463: Exam 2: Depressive disorders

To qualify for a diagnosis of Major Depressive Disorder, symptoms must persist for at least __.Days you must have the symptoms of a __ mood or __ plus at least 4 other SIGE CAPS symptoms for a total of at least 5 symptoms. Depression severity is rated as mild, moderate, or severe based on a __ of number of symptoms and their severity based on _ they cause + the degree they _ functioning in relationships, work, etc.

14; depressed; anhedonia; combination; distress; impair

Depression is a heterogenous diagnosis that can manifest in __ ways. These differences are categorized using __ such as “with anxious distress” or ‘with melancholic features.” While all these different presentations are considered MDD, they may have somewhat different underlying __and respond to different __. Attempts are being made to increasing link symptoms to underlying __ and to match __ to the underlying biology.

different; specifiers; physiology; treatments; biomarkers; treatments

__ depressive disorder is characterized by clinically significant mood disturbance that lasts for at least __ years in adults or __ year in children. The mood symptoms may qualify as __ for the full duration, only qualify as MDD __, or the patient may have __ symptoms that don’t meet the MDD criteria for the full duration.

Persistent; 2; 1; MDD; intermittently; dysthymic

The treatment for Persistent Depressive Disorder is largely the same as treatments for MDD with a combination of __ + __ but it may be extra important, given the chronic nature of the condition, to encourage activities, such as __ that enhance __, a growth factor that promotes healthy neuronal synapses.

psychotherapy; medication; exercise; BPNF

When diagnosing depressive disorder, it is important to rule out __, and the impact of __ that may be causing symptoms. Additionally, it is important to differentiate depression from expected __ in the case the patient has had a recent loss of a loved one or major significant life change.

medical conditions; substance medications; bereavement

__ is diagnosed based on a recurrent pattern of mood disturbance tied to the menstrual cycle. Symptoms start approximately __ week before menses and then begin to resolve in the week following menses. The cause of PMDD is not entirely clear, but appears related to the interaction of fluctuating hormone levels throughout the menstrual period and their interraction with neurotransmitter including __ + __. Smoking __ + __ are risk factors for PMDD and treatments including the use of __ along with exercise and __ can help symptoms. __ therapies that stop ovulation can be used for severe symptoms but often require __ (and other hormone) replacement to prevent early onset menopause and related losses in bone density.

PMDD; 1; serotonin; GABA; cigarrettes; obesity; SSRI’s ; stress management; hormonal; estrogen

Medications can trigger mood episodes including depression. One common class of medications used in treatment of infections + inflammatory disorders that can trigger both depression and mania are __ like Prednisone or hydrocortisone.

corticosteroids

__is a common hormonal imbalance, measure initially by evaluating __ level that can also cause depression + related symptoms.

Hypothyroidism; TSH

Monoamine Oxidase Inhibitors are known as ___. They work by inhibiting the enzyme Monoamine Oxidase that works in neurons and synaptic clef to degrade neurotransmitters like _, _, and _.

MAOI; dopamine; norepinephrine; serotonin

MAOIs prevent the breakdown of Dopamine; norepinephrine, serotonin to improve mood and anxiety. However, most that are used for mood disorders are __ and take a full __ days to be eliminated. Patients hoping to start on a different antidepressant, such as an SSRI, SNRI, or Bupropion (welbutrin) need to wait the full 14 days in order to avoid __.

irreversible; 14; serotonin syndrome

Serotonin syndrome usually develops relatively rapidly, within __ days of starting or changing medications. It is rare when only using one serotonergic medication, and is more likely if multiple serotonergic medications, such as __ with __ an opioid and serotonergic medications or with __, such as Tranylcypromine.

1-3; SSRI; tramadol; MAOI

Serotonin Syndrome is characterized by muscle _ +_. Clonus may be inducible or spontaneous and is common in the feet by may also occur in the \_. Additionally, there is increased \_ and typically fluctuate. Additionally, there is usually dilated \_. Lab findings may include an elevated Creatinine Kinase.

Hyperreflexia, clonus, eyes(ocular clonus), bowel activity, unstable, pupil(mydriasis)

Serotonin syndrome is treated by \_ serotonergic medications, providing supportive care including IV fluids and correction of unstable \_. If needed to prevent muscle breakdown and agitation, sedation with a \_ may be useful both for agitation and to reduce \_ caused by intense muscle activity. Additionally, serotonin antagonists may be used.

stopping, vital signs, benzodiazepine, hyperthermia

MAOI’s also prevent the breakdown of Tyramine, a protein that is common in foods including \_ and processed meats like pepperoni and salami, \_ foods like kimchi and sauerkaut, \_, draft beer, \_ and \_ aged cheeses. Patients taking MAOIs should be educated to avoid tyramine rich foods and eat mostly \_ rather than aged foods to avoid a \_ caused by the tyramine pressor response.

aged, fermented, soy sauce, wine, aged, fresh, hypertensive crisis

Tricyclic antidepressants are known as \_. They are older but effective antidepressants that act as norepinephrine and serotonin reuptake inhibitors but also have \_ and antihistamine properties that have made them prone to cause dry eyes and mouth, \_ retention, \_, and \_ hypotension. Most concerning is their impact on \_ rhythms. They have a narrow \_ and can be lethal in overdose primarily due to cardiac effects. Great care should be used if a patient is \_ and prescribed a TCA to limit the quantity they have on hand at any one time.

TCAs, anticholinergic, urinary, constipation, orthostatic, cardiac, therapeutic index, suicidal

\_ are now considered first line pharmacotherapy for depressive and anxiety disorders primarily because of the \_ overdose and reduced overall \_ profile.

SSRIs, safety, side effect

Common side effects with SSRIs include \_ distress, \_ dysfunction, \_ anxiety, especially for stimulating SSRIs like prozac, and sometimes mild anticholinergic effects like \_ and nasal congestion.

GI, Sexual, onset, dry eyes

When tapering off of SSRs or SNRI there can be a \_ syndrome with increased anxiety, autonomic symptoms, and “brain zaps”. Tapering should be done \_. Switching to a long-half life SSRI like \_(prozac) may help patients taper smoothly.

discontinuation, slowly, fluoxetine

All antidepressants carry a black box warning for increasing \_ risk in adolescents and young adults.

suicide

The SSRIs \_ (Lexapro) and \_ (zoloft) tend to be most well tolerated due to lower amount of drug interactions. Both appear to be most safe to use in \_, though close monitoring is always needed.

Escitalopram, sertraline, pregnancy

\_ work by inhibiting the reuptake of serotonin + \_. They are effective antidepressants and useful for anxiety disorders but because they increase norepinephrine, it is important to monitor these patients \_. Additionally, while safer than older medications in overdose, due to their ability to impact blood pressure and \_ status they are likely somewhat less safe than SSRIs in \_.

SNRIs, norepinephrine, blood pressure, cardiac, overdose

SNRIs like \_ (Cymbalta) and some TCAs because of their reuptake of norepinephrine, may be especially useful in cases where patients have depression and \_.

duloxetine, chronic pain

\_ (Wellbutrin), a NDRI, is an effective antidepressant that has the advantage of not causing \_ dysfunction but can cause \_, especially at higher doses. Additionally, in some patients, it can increase \_.

Buproprion, sexual, seizures, blood pressure

It is important to monitor patients that present with depressive disorder for any possible tendencies toward \_ disorder as antidepressants can cause a \_ switch

bipolar, manic

\_ is a psychosocial treatment with good evidence for the treatment of depressive disorders. It is considered a first-line treatment for mild-moderate depression and is useful in helping patients achieve full remission and prevent \_ by building skills, changing thoughts and behaviors, and improving relationships even when also using antidepressant medications.

Psychotherapy, first-line, relapse

\_ appears to be as effective in the treatment of mild-moderate depression as antidepressant medications. It appears to work in part because it is a potent stimulator of \_, a growth factor needed to promote healthy synapses that often get degraded in depressive disorder.

exercise, BDNF

\_ is a somatic therapy that passes a small electrical current through the brain to induce a series of controlled seizures. Done in a controlled environment, it is highly effective in cases of \_ depression, severe \_, and a number of other disorders including severe psychosis, bipolar disorder, and catatonia. ECT may be the treatment of choice for mood disorders during \_ and in the \_ due to the reduced overall side effect profile.

ECT, treatment resistant, suicidality, pregnancy, elderly

The primary risk factors or drawbacks of ECT are that its effects are \_ and it has the potential to cause some \_ loss.

temporary, memory