Neurotransmitters associated with depression

• Serotonin

  • 95 % is made by gut bacteria

• Norepinephrine

Anergia

• persistent lack of energy and tiredness and also being in a state os passivity

Persistent depressive disorder

• persists for 2 years or more

• Not as severe as MDD

• Rarely need hospitalization

Major depressive disorder

• people often hospitalized with ideas of suicide

• Ongoing therapy and medication management

Light Therapy

• A box that emits a bright light for 30 mins

• You can do other activities but you just have to sit in the light for 30 mins

• Good alternatives for pregnant woman and older people who have to watch how many meds they are taking

Meds for depression

• MAOI’s

  • first antidepressants

  • Good for people who are compliant and engaged

  • Serious SE: hypertensive crisis

• Tricyclics

  • Second choice for depression

  • Takes long time to act in body

  • Elevated risk of OD with small amounts

  • Low doses can help manage pain

  • Serious SE: hypotension

• SSRI’s and SNRI’s

  • Also help with anxiety

  • Make people feel sleepy and have sexual side effects (low libido)

  • Serious SE: serotonin syndrome

    • Overactivation of serotonin receptors

• Newer meds

  • Serotonin antagonists and reuptake inhibitors

  • Norepinephrine dopamine reuptake inhibitor

  • Serotonergic antidepressants

• Brexanolone

  • Only FDA med approved for post-partum depression

  • One time infusion helps relief symptoms of depression

• Esketamine

  • FDA approval for resistant depression

  • Known as Ketamine

  • Used an anesthetic in animals

  • Pt should not eat 2hr before tx because they will vomit

Power Point notes

• DMS-5 criteria for depression

  • 5 of 7 criteria has to me meet to be diagnosed

    • Fatigue

    • Sleep disorders

    • Appetite disorders

    • Concentration and decision making imparirement

    • Activity disorders

    • Suicidal ideation

  • Effects of depression

    • Affect

    • Thought process impairment

    • Bx issues

    • Communication issues

    • Work

    • Fam

    • Friends

    • School

    • ADL’s (showering, eating, oral are, etc)

• Factors that influence depression from forming

  • Ineffective coping skills

  • Other psych issues like anxiety

  • Low economic class

  • Poor support system

  • Adverse child hood events

  • Significant loss involving humiliation

  • Chronic illness

  • Substance abuse

  • Long term meds

• Signs and symptoms of depression

  • Anhedonia

  • Fatigue

  • Sleep disorders

  • Persistent ideations of hopelessness

  • Concentration issues

  • Activity disorders (too much/ not enough)

• Types of depression

  • MDD (major depressive disorder)

    • People often hospitalized

    • Ongoing therapy and med mgmt needed

  • DDD (disruptive dysregulation disorder)

  • Persistent depressive disorder

    • Persists for 2 or more years

    • Not as severe

    • Rarely needs hospitalization

  • Premenstral dysphoric disorder

    • Weetprior to period

    • Physical discomfort and emotional symptoms

    • Keeping a oiurnal helps to dx the disorder

  • Substance induced depressive disorder

    • Prolonged intoxication or withdraw worsen this condition

    • Meth and substances can destroy cells that make serotonin (makes us happy)

  • Peripartum depression

    • Less common before delivery of baby

    • Sudden onset is a concern

    • Requires med and psych attention

    • Post delivery- caused due to changes in hormones

  • Seasonal onset

    • Related to exposure to sun

    • Light therapy is super helpful

  • Depressive disorder not elsewhere classified

• Therapy for depression

  • CBT is very helpful

  • Best tx is meds with therapy and exercise

  • Individual and group therapy is very effective

  • Goal of meds and therapy is to get rid of depression

• Older adults

  • You want to start low and go slow with depression meds for old geezers