Flashcards in Depression Deck (21):
major depressive disorder
How common is MDD?
lifetime prevalence of approx 16% (almost 1 in 6)
How is MDD diagnosed?
when a person has 5 or more of the MDD symptoms consistently through a 2 week period
What are MDD symptoms?
-depressed most of the day
-anhedonia (lack of pleasure)
-feelings of worthlessness or guilt
-inability to concentrate or make decisions
-thought of death or SI (suicidal ideation)
How can neuropathology and/or neuroimaging help to diagnose MDD?
-a small reduction in hippocampal size
-increased activation of the amygdala by negative stimuli
-reduced activation of the nucleus accumbent by rewarding stimuli
-deep brain stimulation (DBS) of either the nucleus accumbent or subgenus area 25 elevates mood in normal and depressed individuals
What are some medical causes of depression?
What are some substance-related causes of depression?
-ethanol ?? wtf
What else can cause depression?
Describe the screening process for depression
validated questionnaires or scales to screen for and measure depression/severity
** always have to consider thyroid function!! If someone is taking medication for depression and are not seeing any improvement, then a thyroid hormone is usually considered for a more desired therapeutic effect
Are benzodiazepines a good solution for depression?
Usually no. If they are being used, then the duration should be kept short and then have a follow up
What 4 disorders are all related to one another?
What do antidepressants target?
neurotransmitters that are under-performing
Describe the use of st. John's wort for depression
-multiple active components which impact many neurotransmitters/targets
-effective for mild to moderate depression
-poor evidence in moderate to severe cases
-potential for interacting with prescription medications.
List the 10 potential sites of drug action
1. action potential in presynaptic fiber.
2. synthesis of transmitter
6. reuptake into the nerve ending or uptake into a glial cell
8. receptor for the transmitter
9. receptor-induced increase or decrease in ionic conductance
10. retrograde singling
** see slide 14 for more info!
Describe the mechanism of action
-enhance impact of neurotransmitter in the synapse (esp. serotonin, norepinephrine and likely DA)
-immediate effects (adverse effects - titrate dose)
-effects on depression: sustained signalling normalizes downstream processes, appears to include gene expression, which increases brain derived neurotrophic factor (and other NF's)
-do not cause addiction or dependency
Describe "brain-derived neurotrophic factor" (BDNF)
-various sites on it help to repair nerve cells, and enhance their function - known as "brain fertilizer"
long-term administration is needed for ___ and _______ benefits
List 4 markers of poor outcomes
-more severe presentation
-longer time undertreated
-increasing number of episodes
-frequency of relapse
List 4 markers of good outcomes
-access to supports
-adherence to treatment
-history of more rapid response
-lower life stressors
What is a pharmacists' role in a patient with depression?
-adverse effect reduction/management