Behavioral Health: Major Depressive Disorder (1-50)

dysthymia

persistent depressive disorder (PDD)

changes in appetite and weight, changes in sleep and activity, lack of energy, feelings of guilt, problems thinking and making decisions

MDD

what NTs are involved in MDD?

serotonin, NE

what gender is more likely to have MDD?

females

what are risk factors for MDD?

female, low socioeconomic status, substance abuse, other disorders, relatives with MDD, medications, chronic medical conditions, low self esteem, perfectionism

the highest lifetime prevalence of any psychiatric disorder

MDD, 7%

what age has the highest incidence for MDD?

18-29 years, peaks in 20s

what is the hallmark sign for MDD?

loss of interest of pleasure

helpless, worthless, unable to cry, suicidal ideation, reduced energy, impairment at work or school

MDD

poor motivation, trouble sleeping, hypersomnia, decreased appetite and weight loss, increased appetite and weight gain, anxiety

MDD

S/S in children with MDD?

school phobia and excessive clinging to parents

running away/absenteeism

truancy

S/S in adolescents with MDD?

poor academic performance, substance abuse, antisocial behavior, sexual promiscuity, truancy, running away

S/S in elderly with MDD?

somatic complaints (physical complaints, headaches/physical pain

patient has slowed responsiveness to your questions, stooped posture, and no spontaneous movement

MDD

downcast gaze, socially withdrawn, decreased activity, decreased rate and volume of speech

MDD

what are regression MDD symptoms?

mute, not bathing, soiling

thought blocking, poverty of thought, ruminations/obsessing about loss, guilt, suicide, death

MDD

regression symptoms, somatic illnesses, negative view of the world and themselves

MDD

most patients are (oriented, disoriented) in MDD

oriented

what percentage of patients with MDD commit suicide?

suicidal ideation?

10-15%

2/3 with suicidal ideation

impaired judgement and insight

50-70% of patients with this motor disorder have depressive symptoms

Parkinson's

5 or more symptoms have been present during the same 2 week period and represent a change from previous functioning

what does at least 1 of the MDD symptoms need to be to meet criteria?

depressed mood or loss of interest or pleasure

significant weight loss, insomnia or hypersomnia, slow thought process, fatigue, feelings of worthlessness

MDD

diminished ability to think/concentrate, indecisiveness, recurrent thoughts of death, suicidal ideation without a specifical plan, or suicide attempt

MDD

to be diagnosed with MDD, there is (manic episodes, hypomanic episodes, no manic/hypomanic episodes)

no manic episodes or hypomanic episodes

what is the 1st line therapy for MDD?

SSRIs

how long does it take for antidepressants to achieve therapeutic effects?

4-6 weeks

what are some treatment options for MDD?

psychotherapy, phototherapy, pharmacotherapy, ECT treatment

a medical treatment that involves using electrical currents to induce a controlled seizure in the brain, primarily used to treat severe mental health conditions like depression and bipolar disorder.

ECT (electroconvulsive therapy)

a non‑invasive treatment that uses bright artificial light to help regulate mood, circadian rhythms, and sleep

phototherapy

electric currents are passed through the brain to deliberately trigger a brief seizure

ECT

true or false: patients are placed under general anesthesia when undergoing ECT treatments

true

seizure time during ECT treatment is how long of a duration?

30-60 seconds

what are some risks or SE to ECT treatments?

confusion, memory loss, nausea, vomiting, headache, jaw pain

how many total ECT treatments do patients normally receive? when do they see results?

6-12 treatments

improve in symptoms after 2-3 treatments

what depression treatment can cause retrograde amnesia (not remembering events before the treatment began)

ECT

what is the second line for antidepressants? third line?

2nd line: SNRIs, TCA

3rd line: atypical antidepressants/alternative agents

MOA of SSRI

increase the level of serotonin by inhibiting its reuptake into the presynaptic cell

BBW for SSRI

suicidal ideation for 4-6 weeks

what are some SE of SSRI?

sexual dysfunction, GI disturbance, insomnia, headache

what is an SE of combination SSRI and MAOI?

serotonin syndrome

occurs when you take medications that cause high levels of serotonin to accumulate in your body

serotonin syndrome

SNRI MOA

increase serotonin and NE by limiting their reuptake into the presynaptic cell

studies on this drug class show a benefit in multiple pain syndromes

SNRIs

dry mouth, dry nose, blurred vision, constipation, urinary retention are side effects for what antidepressant?

TCAs

what is the last line of treatment for depression?

MAOIs

why are MAOIs the last line treatment for depression?

many food restrictions due to Tyramine, and drug interactions

antidepressant used for patient who has depression and has trouble sleeping

trazodone

what atypical antidepressant can be used in combo with SSRI, SNRI, or TCA?

mirtazapine (remeron)

what are our "go to" atypical antidepressants for MDD?

wellbutrin, remeron, trazodone

what is adjunct therapy for MDD?

Spravato (esketamine)

nasal spray that is indicated for MDD that is treatment resistant

Spravato (esketamine)

this therapy for MDD causes extreme sedation, dissociation, and potential for abuse and misuse, and also increases risk for suicide

Spravato (esketamine)

this MDD therapy causes CNS depression, SEVERE HTN, dissociation, sedation, etc.

Spravato (esketamine)

patients with MDD but be enrolled in a program to receive this MDD therapy, patient must be monitored for at least 2 hours after administration of medication with regular BP CHECKING

Spravato (esketamine)

agitation, restlessness, confusion, rapid heart rate, high bp, dilated pupils, heavy sweating, diarrhea, headache are side effects to what psychological syndrome?

serotonin syndrome

what is prognosis for MDD?

tends to be chronic, relapse very common

what are good prognostic indicators for MDD?

mild episodes, absence of psychotic symptoms, short hospital stay, good social functioning, absence of comorbid psych disorders, advanced age of onset

presence of a depressed mood that lasts most of the day and is present almost continuously

dysthymia

characterized by at least 2 years of depressed mood that isn't severe enough to fit the diagnosis of MDD

dysthymia

dysthymia is more common in those with what familial history?

more common in those with 1st degree relatives with MDD

dysthymia has an (early, late) onset and follows an (acute, chronic) course

early, chronic

dysthymia is more common in what gender?

women

dysthymia is more common in (married, single) persons

single

patient is gloomy for most of the day, brooding, lack of joy in life, and preoccupation with inadequacy

dysthymia

"always been depressed"

dysthymia

how does dysthymia differ from MDD?

symptoms tend to outnumber signs in dysarthria (more subjective than objective)

disturbances in libido are (characteristic, uncharacteristic) for dysthymia.

disturbances in libido are (characteristic, uncharacteristic) for MDD

uncharacteristic, characteristic

what does the duration need to be for dysthymia?

for at least 2 years

depressed mood for most of the day, for more days that not, as indicated by either subjective account or observation by others, for at least 2 years

dysthymia

while depressed, this patient still goes to school, work, and keeps up with hobbies

dysthymia

what is the 1st line treatment for dysthymia?

psychotherapy

what is the 1st and 2nd line treatment for dysthymia?

pharmacotherapy with antidepressants (SSRIs, SNRIs, bupropion)

the earlier the onset of dysthymia, the more at risk for what 2 additional mental health disorders?

MDD, bipolar 1

recurrent luteal phase condition characterized by physical, psychological, and behavioral changes of sufficient severity to result in deterioration of interpersonal relationships and normal activity

premenstrual dysphoric disorder

severe form of PMS

premenstrual dysphoric disorder

what is the etiology of premenstrual dysphoric disorder?

unknown

what 2 electrolytes might be deficient in premenstrual dysphoric disorder?

mangesium and calcium

exaggerated response to normal hormonal changes

premenstrual dysphoric disorder

experience of abuse in early life places women at a higher risk for this psych disorder

premenstrual dysphoric disorder

premenstrual dysphoric disorder affects what phase?

luteal

what might make premenstrual dysphoric disorder better OR worse?

oral contraceptives

stress, interpersonal trauma, seasonal changes, sociocultural aspects of female sexual behavior in general

environmental risk factors for premenstrual dysphoric disorder

hereditability for PMDD

genetic and psychological risk factors for premenstrual dysphoric disorder

at least 5 symptoms present in the final week before the onset of menses and start to improve within a few day after onset of menses, and become minimal or absent the week post menses

PMDD

mood swings, feeling suddenly sad or tearful

lability

mood swings, feeling suddenly sad or tearful, marked irritability or anger, increased interpersonal conflicts, marked depressed mood, feelings of hopelessness, or self deprecating thoughts, marked anxiety, or being on edge

premenstrual dysphoric disorder

decreased interest in usual activities, subjective difficulty in concentration, lethargy, easily fatigued, marked change in appetite, sleeping problems, being overwhelmed, breast tenderness/swelling, a sensation of "bloating" or weight gain

premenstrual dysphoric disorder

what is 1st line treatment for premenstrual dysphoric disorder?

SSRIs

what is the general treatment for premenstrual dysphoric disorder?

behavior therapy and pharmacotherapy

what NT is commonly implicated in premenstrual dysphoric disorder?

serotonin

current recs in literature regard that oral contraceptives are conflicting to what psych disorder?

premenstrual dysphoric disorder

true or false: there is a single pharmacologic treatment that is universally effective for premenstrual dysphoric disorder

false