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50% of depression cases are under-diagnosed and untreated
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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 |
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Symptoms directly r/t physiological effect of substance
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Associated with withdrawal or intoxication of substance
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Alcohol, amphetamines, cocaine, hallucinogens, opioids, sedatives, anxiolytics
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Depressed but also experiences delusions and hallucinations
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Mood congruent - put client at serious risk for self-harm/suicide
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Moon incongruent - hears voices disagreeing with their current beliefs regarding self-esteem
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ECT treatment of choice
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50% post partum depression begins prior to delivery
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may occur up to 1 year post-delivery
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Predictor for bipolar disorder in later years
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Etiology
Combination of hormonal, metabolic and psychosocial influences |
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Treatment is based on severity
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4-25% developing post-partum depression in fathers
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Inhibits re-uptake of norepinephrine and serotonin
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Elevates levels of neurotransmitters therefore elevating mood
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May cause sedation
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Anticholinergic effects (Dry mouth, blurred vision, N&V, constipation)
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Amitryptyline, Desipramine, Nortriptyline, Imipramine
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May take up to 8 weeks to be effective
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Take as directed, usually at hs
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Cannot ingest tyramines as it may lead to hypertension crisis
Cheese, liver, wines, most dairy, bananas, soy sauce, beer, avocados |
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Watch use of over-the-counter drugs
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Ie.
Phenelzine (Nardil), Tranylcypromine (parnate), isocarboxazid (marplan) |
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Higher in females than males (2:1)
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Women experience depression from age 10-midlife
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Age 44-65 gender difference is less pronounced
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65+ y/o have higher tendency to be depressed
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Genetics
Monozygotic twins: 37% MDD common amongst first degree relatives |
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Biochemical Factors
Deficiency in neurotransmitters (Norepinephrine, serotonin, dopamine and Acetylcholine) Serotonin plays important role in mood/anxiety/arousal/etc. |
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Electrolyte disturbances
Excessive sodium bicarbonate/calcium levels Excess potassium |
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Hormonal Disturbances
Dysfunction in adrenal cortex Depression associated with hyperthyroidism Imbalance of estrogen and progesterone |
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Nutritional Deficiencies
Vitamin B, Vitamin C, iron, folic acid, zinc, calcium, potassium Glucose intolerance fluctuations, abnormal fatty acids |
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Different presentation of Symptoms
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Mood reactivity, weight gain, hypersomnia, leaden paralysis, etc.
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Intervention with anti-depressants may worsen symptoms
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Treated with mood stabilizers
Lithium, lamotrigine, carbamazepine |
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Blocks neural uptake of serotonin which increases levels of serotonin available
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Increases serotonin therefore elevating moods
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Fewest adverse and cardiotoxic effects
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Decreases libido, agitation, insomnia, weight loss, seizures, increase suicidal ideation
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Fluoxitine (prozac), paroxetine (paxil), Citalopram (Celexa), Sertraline (zoloft), and venlafaxine (Effexor)
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Norepinephrine dopamine re-uptake inhibitor
Wellbutrin (bupropion) |
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Serotonin norepinephrine Disinhibitor
Remeron (mirtazapine) |
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Alter neurotransmitters in the brain
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Similar to MDD, but milder
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Chronically depressed for most of day, more days than not for at least 2 years
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Depressed mood
Excessive anxiety mood swings decreased interest in activities |
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Occurs week prior to menstruation
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Becomes minimal or absent in well post menstruation
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S
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Sleep disturbances
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A
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Appetite changes
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D
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Dysphoria
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A
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Anhedonia
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F
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Fatigue
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A
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Agitation
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C
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Concentration
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E
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Esteem
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S
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Suicide
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Meets criteria for MDD but experiences anxiety symptoms
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Anxiety usually present in depression
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Pharmacotherapy
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Psychotherapy
Cognitive Behavioural Therapy Interpersonal Therapy |
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ECT
Develops quick response |
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Group Therapy
WOrks better after recovery has begun |
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Assess if pt is on high doses of SSRIs
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Signs and Symptoms
Change in mental status Diaphoresis Lethargy Abdominal pain Myoclonus/tremors specific for serotonin syndrome Hyperthermia & tachycardia apnea |
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Discontinue SSRIs immediately
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Used to treat anxiety and anxiety disorders
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Potentiates the action of GABA - major calming neurotransmitter in the CNS
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Diazepam (valium), Alprazolam (xanax), lorazepam (ativan)
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Decreases anxiety while antidepressant takes effect
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Should be decreased and stopped once antidepressant becomes effective
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