Podcast
Questions and Answers
Which side effect is common (greater than 30% frequency) for Venlafaxine?
Which side effect is common (greater than 30% frequency) for Venlafaxine?
- Somnolence
- Dry mouth
- Nausea (correct)
- Headaches
What is the recommended dose range for Citalopram?
What is the recommended dose range for Citalopram?
- 20–40 mg (correct)
- 100–300 mg
- 10–20 mg
- 50–200 mg
Which antidepressant has the highest recommended dose range?
Which antidepressant has the highest recommended dose range?
- Bupropion (correct)
- Moclobemide
- Fluoxetine
- Duloxetine
Which side effect is specifically associated with Fluvoxamine?
Which side effect is specifically associated with Fluvoxamine?
What is a common side effect of Paroxetine?
What is a common side effect of Paroxetine?
Which of the following medications is not routinely available in the United States?
Which of the following medications is not routinely available in the United States?
What is the common side effect frequency for Male sexual dysfunction in SSRIs?
What is the common side effect frequency for Male sexual dysfunction in SSRIs?
Which SNRI has a dose range that starts at 75 mg?
Which SNRI has a dose range that starts at 75 mg?
What is a side effect seen with Bupropion?
What is a side effect seen with Bupropion?
Which medication has a higher incidence of nausea than any other side effects?
Which medication has a higher incidence of nausea than any other side effects?
What is a key factor in determining the initial treatment for a major depressive disorder?
What is a key factor in determining the initial treatment for a major depressive disorder?
What percentage of outpatients with uncomplicated, nonchronic major depressive disorder typically respond to medication?
What percentage of outpatients with uncomplicated, nonchronic major depressive disorder typically respond to medication?
What is the recommended duration for maintaining antidepressant treatment?
What is the recommended duration for maintaining antidepressant treatment?
What should be done when discontinuing antidepressant treatment?
What should be done when discontinuing antidepressant treatment?
Which group of patients is typically considered for maintenance treatment?
Which group of patients is typically considered for maintenance treatment?
What is a potential indication for prophylactic treatment in depressive patients?
What is a potential indication for prophylactic treatment in depressive patients?
Which treatment is effective for patients suffering from seasonal winter depression?
Which treatment is effective for patients suffering from seasonal winter depression?
Which type of antidepressants may provide greater efficacy in treating melancholic depressions?
Which type of antidepressants may provide greater efficacy in treating melancholic depressions?
What is the primary purpose of repetitive transcranial magnetic stimulation (rTMS)?
What is the primary purpose of repetitive transcranial magnetic stimulation (rTMS)?
What is one of the most common side effects associated with rTMS treatment?
What is one of the most common side effects associated with rTMS treatment?
During what time of day is phototherapy typically administered?
During what time of day is phototherapy typically administered?
What demographic primarily represents patients with seasonal affective disorder (SAD)?
What demographic primarily represents patients with seasonal affective disorder (SAD)?
Which condition is NOT a significant indication for phototherapy?
Which condition is NOT a significant indication for phototherapy?
What is the light intensity range typically used in phototherapy?
What is the light intensity range typically used in phototherapy?
Which statement is true regarding the use of light visors for phototherapy?
Which statement is true regarding the use of light visors for phototherapy?
What potential risk does phototherapy pose on rare occasions?
What potential risk does phototherapy pose on rare occasions?
Which disorder has the highest rate of progression from dysthymia?
Which disorder has the highest rate of progression from dysthymia?
What is a common correlation of depression in older persons?
What is a common correlation of depression in older persons?
What percentage of patients with dysthymia never attain complete recovery?
What percentage of patients with dysthymia never attain complete recovery?
Which of these factors contributes to the underdiagnosis of depression in older adults?
Which of these factors contributes to the underdiagnosis of depression in older adults?
What is the prognosis for patients with major depressive disorder after their first hospitalization?
What is the prognosis for patients with major depressive disorder after their first hospitalization?
What is the primary feature of major depressive disorder?
What is the primary feature of major depressive disorder?
Which of these treatments is noted to have positive effects on the prognosis of dysthymia?
Which of these treatments is noted to have positive effects on the prognosis of dysthymia?
Which type of psychotic symptoms is aligned with the mood disorder in major depressive disorder?
Which type of psychotic symptoms is aligned with the mood disorder in major depressive disorder?
What happens to the severity of depressive episodes as a patient experiences more episodes?
What happens to the severity of depressive episodes as a patient experiences more episodes?
What are melancholic features associated with in terms of depressive disorders?
What are melancholic features associated with in terms of depressive disorders?
What is the likelihood of recurrence for patients after two years of leaving the hospital?
What is the likelihood of recurrence for patients after two years of leaving the hospital?
What percentage range of older persons is reported to experience depression?
What percentage range of older persons is reported to experience depression?
What characterizes the relapse rate among patients on prophylactic psychopharmacological treatment?
What characterizes the relapse rate among patients on prophylactic psychopharmacological treatment?
Why might clinicians undersell depressive symptoms in older patients?
Why might clinicians undersell depressive symptoms in older patients?
What percentage of major depressive disorder patients experience a recurrence within five years?
What percentage of major depressive disorder patients experience a recurrence within five years?
Which condition is typically an indicator of a poor prognosis in major depressive disorder?
Which condition is typically an indicator of a poor prognosis in major depressive disorder?
What is a primary characteristic of melancholia?
What is a primary characteristic of melancholia?
How many symptoms are required for a diagnosis of Major Depressive Disorder?
How many symptoms are required for a diagnosis of Major Depressive Disorder?
What distinguishes melancholic features in Major Depressive Disorder?
What distinguishes melancholic features in Major Depressive Disorder?
Which of the following is not a symptom of Major Depressive Disorder?
Which of the following is not a symptom of Major Depressive Disorder?
What is often noted about the timing of symptoms in melancholia?
What is often noted about the timing of symptoms in melancholia?
Which of the following is a characteristic of atypical features in depression?
Which of the following is a characteristic of atypical features in depression?
What type of depression is melancholia sometimes referred to as?
What type of depression is melancholia sometimes referred to as?
Which of the following exclusions would not lead to a Major Depressive Disorder diagnosis?
Which of the following exclusions would not lead to a Major Depressive Disorder diagnosis?
In which scenario would psychotic features be present during Major Depressive Disorder?
In which scenario would psychotic features be present during Major Depressive Disorder?
Which symptom is associated with an increased chance of suicidal ideation in melancholic depression?
Which symptom is associated with an increased chance of suicidal ideation in melancholic depression?
What is a common psychosocial consequence of Major Depressive Disorder?
What is a common psychosocial consequence of Major Depressive Disorder?
Which duration is typically necessary for the symptoms to be considered for a Major Depressive Disorder diagnosis?
Which duration is typically necessary for the symptoms to be considered for a Major Depressive Disorder diagnosis?
Which of the following is not considered a symptom of Major Depressive Disorder in the DSM-5?
Which of the following is not considered a symptom of Major Depressive Disorder in the DSM-5?
Which treatment may be noted for patients who demonstrate melancholic features?
Which treatment may be noted for patients who demonstrate melancholic features?
Flashcards
Depression prevalence in older adults
Depression prevalence in older adults
Depression is more prevalent in older adults compared to the general population, with studies reporting rates between 25-50%. However, the portion of these cases attributable to Major Depressive Disorder is uncertain.
Factors linked to depression in older adults
Factors linked to depression in older adults
Socioeconomic status, loss of a spouse, physical illness, and social isolation are factors known to be associated with depression in older adults.
Underdiagnosis of depression in older adults
Underdiagnosis of depression in older adults
Depression in older adults is often missed and not treated effectively, potentially due to the preference of general practitioners to focus on physical ailments.
Somatic presentation of depression in older adults
Somatic presentation of depression in older adults
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Ageism and depression in older adults
Ageism and depression in older adults
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Major Depressive Disorder
Major Depressive Disorder
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Psychotic features in Major Depressive Disorder
Psychotic features in Major Depressive Disorder
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Melancholic features in Major Depressive Disorder
Melancholic features in Major Depressive Disorder
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Melancholic Depression
Melancholic Depression
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Anhedonia
Anhedonia
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Early Morning Awakening
Early Morning Awakening
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Weight Loss
Weight Loss
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Guilt
Guilt
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Suicidal Ideation
Suicidal Ideation
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Autonomic Nervous System Changes
Autonomic Nervous System Changes
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Endocrine Function Changes
Endocrine Function Changes
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Endogenous Depression
Endogenous Depression
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Major Depressive Disorder (MDD)
Major Depressive Disorder (MDD)
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Dysphoria
Dysphoria
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Low Energy
Low Energy
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Impaired Concentration
Impaired Concentration
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Insomnia
Insomnia
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Appetite Changes
Appetite Changes
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Progression of Dysthymia
Progression of Dysthymia
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Prognosis of Dysthymia
Prognosis of Dysthymia
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Chronic Nature of Major Depressive Disorder
Chronic Nature of Major Depressive Disorder
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Recovery Rates After Hospitalization for Depression
Recovery Rates After Hospitalization for Depression
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Transition to Dysthymia
Transition to Dysthymia
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Depressive Episode Recurrence
Depressive Episode Recurrence
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Prognostic Indicators in Major Depressive Disorder
Prognostic Indicators in Major Depressive Disorder
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Treatment Approaches for Mood Disorders
Treatment Approaches for Mood Disorders
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What is rTMS?
What is rTMS?
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What is a common side effect of rTMS?
What is a common side effect of rTMS?
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Who cannot receive rTMS treatment?
Who cannot receive rTMS treatment?
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What is phototherapy?
What is phototherapy?
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How is phototherapy administered?
How is phototherapy administered?
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Are light visors effective for phototherapy?
Are light visors effective for phototherapy?
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What are potential side effects of phototherapy?
What are potential side effects of phototherapy?
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What other conditions can phototherapy be used for?
What other conditions can phototherapy be used for?
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What are SSRIs?
What are SSRIs?
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What are SNRIs?
What are SNRIs?
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What's a common side effect of SSRIs and SNRIs?
What's a common side effect of SSRIs and SNRIs?
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What's another frequently seen side effect of SSRI and SNRI medication?
What's another frequently seen side effect of SSRI and SNRI medication?
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What's a significant side effect that can affect men taking SSRIs and SNRIs?
What's a significant side effect that can affect men taking SSRIs and SNRIs?
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Can you name some specific SSRIs?
Can you name some specific SSRIs?
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Can you name some specific SNRIs?
Can you name some specific SNRIs?
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What are some other types of antidepressants?
What are some other types of antidepressants?
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Who should avoid taking these antidepressant medications?
Who should avoid taking these antidepressant medications?
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What are some important considerations when dealing with side effects of antidepressants?
What are some important considerations when dealing with side effects of antidepressants?
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Antidepressant Treatment Duration
Antidepressant Treatment Duration
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Discontinuing Antidepressants
Discontinuing Antidepressants
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Prophylactic Antidepressant Treatment
Prophylactic Antidepressant Treatment
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Maintenance Treatment for Depression
Maintenance Treatment for Depression
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Treatment for Different Depression Types
Treatment for Different Depression Types
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Light Therapy for Seasonal Affective Disorder
Light Therapy for Seasonal Affective Disorder
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Medication Response Rates in Depression
Medication Response Rates in Depression
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Factors Influencing Initial Depression Treatment
Factors Influencing Initial Depression Treatment
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Study Notes
Depressive Disorders
- A depressed mood and a loss of interest or pleasure are key symptoms of depression. These symptoms often manifest in various aspects of a person's life, affecting their daily functioning and overall well-being. Many individuals may find it challenging to engage in activities that previously brought them joy, leading to a significant decline in life satisfaction.
- Patients may describe feeling blue, hopeless, or worthless, as distinct from normal sadness or grief. This distinction is crucial, as these feelings are more pervasive and can last for extended periods, sometimes months or even years, rather than subsiding with time as typical sadness would.
- Depression can present as agonizing emotional pain, exhaustion, or a lack of motivation. Some patients report an inability to cry or experience pleasure. This emotional distress can be coupled with physical symptoms, further complicating the individual's ability to cope and maintain their day-to-day activities.
- Classic presentation: stooped posture, decreased movement, downward gaze. These physical manifestations are often evident in individuals suffering from depression and can particularly influence how they are perceived by others.
- Psychomotor retardation: observable decreased spontaneous movement. This can include slower reactions, reluctance to engage in physical activities, and a noticeable reduction in facial expressions.
- Catatonia: a severe form of psychomotor retardation that may be difficult to differentiate from other conditions. This state may manifest as lack of response to external stimuli, rigid posture, and a significant decrease in verbal communication.
- Ms. A, a 34-year-old literature professor, presented with a lack of direction, purpose, and inability to assert herself, with thoughts halted. Her case exemplifies how depression can affect individuals deeply, altering their identity and capabilities in both personal and professional realms.
Neurovegetative Symptoms
- Reduced energy, difficulty finishing tasks, and reduced motivation are common complaints. As a result, individuals often struggle to meet personal and professional obligations, leading to increased stress and relationship difficulties.
- Difficulty sleeping, especially early morning awakening (terminal insomnia) and multiple awakenings at night, are common. These sleep disturbances can exacerbate feelings of fatigue and dissatisfaction, creating a vicious cycle that perpetuates depressive symptoms.
- Decreased appetite and weight loss is common, but some experience increased appetite and weight gain and longer sleep than usual. This may be called reversed neurovegetative symptoms or atypical features. These differing patterns of appetite and sleep can make diagnosis challenging, as they present a wide range of symptoms that may not fit classic models of depression.
- Neurovegetative symptoms present a variety of physical symptoms which are essential in the diagnostic process, listed in Table 7.1. Understanding these symptoms is critical for identifying the severity of the disorder and tailoring appropriate treatment options.
- Many depressed patients have a decreased rate and volume of speech and delayed responses, and observable symptoms are helpful, but lack of symptoms does not negate a disorder. Recognizing that depression can manifest in various ways emphasizes the need for comprehensive assessment during diagnosis.
- The most typical somatic symptoms of depression are characterized as neurovegetative symptoms. These encompass physical signs that can be assessed objectively, providing a clearer picture of the disorder's impact on the individual's health.
Dysphoria and Anhedonia
- Dysphoria: encompasses various subjective depressive feelings such as sadness, depression, or feeling blue. It serves as a broad term that encapsulates the emotional landscape of those suffering from depression.
- Anhedonia: describes the inability to experience pleasure from normally enjoyable activities. This symptom is particularly significant, as it underscores the profound impact of depression on an individual's ability to engage in life and derive satisfaction from everyday moments.
Suicide Risk
- Two-thirds of depressed patients contemplate suicide, and 10-15% commit suicide. These alarming statistics highlight the critical importance of early intervention and support for individuals experiencing severe depressive episodes.
- Recently hospitalized patients with suicide attempts have a higher risk of future suicide. This necessitates ongoing monitoring and comprehensive mental health care for those who have previously faced acute suicidal ideation, as they are among the most vulnerable populations.
Cognitive Impairment
- The majority (50-75%) of depressed patients experience cognitive impairment, which includes problems with concentration and thinking. This cognitive dysfunction can significantly hinder an individual's ability to perform daily tasks and participate fully in their lives.
- Subtle memory difficulties may also occur as part of the cognitive impairment. These memory issues can interfere with both short-term and long-term memory, making it difficult for individuals to recall important information or events.
Depression in Special Populations
- Children/adolescents: may present with school phobia, excessive clinging, poor academic performance, substance abuse, antisocial behavior, sexual promiscuity, truancy, and running away. These presentations highlight the complex nature of depression in younger populations, which may not always align with traditional markers of the disorder.
- Older adults: prevalence is higher than in the general population and commonly co-occurs with other illnesses, often with somatic (physical) rather than emotional complaints. This can lead to underdiagnosis and undertreatment, as their depressive symptoms may be mistaken for side effects of comorbid conditions.
Major Depressive Disorder (MDD) and Diagnosing Criteria
- One or more major depressive episodes. Notably, these episodes can vary in intensity and duration, impacting overall functioning and quality of life.
- Criteria in Table 7-2, comparing DSM-5 and ICD-10 systems. Understanding the specific criteria required for diagnosis is essential for proper treatment planning and facilitating appropriate care pathways for affected individuals.
Depression With Psychotic Features
- Mood-congruent delusions/hallucinations that are consistent with depressed mood. These symptoms reflect the pervasive nature of depressive states that can distort reality, making it crucial to address them in a therapeutic context.
- Mood-incongruent delusions/hallucinations not consistent with depressed mood. Such features indicate a more complex psychiatric condition that necessitates careful management and intervention strategies.
Depression With Melancholic Features
- Includes characteristics like severe anhedonia, early morning awakening, weight loss, and profound feelings of guilt. These features are indicative of a more severe form of depression, often requiring more intensive treatment approaches to address the depth of suffering experienced.
Dysthymic Disorder (persistent depressive disorder)
- Depressive symptoms less severe than major depressive disorder. Despite being less intense, these symptoms can persist for years, affecting an individual’s overall functioning and happiness.
- Chronically depressed mood most of the day for at least two years. Dysthymia can be insidious, as individuals may become accustomed to their low mood, complicating diagnosis and treatment. This condition is also listed in both DSM-5 and ICD-10, ensuring that healthcare professionals use standardized criteria for diagnosis and treatment planning.
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Description
Explore the key symptoms and presentations of depressive disorders, including emotional pain, psychomotor retardation, and neurovegetative symptoms. This quiz delves into the experiences of patients, such as feelings of hopelessness and lack of motivation, as well as the impact on daily functioning.
