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ComPbms.Mental Healt
MDD
| Question | Answer |
|---|---|
| DSM IV Diagnostic Criteria (must have) For past 2 weeks. | Reports acute symptoms of depressed mood most of the day, nearly every day, or loss of interest or pleasure in all or almost all activities of the day, nearly every day. |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Depressed mood most of the day nearly every day, as indicated either by subjective report or observation made by others. |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective report or observations made by others) |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Significant weight loss when not dieting or weight gain (a change of more than 5% of body weight in a month), or decrease or increase in appetite early every day. |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Insomnia or hypersomnia nearly every day |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Fatigue or loss of energy nearly every day |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self reproach pr guilt about being sick). |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) |
| DSM IV Diagnostic Criteria; Five or more of these symptoms | Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. |
| DSM IV Diagnostic Criteria | The symptoms do not meet criteria for Mixed episode. |
| DSM IV Diagnostic Criteria | The symptoms cause clinically significant distress or impairment in social, occupation, or other important ares of functioning. |
| DSM IV Diagnostic Criteria | the symptoms are not due to the direct physiologic effects of a substance or a general medical condition. |
| DSM IV Diagnostic Criteria | The symptoms are not better accounted for by Bereavement |
| Physical Findings | May appear unkempt, wuth unusual dress; general state of poor nutrition. Depressed demeanor. Facial expression is sad, dejected, downcast. Speech may be soft and monotonous with little spontaneity. |
| Diagnostics | Blood tests to evaluate nutritional, endocrine and thyroid function are critical in ruling out medical, reversible causes for presenting symptoms. |
| Physical findings | Many patients have vague somatic concerns rather than identifying or sharing emotions such as sadness or hoplessness. |
| Treatment (MAOI) | Monoamine oxidase (MAO) inhibitors - ↑ level of tyramine, making it necessary for pts to restrict ingestion of foods containing tyramine. Ex: phenelzine (Nardil), tranylcypromine |
| Treatment (TCA) | Tricyclic antidepressants (TCA) – carry risk of arrhythmias & are highly anticholinergic Ex: amitriptyline (Elavil), desipramine (Norparmin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor). |
| Treatment (SSRI) | Selective serotonin reuptake inhibitor (SSRI) – gentler side effect profile. Ex: citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), escitalopram (Lexapro). |
| Treatment general rules re: Rx | Maintain initial dose for 1 – 2 weeks before increasing to target dose. Trial for 6 – 8 weeks and continue for 6 – 9 months. If meds stopped after 9 months, use same agent for 2nd depressive episode for at least 1 year. |
| Treatment with Rx | Lifelong tx after the 3rd depressive episode. |
| Non Pharm Tx | Combo of meds and psychotherapy offers best odds for recovery. Interpersonal therapy, cognitive therapy, behavioral, combo cognitive behavior, brief dynamic therapy. Requires referral to specialty provider. |
| Non Pharm Tx | Nutrition plays a role in mood (glycemic variability, vitamin deficiencies, e-lyte imbalances) – adequate intake of good nutrition. Diets low in sugars and carbs and high in Omega 3 fatty acids and antioxidants. Exercise and life-style modifications. |
| Non Pharm Tx | Bright light therapy. Electroconvulsive therapy (ECT) – considered after resistance to pharmacologic interventions has been established. Repetitive transcranial magnetic stimulation (research) for MDD resistant to meds. |
| Refer or hospitalize | Pts experiencing serotonin syndrome or w/d, profoundly impaired, provider is unsure of risk. Urgent intervention within 1 week when: pt is assessed as being at high risk for suicide yet is currently safe, other psychiatric co-morbidities are present. |
| Refer or hospitalize | Follow up w/ specialty provider is needed within 1 month: recurrent sx are not responding to tx provided in primary care setting, complications w/ medical management require frequent follow up, dementia is also present. |
Created by:
DianaB
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