pathophysiology
role of genetics in MDD
large genetic association
high concordance with twins
first-degree relatives of depressed individuals are about 3 times as likely to develop depression
but depression can still occur without a family hx
review ASEPTIC
Appearance/behavior
Speech
Emotions (mood/affect)
Perception
Thought content/process
Insight/judgement
Cognition
freebie
:)
what foods to avoid if taking a MAO inhibitor?
tyramine-containing foods
aged cheese, red wine, beer, soy sauce, aged meat, fava beans, avocado, liver, bananas
explain the consequences on Texas medical licensing of seeking versus not seeking mental health care
The Texas Medical Board (TMB) does not discipline physicians for:
Having depression
Seeing a psychiatrist
Taking SSRIs
Being in therapy
Having a history of MDD
They intervene only if current mental illness impairs safe practice.
BONUS POINTS + 400
what kind of physician was the patient?
general surgeon (resident)
list the ddx for a patient presenting with symptoms of depression
persistent depressive disorder: milder than MDD, ≥ 2 depressive symptoms lasting more than 2 years, remission of less than 2 months
seasonal affective disorder: during the winter in ≥ 2 consecutive years
depression with atypical features: has transient improvement in response to positive events
MDD with psychotic features: hallucinations or delusions during a major depressive episode
list protective factors of suicide
effective medical care, interpersonal connections, cultural & religious norms regarding self preservation, strong problem solving skills, proper management
identify other pharmacologic options for treating MDD
SNRIs, TCAs, MAOIs, trazodone, mirtazapine, bupropion
treatment for MDD with seasonal pattern
light therapy + MDD management
summarize changes in the HPA axis associated with MDD
↑ cortisol ↓ dexamethasone suppression
link to growth and thyroid hormones (hypothyroidism)
identify risk factors of MDD
females > males
average age of onset in 20s
childhood trauma and stressful life events
no close interpersonal connections
often have comorbid disorders (substance use disorders, panic disorder, social anxiety disorder, and obsessive-compulsive disorder)
contrast dysthymia vs MDD
dysthymia (persistent depressive disorder) has less than 5 symptoms of SIGECAPS for more than 2 years
MDD has ≥ 5 symptoms ≥ 2 weeks
MOA of esketamine
NMDA receptor antagonist
nasal spray, used for treatment-resistant depression
discuss the role of electroconvulsive therapy (ECT)
rapid acting method to treat depression
induces tonic-clonic seizures under anesthesia and neuromuscular blockade
safe in pregnant individuals and older adults (!)
structural changes of the brain associated with MDD
reduced volume in the hippocampus and changes in the prefrontal cortex
lower plasma, CSF, and brain GABA levels
indicating impaired structural and synaptic plasticity
review the role of the PHQ-9 and the scoring
self report screening for depression
1–4 minimal
5–9 mild
10–14 moderate
15–19 moderately severe
20–27 severe
BONUS POINTS + 800
name of the patient?
robert garcia
indications, contraindications, & adverse effects of SSRIs
1st line indication for depression
contraindicated in mania
FX: serotonin syndrome, SIADH, sexual dysfunction, decreased libido, GI distress
list other non-pharm options for MDD
electroconvulsive therapy (ECT), vagal nerve stimulation, deep brain stimulation
exercise, sleep regulation, structured routines, strong social support
describe the changes in neurotransmitters associated with MDD
monoamine hypothesis:
↓ dopamine in ventral tegmentum and SNc
↓ norepinephrine in locus ceruleus
↓ serotonin in the raphe nuclei
identify the DSM-5-TR criteria for diagnosing MDD
Remember SIGECAPS!
Recurrent episodes lasting ≥ 2 weeks and ≥ 5 of 9 symptoms including depressed mood:
Sleep disturbances
↓ Interest in pleasurable activities (anhedonia)
Guilt or feelings of worthlessness
↓ Energy
↓ Concentration
Appetite or weight changes
Psychomotor retardation
Suicidal ideation
& there is impaired functioning in daily life, not due to a medical condition, not due to another psych disorder, and no history of hypomanic episodes
identify risk factors for suicide
SAD PERSONS
Sex (male)
Age (young or older adult)
Depression
Previous attempt (highest risk)
Ethanol or drug use
Rational thinking loss (psychosis)
Sickness (medical illness)
Organized plan
No spouse or other social support
Stated future intent
MOA of escitalopram
selective serotonin reuptake inhibitor (SSRI)
inhibits 5-HT reuptake
identify the 1st line non-pharmacological option for MDD
cognitive behavioral therapy (CBT)