Term
|
Definition
-16% lifetime risk
-18-29 have highest rates always
-65-80 are 20% in women/10% in men
-family history
-20% suicide |
|
|
Term
|
Definition
->1 MDD episodes without manic mixed or hypomanic episodes and meets DSM criteria
-is associated with significant functional impairment, morbidity, and mortality |
|
|
Term
|
Definition
-unknown and complicated
-consistent consensus alter NTs
-biomarkers-neuroendocrine abnormality, hypersecretion of of cortisol, disruption of BDNF |
|
|
Term
| MDD clinical course and presentation |
|
Definition
-initial symptoms over days to weeks
-symptoms of anxiety can appear first
-untreated can last 4 months or more
-varies person to person
-repeat episodes (60% see second episode, 70% see third, 90% see fourth)
-depression may end completely, partially or not at all
-medical disorders must be RULED OUT (TSH, CBC, electrolytes) |
|
|
Term
|
Definition
-continued diminished capacity to experience pleasure in activities that brought pleasure before the episode
-life stressors may trigger depression in some but not others
-anxiety symptoms present in 90% of OP
-psychotic features may be present but this may require hospitalization and stabilization with APS |
|
|
Term
|
Definition
-psychomotor retardation-slowed physical movements or speech
-psychomotor agitation-pacing, purposeless restless movements
-more common in elderly-chronic fatigue/pain
-sleep disorders-insomnia/daytime sleepiness
-changes in appetite |
|
|
Term
|
Definition
-5 or more present during same 2 week period
-most of the day nearly everyday
-MUST result in a decreased function from baseline and exhibit at least one of the required symptoms of either
-depressed mood/markedly diminished interest in pleasurable activities |
|
|
Term
|
Definition
-insomnia/hypersomnia
-fatigue/loss of energy
-feelings of worthlessness/guilt
-diminished concentration
-pyschomotor agitation/retardation
-significant weightloss or gain
-recurrent thoughts of death or suicide |
|
|
Term
|
Definition
-male
-single/living alone
-describing feelings of hopelessness/suicide plans
-substance abuse
-unusual behavior-missed work,giving things away
-during initial stages of medication therapy (risk can increase with those recovering from MDD as they experience INCREASE in energy) |
|
|
Term
|
Definition
-2004 required since risk in ST studies in children and teens with depression
-2007 expanded to inc risk of suicide (thoughts and behavior) in 18-24 yo esp in early stages of tx |
|
|
Term
| what to do about suicide risk |
|
Definition
-counsel pt/family to monitor closely at beginning of tx
-possible ADRs could include agitation
-deal with the subject of suicide directly
-get help immediately |
|
|
Term
|
Definition
-reduce symptoms of acute depression, facilitate, pt return to a level of function before illness
-prevent future episodes of depression |
|
|
Term
|
Definition
-goal-remission-absence of symptoms
-assess response-full,partial,minimal,none
-decision pts: 4,6,8 weeks
-ensure safety (inc suicide risk)
-obtain effective/adequate dose ASAP and as tolerated |
|
|
Term
|
Definition
| -4-9 months after remission is achieved to prevent relapse or residual symptoms |
|
|
Term
|
Definition
-12 to 36 months
-to prevent recurrence (new episode) |
|
|
Term
| risk of recurrence inc as |
|
Definition
|
|
Term
|
Definition
| -50% reduction in symptoms within 6 months of tx initiation |
|
|
Term
|
Definition
|
|
Term
|
Definition
-separate new episode following remission
-duration of therapy depends on risk of recurrence
-1st episode treat 6-12 months, >2 episodes 15 months to 5 years
-some suggest lifelong therapy |
|
|
Term
|
Definition
-psychotherapy
-not for exclusive use in severe cases
-combination with medicine is best practice
-for mild cases, combo does not produce advantage
-CBT
-vagus nerve stimulation
-transcranial magnetic stimulation |
|
|
Term
|
Definition
-safe and effective tx for severe mental illness
-when rapid response needed
-risk includes cardiovascular changes and apnea
-no absolute contraindication but caution with recent MI, intracerebral bleeding, unstable vascular conditions, inc cranial pressure |
|
|
Term
|
Definition
|
|
Term
|
Definition
-60-70% of pts improve
-30% respond to placebo
-big gap btw efficacy and effectiveness
-lack of improvment can be due to lack of adherence |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-desvenlafaxine
-duloxetine
-venlafaxine |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-can cause CV block
-very anticholinergic
-amitriptyline
-clomipramine
-doxepin |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-desipramine
-nortriptyline |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-can cause HT crisis with Tyr
-phenelzine
-selegiline
-tranylcypromine
-isocarboxazid |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
-bupropion
-risk of seizure
-tx smoking cessation
-no sexual SE |
|
|
Term
|
Definition
-mirtazapine (remeron)
-SE inc cholesterol |
|
|
Term
|
Definition
-previous response to meds
-family history/response to therapy
-med comorbidities and PMH
-pt pref and cost
-potential for DI and ADR |
|
|
Term
| evaluate therapeutic outcomes |
|
Definition
-serum concentrations
-SEs
-remission of target symptoms
-rating scales-objective results of subjective descriptions |
|
|
Term
|
Definition
| -higher the score the worse the symptoms of depression |
|
|
Term
|
Definition
-montgomery asberg depression rating scale
-the higher the score the worst the symptoms of depression |
|
|
Term
|
Definition
| -inventory of depressive symptomatology |
|
|
Term
|
Definition
|
|
Term
|
Definition
| -less than 25% in baseline symptoms |
|
|
Term
|
Definition
|
|
Term
| partial remission or response |
|
Definition
| -greater than 50 decrease |
|
|
Term
|
Definition
|
|
Term
|
Definition
-start low go slow
-expect initial anxiety
-watch for signs of switch for pt who may have bipolar
-advocate adequate trial and dose
-taper only according to guidlines |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| cardiac complications avoid |
|
Definition
|
|
Term
| GI bleed and anticoagulation avoid |
|
Definition
|
|
Term
|
Definition
| -guide for id of meds which may have risks which outweigh benefits for elderly |
|
|
Term
|
Definition
-misdiagnosis
-anhedonia (lack of pleasure)
-highest rate of suicide >65 yo
-inc ADR due to altered PK/PD
-SSRI usually best initial tx
-second choice often bupropion and venlafaxine
-evidence of mirtazapine benefits anxiety and sleep (watch cholesterol)
-avoid TCA - very anticholinergic
-co-occurs with dementia/anxiety |
|
|
Term
|
Definition
-CDRS-R rating scales
-2% children,8% adolescents
-gender ratio the same
-support of efficacy of antidepressants is sparse |
|
|
Term
| children black box warning |
|
Definition
-2004
-data since bb warning has demonstrated that there may be no significant inc risk of suicide
-MEDGUIDES are required to be given out per FDA
-bigger issue is untreated depression and risk of suicide
-risk of sudden death-baseline ECG for any TCA |
|
|
