Final: depression

disruptive mood dysregulation disorder

• children 6-18

• persistent irritability or anger, most days

• severe, recurrent temper outbursts, not developmentally appropriate

• 3x a week for 12 months or more

• interfere w/ life activities

premenstrual dysmorphic disorder

• week before period

  • must have 1: mood lability, depressed mood, marked irritability/anger, marked anxiety

  • must have 5: decreased interest, productivity, sleep, and energy, appetite change, overwhelmed, difficulty concentrating, swelling/pain

• try to find hormonal balance for tx

persistent depressive disorder (dysthymia)

• chronic sadness, low mood

• low level depression, most days, two years, onset often teenage years

  • decreased appetite, sleep, energy, thinking, hopelessness

  • most of the day, most days, at least 2 years

substance induced medical condition

• depressive sx dt substance use, medication, stroke, hypothyroidism, heart failure, TBI

major depressive disorder dx

1 or more, same 2 weeks:

• depressed mood, loss of interest/pleasure (anhedonia)

5 or more:

• wgt change

• sleep change

• psychomotor change

• fatigue

• worthless

• guilt

• recurrent thoughts of death

• concentration problems

qualifiers:

• mild, moderate, severe

• w/ psychosis, peri-partum, PP, seasonal (fall to spring)

MDD: PP

blues:

• brief: 1-4 days (5-7 at most)

• labile mood, tearful

• 50-80% of women

• resolves itself

• want to care for baby

depression:

• 2w-12m

• more intense sx, last longer, impact ability to care for self and child

• support, time, ensure safety

psychosis: (usually have bi-polar hidden)

• usually within 2 weeks

• physical: refusal to wait, attempt to harm self/child, frantic energy

• mental: confusion, memory loss, incoherence

• behavioral: paranoia, preoccupation w/ trivial things

• baby safety important

MDD risk factors

• prior episode of depression

• family hx

• female 2:1

• medical comorbidity

• lack of social support

• stressful life event

• hx of sexual abuse

• substance abuse

• prior suicide attempt

MDD clinical presentation

usually why they go to doctor

• GI disturbance

• pain

• irritability

• palpatations

• dizziness

• appetite changes

• lack of energy

• change in sex drive

• sleep disturbances

MDD screening

PHQ-2, > or equal to 3 proceed to PHQ-9 (PHQ-2 + 7 questions)

• 20 = possible hospitalization

suicide terms

suicide death: death by self inflicted means

suicide attempt: nonfatal injurious attempt w/ intent to die

suicide ideation: thinking about or planning

suicidal gesture: self destructive behavior that is not life threatening but does resemble an attempt

suicidal threat: verbalization of intent

suicidal intent: concrete plans and steps to commit

passive SI: vague, wouldnt care if they die

active SI: specific, typically accompanied by a plan

native americans and native alaskans higher

males higher

2x LGBTQ+

high risk suicide individuals

• those w/ psychiatric disorder, neurological disorder, or substance abuse disorder

• adolescents

• minorities

• recent divorce or separation

• homelessness

suicide clues

• talking about death or wanting to be dead

• searching for lethality on the internet

• isolation

• feelings of guilt, worthlessness, and hopelessness

• giving away personal and loved items

• SUDDENLY APPEARING HAPPY AFTER LONG PERIOD OF PROTRACTED SADNESS

• hx of suicide attempts

MDD tx

• medication

• therapy

• milieu (environment)

• ECT

• best evidence: medication and therapy

• treatable

MDD alternatives

• st johns wort: should not be used w/ SSRI, interferes w/ oral contraceptives and wrafrin

• SAMe: act like SNRI

• B vitamins: energy and cognition

• melatonin: sleep

• omega 3: improve nerve conduction

• phototherapy: seasonal depression

• transcranial magnetic stimulation: ECT w/ magnet, no anesthesia, 6w

• vagal nerve stimulation: implant

MDD pt education

• medications: how and when to take, importance of tapering, time of effectiveness

• meds dont work alone; meds and therapy

• take care of body

• take care of soul: socialization, spirituality, nature