L5: Depressive Disorders

Question 1

What is another name of mood disorders?

Answer 1

affective disorders.

Question 2

What do Mood Disorders Include?

Answer 2

Question 3

Unipolar & Dipolar Depression

Answer 3

Depression can occur alone or as part of bipolar disorder, When it occurs alone it is also known as unipolar depression.

Question 4

Duration of depressive disorders

Answer 4

Symptoms must be present for at least 2 weeks and represent a change from previous functioning.

Question 5

Incidence of Depressive diorders

Answer 5

More common in women than in men by 2:1. (F>M) (F:M = 2:1)

Question 6

Precipitating events & Depression

Answer 6

Precipitating event occurs in at least 25% of patients.

Question 6

Epidemeology of Depressive Disorders

Answer 6

Question 6

DSM5 Cr of Major Depressive Disorder

Answer 6

Question 7

Etiology of Depressive Disorders

Answer 7

Question 7

Signs & Symptoms of of Major Depressive Disorder

Answer 7

Question 8

Investigation in Depressive Disorders

Answer 8

Question 9

what are subtypes of Major Depressive Disorder?

Answer 9

Question 9

Characters of Persistent Depressive Disorder (Dysthymia)

Answer 9

Question 10

Onset of Persistent Depressive Disorder (Dysthymia)

Answer 10

Insidious onset.

Question 11

Duration of Persistent Depressive Disorder (Dysthymia)

Answer 11

2 Years

Question 11

Incidence of Persistent Depressive Disorder (Dysthymia)

Answer 11

• More common and chronic in women than in men. (F>M)
• Occurs more often in persons with history of long-term stress or sudden losses
• Often coexists with other psychiatric disorders.

Question 12

Signs & Symptoms of Persistent Depressive Disorder (Dysthymia)

Answer 12

Question 13

Disruptive Mood Dysregulation Disorder

Answer 13

Question 14

Premenstrual Dysphoric Disorder

Question 15

Hallmark Symptoms of Premenstrual Dysphoric Disorder

Answer 15

Question 16

DDx of Depressive Disorder

Answer 16

Question 17

Suicide & Depressive Disorder

Answer 17

15% of depressed patients eventually commit suicide.

Question 18

How long does an untreated depressed episode last?

Answer 18

about 10 months.

Question 19

At least 75% of affected patients have …….

Answer 19

At least 75% of affected patients have a second episode of depression, usually within the first 6 months after the initial episode.

Question 20

average number of depressive episodes in a lifetime

Answer 20

5

Question 20

Prognosis of **Depressive Disorder**

Answer 20

- 50% recover - 30% partially recover - 20% have a chronic course

Question 21

what are groups of antidepressants?

Answer 21

Question 21

Summary of TTT of **Depressive Disorder**

Answer 21

- The most effective approach is to integrate pharmacotherapy with psychotherapeutic interventions. - Hospitalization: Indicated if patient is at risk for suicide, homicide, or is unable to care for him/herself.

Question 22

Selective serotonin reuptake inhibitors (SSRIs) - Advantages - Side Effects

Answer 22

- Safer and better tolerated than other classes of antidepressants - Side effects are mild but include: headache, gastrointestinal disturbance, sexual dysfunction, and rebound anxiety.

Question 23

TCA - Disadvantages - Side Effects

Answer 23

- Most lethal in overdose due to cardiac arrhythmias. - Side effects include: sedation, weight gain, orthostatic hypotension, and anticholinergic effects. Can aggravate prolonged QTc syndrome.

Question 24

MAOIs - Advantages - Adverse Effects

Answer 24

- Older medications occasionally used for refractory depression. - Risk of hypertensive crisis when used with sympathomimetics or ingestion of tyramine-rich foods, such as: wine, beer, aged cheeses, liver, and smoked meats

Question 25

Medications that also have activation of other neurotransmitter include ....

Question 26

Characters of SNRIs in TTT of depression

Answer 26

Side effect: Increase blood pressure (contraindicated in hypertensive patients)

Question 27

Characters of a2-adrenergic receptor antagonist mirtazapine (Remeron) in TTT of depression

Answer 27

- It has no sexual side effects - Side effect: sedation, postural hypotension, increase appetite and cause weight gain.

Question 28

Characters of dopamine-norepinephrine reuptake inhibitor: bupropion (Wellbutrin) in TTT of depression

Answer 28

- It has no sexual side effects - Side effect: Decrease seizure threshold

Question 29

Adjuvant Medications in TTT of deperession

Answer 29

Question 30

Indications of ECT in Depression

Answer 30

1. Unresponsive to pharmacotherapy 2. Cannot tolerate pharmacotherapy (pregnancy, etc.) 3. If rapid reduction of symptoms is desired (e.g., immediate suicide risk, homicide, refusal to eat/drink, catatonia). 4. Emergency conditions (e.g. risk of suicide) 5. Presence of psychotic features

Question 31

Procedure of ECT

Answer 31

Question 32

Psychological Therapy in Depression

Answer 32

Question 32

Side effects of ECT

Answer 32

- Retrograde and anterograde amnesia are common side effects, which usually resolve within 6 months. - Other common but transient side effects: Headache, nausea, muscle soreness

Question 33

what are other modalities of Managment of Depression?

Answer 33

1- Deep brain stimulation 2- Transcranial Magnetic Stimulation 3- Vagus nerve stimulation

Question 34

Answer 34