)/rage/seeking revenge
Recklessness/risky acts - unthinking
Mood changes (dramatic)

21

What are the three stages of Grief

Shock
preoccupation with deceased
Resolution

22

What happens during the first stage of grief

SHOCK:
• Emotions
– Numbness
– Sense of unreality
• Somatic – Crying
– Abdominal pangs/emptiness – Sighing
– Tightness in throat
Denial and disbelief

23

What occurs during the second stage of grief

• Thoughts – Dreams
– Thoughts of the deceased
• Motivational stage – Anhedonia
– Introversion
• Emotions – Guilt
– Anger
– Sadness
• Somatic
– Weakness
– Anorexia – Insomnia – Fatigue

24

What occurs during the third stage of grief


• Thoughts
– Think of past with pleasure
• Motivational Stage
– Regain interest in activities – Form new relationships

25

Recommended meds for depression


• Tricyclic antidepressant (TCA)
• Selective Serotonin Reuptake Inhibitors (SSRI)
• Atypical
• Monoamine Oxidase Inhibitors (MAOI)

26

– Imipramine (Tofranil)
– Amitriptyline (Elavil)
– Desipramine (Norpramin) – Nortriptyline (Pamelor)
– Doxepin (Sinequan)
– Clomipramine (Anafranil

All examples of TCAs

27

When prescribing TCAs, what do we need to take into consideration

side effect profile:
• Effective First Line Treatment
• Preferred by Managed Care
• Compliance Issues Due to Side Effects – Dry mouth
– Sedation
– Orthostatic Hypotension
• Cardiac arrythmias with overdose

28

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram (Celexa)
• Fluvoxamine (Luvox)- not approved for depression
• Escitalopram (Lexapro)

all examples of SSRIs

29

What do we need to keep in mind when prescribing SSRIs

DOSAGE; varies for all of them

30

What are side effects seen with SSRIs

Side effects
– Headache, dizziness
– Nausea, loose stools, constipation – Somnolence or insomnia
– Sweating, tremor, dry mouth
– Anxiety, restlessness
– Sexual Drive

31

• Bupropion (Wellbutrin/Zyban) • Trazodone (Desyrel)
• Nefazodone (Serzone)
• Venlafaxine (Effexor)
• Mirtazapine (Remeron) • Duloxetine (Cymbalta) • Alprazolam (Xanax)

Atypical antipyschotics

32


• Phenelzine (Nardil)
• Isocarboxazid (Marplan)
• Tranylcypramine (Parnate) • Selegiline patch (Emsam)

MAOIs

33

What are supplemental or alternative therapies to depression

• Lithium
• Augmentation therapy – Lithium
– T-3 L-triiodothyronine Cytomel
• Psychotherapy -
• ECT (Electro-Convulsive Therapy) • Vagal Nerve Stimulation
• Transcranial Magnetic Stimulation • Deep Brain Stimulation

34

What are the 5 Rs of Depression tx

Response
Remission
Relapse
REcovery
Recurrence