P Newton Lecture 1
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- Drugs that can induce depression
- antihypertensives, sedatives, anti-inflammatories, analgesics, steroids, neuroleptics, antineoplastics
- Diseases that can induce depression
- endocrine, CNS, CV, arthritis, infection, SLE
- Indications for antidepressants (8)
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depression
eating disorders
OCD
panic
social phobia
post-traumatic stress
substance abuse
dementia with depression - Criteria for major depression
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Five or more Sx for 2 weeks, must include #1 or #2:
1) depressed mood everyday
2) anhendonia
3) change in appetite or weight
4) insomnia or hypersomnia
5) agitation or retardation
6) fatigue
7) feeling worthless or guilty
8) difficulty concentrating
9) suicidal thoughts - Define dysthymia
- chronic, low level depression
- Criteria for dysthymia?
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2 or more of the following most days for at least two years:
poor appetite or overeating, insomnia or hypersomnia, low energy, low self esteem, difficulty making decisions, poor concentration, hopelessness - SIG E CAPS diagnosis tool for depression?
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Sleep
Interest
Guilt
Energy
Concentration
Appetite
Pscyhomotor
Suicide - Treatment strategies for resistant pts
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Change antidepressant
Add second antidepressant, lithium, cytomel, or anticonvulsant - Critical risk factors for suicide (8)
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1) prior attempts
2) acute suicidal ideation
3) severe hopelessness
4) attraction to death
5) famiy hx
6) acute overuse of alcohol
7) loss or separation
8) age (teens, 80-84) - Best tx for bipolar depression?
- mood stabilizer +/- antidepressant
- Tx consideration for high suicide risk?
- not TCAs, MAOIs, or sedatives
- Best tx for severe refractory pts?
- ECT
- Best tx for OCD?
- SSRIs
- Best tx for panic disorders?
- SSRIs +/- BZD
- Best tx for atypical depression?
- MAOIs or SSRIs
- Best tx for pregnancy?
- none, Prozac or Zoloft
- When should long-term maintenance tx be considered?
- if three or more episodes