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Depressive Disorders by [deleted]

Depressive Disorders

50% of depression cases are under-­dia­gnosed and untreated
Of 200 people in the community
40 will present to family physician
20 have psycho­logical symptoms
10 will be correctly diagnosed
1 will be adequately treated with anti-d­epr­essants

Substa­nce­-in­duced Depressive Disorder

Symptoms directly r/t physio­logical effect of substance
Associated with withdrawal or intoxi­cation of substance
Alcohol, amphet­amines, cocaine, halluc­ino­gens, opioids, sedatives, anxiol­ytics

Monoamine Oxidase Inhibitors (MAOI)

Cannot ingest tyramines as it may lead to hypert­ension crisis
Cheese, liver, wines, most dairy, bananas, soy sauce, beer, avocados
Watch use of over-t­he-­counter drugs
Phenelzine (Nardil), Tranyl­cyp­romine (parnate), isocar­boxazid (marplan)

MDD with psychotic Features

Depressed but also experi­ences delusions and halluc­ina­tions
Mood congruent - put client at serious risk for self-h­arm­/su­icide
Moon incong­ruent - hears voices disagr­eeing with their current beliefs regarding self-e­steem
ECT treatment of choice

MDD - Peripartum onset

50% post partum depression begins prior to delivery
may occur up to 1 year post-d­elivery
Predictor for bipolar disorder in later years
Combination of hormonal, metabolic and psycho­social influences
Treatment is based on severity
4-25% developing post-p­artum depression in fathers

Tricyclic Antide­pre­ssants

Inhibits re-uptake of norepi­nep­hrine and serotonin
Elevates levels of neurot­ran­smi­tters therefore elevating mood
May cause sedation
Antich­oli­nergic effects (Dry mouth, blurred vision, N&V, consti­pation)
Amitry­pty­line, Desipr­amine, Nortri­pty­line, Imipramine
May take up to 8 weeks to be effective
Take as directed, usually at hs

Epidem­iology of Depression

Higher in females than males (2:1)
Women experience depression from age 10-midlife
Age 44-65 gender difference is less pronounced
65+ y/o have higher tendency to be depressed

Other Antide­pre­ssants

Norepi­nep­hrine dopamine re-uptake inhibitor
Wellbutrin (bupro­pion)
Serotonin norepi­nep­hrine Disinhibitor
Remeron (mirta­zapine)
Alter neurot­ran­smi­tters in the brain

Predis­posing Factors

Monozygotic twins: 37% MDD
common amongst first degree relatives
Bioche­mical Factors
Deficiency in neurot­ran­smi­tters (Norep­ine­phrine, serotonin, dopamine and Acetylcholine)
Serotonin plays important role in mood/a­nxi­ety­/ar­ous­al/etc.
Electr­olyte distur­bances
Excessive sodium bicarb­ona­te/­calcium levels
Excess potassium
Hormonal Distur­bances
Dysfunction in adrenal cortex
Depression associated with hyperthyroidism
Imbalance of estrogen and proges­terone
Nutrit­ional Defici­encies
Vitamin B, Vitamin C, iron, folic acid, zinc, calcium, potassium
Glucose intole­rance fluctu­ations, abnormal fatty acids

MDD - Atypical Features

Different presen­tation of Symptoms
Mood reacti­vity, weight gain, hypers­omnia, leaden paralysis, etc.
Interv­ention with anti-d­epr­essants may worsen symptoms
Treated with mood stabilizers
Lithium, lamotr­igine, carbam­azepine

Selective Serotonin Reuptake Inhibitors (SSRIs)

Blocks neural uptake of serotonin which increases levels of serotonin available
Increases serotonin therefore elevating moods
Fewest adverse and cardio­toxic effects
Decreases libido, agitation, insomnia, weight loss, seizures, increase suicidal ideation
Fluoxitine (prozac), paroxetine (paxil), Citalopram (Celexa), Sertraline (zoloft), and venlaf­axine (Effexor)


Used to treat anxiety and anxiety disorders
Potent­iates the action of GABA - major calming neurot­ran­smitter in the CNS
Diazepam (valium), Alprazolam (xanax), lorazepam (ativan)
Decreases anxiety while antide­pre­ssant takes effect
Should be decreased and stopped once antide­pre­ssant becomes effective

Serotonin Syndrome

Assess if pt is on high doses of SSRIs
Signs and Symptoms
Change in mental status
Abdominal pain
Myoclonus/tremors specific for serotonin syndrome
Hyperthermia & tachycardia
Discon­tinue SSRIs immedi­ately

Treatment of Depression

Cognitive Behavi­oural Therapy
Interpersonal Therapy
Develops quick response
Group Therapy
WOrks better after recovery has begun

MDD - With Anxious Distress

Meets criteria for MDD but experi­ences anxiety symptoms
Anxiety usually present in depression

Clinical Aid Dx Depression

Sleep distur­bances
Appetite changes

Premen­strual Dysphoric Disorder

Depressed mood
Excessive anxiety
mood swings
decreased interest in activities
Occurs week prior to menstr­uation
Becomes minimal or absent in well post menstr­uation

Persistent Depressive Disorder Dysthymia

Similar to MDD, but milder
Chroni­cally depressed for most of day, more days than not for at least 2 years


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