Major Depressive Disorder (MDD) Flashcards

Flashcards based on lecture notes about Major Depressive Disorder.

The essential feature of major depressive disorder (MDD) is a clinical course characterized by one or more major depressive episodes without a history of or episodes.

manic, hypomanic

The Monoamine hypothesis suggests that decreased brain levels of the neurotransmitters norepinephrine (NE), serotonin (5HT), and __ may cause depression.

dopamine (DA)

The __ hypothesis suggests that the failure of homeostatic neurotransmitter regulation, rather than absolute increases or decreases in their activities, causes depression.

Dysregulation

The __ hypothesis suggests that chronic stress and inflammation may alter glutamatergic and GABA transmission.

Inflammatory

Brain-derived neurotrophic factor (BDNF) is a primary mediator of neuronal changes and __, whose expression is reduced due to stress and may be associated with depression.

synaptogenesis

Emotional symptoms of depression include diminished ability to experience pleasure, loss of interest in usual activities, sadness, pessimism, crying, hopelessness, anxiety, feelings of worthlessness or guilt, and __ features.

psychotic

Cognitive symptoms of depression include decreased ability to concentrate, poor memory for recent events, confusion, and __.

indecisiveness

Psychomotor disturbances include psychomotor __ (slowed physical movements, thought processes, and speech) or psychomotor agitation.

retardation

Diagnosis of MDD requires a medication review, physical examination, mental status examination, a complete blood count with differential, thyroid __ tests, and electrolyte determination.

function

What standardized tool should be used to diagnose depression and evaluate treatment?

Standardized rating scale

One goal of Major Depressive Disorder treatment is to achieve resolution of current symptoms, otherwise known as .

remission

_ is recommended as a primary treatment for mild to moderately severe major depressive episode.

Psychotherapy

Electroconvulsive therapy (ECT) may be considered when a __ response is needed or in patients who have a history of poor response to medications.

rapid

__ are considered first line and are equal in efficacy when administered in comparable doses for the pharmacologic treatment of MDD.

Antidepressants

An individual’s __ may be useful when choosing therapy as a way to better predict antidepressant adverse effects or response.

pharmacogenomics

The acute phase of treatment for MDD lasts 6–12 weeks, and the goal is __ (absence of symptoms).

remission

Early in treatment, all antidepressants can increase __ thinking and behavior in children, adolescents, and young adults less than 25 years of age.

suicidal

Occurrence of a __ syndrome with some antidepressants may be reduced with a slow taper when the medication is being discontinued.

withdrawal

The SSRIs inhibit the reuptake of __ into the presynaptic neuron.

5HT

Any antidepressant that enhances serotonergic activity can be associated with __ characterized by mental status changes, autonomic instability, and neuromuscular abnormalities.

serotonin syndrome

Potentially fatal reactions may occur when any SSRI and __ are co-administered.

MAOI

CYP2D6 and __ are responsible for the metabolism of more than 80% of current medications.

3A4

Venlafaxine may cause a dose-related increase in __ blood pressure, which may require dosage reduction or discontinuation if sustained hypertension occurs.

diastolic

Mirtazapine enhances central noradrenergic and serotonergic activity by antagonizing central presynaptic __ adrenergic auto receptors and hetero- receptors.

α2

Common adverse effects with nefazodone are dizziness, __ hypotension, and somnolence.

orthostatic

Nefazodone carries a black box warning for life threatening __ failure.

liver

Vilazodone and vortioxetine are antidepressants with mixed serotonin effects that are a combination SSRI and __ presynaptic receptor partial agonists.

5HT1A

Bupropion inhibits both the NE and DA reuptake making it one of the most __ antidepressants.

activating

use has diminished given other equally effective therapies that are safer on overdose and better tolerated. They inhibit the reuptake of NE and 5HT and have affinity for adrenergic, cholinergic, and histaminergic receptors.

Tricyclic antidepressant (TCA)

Increased plasma concentrations of TCAs and symptoms of toxicity may occur when __ inhibitors are added.

CYP2D6

Isocarboxazid, phenelzine, and tranylcypromine increase the concentrations of NE, 5HT, and DA within the neuronal synapse through inhibition of __.

monoamine oxidase (MAO)

The potentially fatal __ crisis can occur when MAOIs are taken concurrently with foods high in tyramine, and with certain medications.

hypertensive

Ketamine modulates glutamate activity via extra synaptic N- methyl-D- aspartate (NMDA) receptor __ resulting in increased BDNF activity and synaptogenesis.

antagonism

___ (exogenous allopregnanolone) is thought to exert antidepressant effect by allosteric modulation of GABAA receptors.

Brexanolone

Fluoxetine and __ are FDA approved for patients below 18 years of age to treat symptoms of depression in childhood.

escitalopram

One in four may achieve remission after switching to a different __.

antidepressant

Before changing treatment, evaluate the adequacy of the medication __ and adherence.

dosage

Regularly monitor blood __ of patients given serotonin–norepinephrine reuptake inhibitors.

pressure

Monitor for __ ideation after initiation of any antidepressant, especially in the first few weeks of treatment and up to 30 days after treatment discontinuation.

suicidal