Depressive Disorders Lecture Review

This flashcard set covers the epidemiology, neurobiology, clinical diagnosis (DSM-5 and PHQ-9), pharmacological treatments (SSRIs, SNRIs, TCAs, MAOIs), and procedural interventions for Depressive Disorders based on the PHAS 551 lecture by Jessica Stager.

Major Depressive Disorder (MDD) Lifetime Prevalence

$$15-20\%$$

MDD Gender Ratio

Women are affected twice as often as men ($2:1$).

MDD Recurrence Rate

Following $1$ episode, the rate of recurrence over the next $2$ months is $>40\%$ and within $5$ years is $>75\%$.

Serotonin (5-HT) Pathway Origin

Pathways originate in the raphe nuclei and influence mood, anxiety, sleep, appetite, and pain perception.

Norepinephrine (NE) Pathway Origin

Pathways originate in the locus coeruleus and influence alertness, energy, focus, and stress response.

Dopamine (DA) Pathway Origin

Pathways originate in the ventral tegmental area (VTA) and substantia nigra, supporting reward, motivation, and pleasure.

Monoamine Hypothesis

The theory that a deficiency in monoamines (serotonin, norepinephrine, dopamine) contributes to depression.

PHQ-9 Scoring for Moderate Depression

A score of $10-14$.

PHQ-9 Scoring for Severe Depression

A score of $20-27$, indicating immediate initiation of pharmacotherapy and expedited referral.

Adolescent Depression Screening

Annual screening recommended starting at age $12$ using the PHQ-A.

MDD Partial Remission

A period lasting less than $2$ months without any significant symptoms of a major depressive episode following the end of an episode.

MDD Full Remission

The absence of significant signs or symptoms of the disturbance for a period of $2+$ months.

Persistent Depressive Disorder (Dysthymia) Duration

Symptoms occur on most days for at least $2$ consecutive years in adults ($1$ year for children) with symptom-free periods not exceeding $2$ consecutive months.

Specific Medical Conditions Associated with Depression

Includes adrenal insufficiency, Huntington's disease, hypercortisolism, hypothyroidism, multiple sclerosis, Parkinson disease, and vitamin $B_{12}$ deficiency.

Serotonin Syndrome Classic Triad

Mental status changes, autonomic instability, and neuromuscular hyperactivity.

SHIVERS Mnemonic

S-Shivering, H-Hyperreflexia and Myoclonus, I-Increased Temperature, V-Vital Sign instability, E-Encephalopathy, R-Restlessness, S-Sweating.

Serotonin Syndrome Treatment

Stop all serotonergic medications, provide supportive care, and use benzodiazepines for sedation; Cyproheptadine is used in severe cases.

Fluoxetine (Prozac) Half-life

Very long half-life of $1$ to $2$ weeks, meaning no taper is required if used for only a few weeks.

Paroxetine (Paxil) Side Effects

General SSRI effects plus weight gain, sexual dysfunction, and sedation; Pregnancy Category D.

Sertraline (Zoloft) GI Side Effect

Most likely SSRI to cause nausea; sometimes referred to as "squirt-raline."

Citalopram (Celexa) Cardiac Risk

Associated with QTc prolongation; doses should not exceed $40\,mg/day$.

Escitalopram (Lexapro)

The S-enantiomer of citalopram; considered the "cleanest" SSRI with the fewest side effects.

Venlafaxine (Effexor) Monitoring

Requires periodic blood pressure monitoring due to potential for hypertension.

Duloxetine (Cymbalta) Indications

FDA approved for MDD, GAD, diabetic peripheral neuropathic pain, fibromyalgia, and chronic MSK pain.

Mirtazapine (Remeron) Mechanism

Serotonin antagonist and alpha-2 adrenergic antagonist; causes somnolence and increased appetite.

Trazodone Adverse Effect

Drowsiness, dry mouth, orthostatic hypotension, and priapism ("TrazoBone").

TCA Overdose EKG Features

Sinus tachycardia, QRS prolongation ($>100\,ms$), and QT prolongation.

TCA Overdose Management

Sodium bicarbonate for QRS prolongation and Diazepam for seizures (Phenytoin is contraindicated).

MAOI Dietary Restriction

Must avoid foods high in tyramine, such as aged cheeses, fermented meats, and tap beer, to prevent hypertensive crisis.

Neonatal Adaptation Syndrome (NAS)

Seen in $25-30\%$ of babies exposed to SSRIs in late pregnancy; symptoms include fussiness, jitteriness, and hypoglycemia.

Light Box Therapy Intensity

Standard minimum intensity of $10,000\,lux$ to decrease melatonin production.

Electroconvulsive Therapy (ECT) Relapse

Despite having the highest remission rate, relapse is common without maintenance treatment.

Transcranial Magnetic Stimulation (TMS) Target

Modulates activity in cortical regions; specifically targets the left dorsolateral prefrontal cortex, which is theorized to be underactive in depression.