{"id":2726,"date":"2010-02-13T19:04:26","date_gmt":"2010-02-14T00:04:26","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=2726"},"modified":"2010-02-13T19:55:10","modified_gmt":"2010-02-14T00:55:10","slug":"major-depression","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2010\/02\/major-depression\/","title":{"rendered":"Major Depression"},"content":{"rendered":"
1)<\/strong> depressed mood daily for a minimum of 14 days 2)<\/strong> not associated with general medical condition or bereavement<\/p>\n Signs and Symptoms<\/strong><\/p>\n 1)<\/strong> diminished pleasure or interest in daily activities 2)<\/strong> sadness, thoughts of death, suicidal ideation 3)<\/strong> irritability 4)<\/strong> feelings of hopelessness or worthlessness 5)<\/strong> insomnia or hypersomnia 6)<\/strong> early morning awakening 7)<\/strong> fatigue 8)<\/strong> weight loss or gain 9)<\/strong> decrease in concentration and\/or ability to make decisions<\/p>\n Characteristic Test Findings<\/strong><\/p>\n Laboratory<\/em> – 1)<\/strong> decreased plasma tryptophan 2) increased plasma cortisol Radiology<\/em> – 3)<\/strong> PET scan shows decreased glucose metabolism in caudate nucleus and frontal lobes<\/p>\n Histology\/Gross Pathology<\/strong><\/p>\n decreased noradrenergic neurons in locus ceruleus<\/p>\n Associated Conditions<\/strong><\/p>\n 1)<\/strong> suicide (15%) 2)<\/strong> bipolar disease 3)<\/strong> trauma or assault 4)<\/strong> seasonal affective disorder 5)<\/strong> decreased REM sleep onset (latency)<\/p>\n Biochemistry<\/strong><\/p>\n 1)<\/strong> decreased serotonin levels 2)<\/strong> involvement of prefrontal cortex and basal ganglia in abnormal neurotransmitter functioning 1)<\/strong> affects 15% of USA population sometime in lifetime 2)<\/strong> female to male, 2:1 3)<\/strong> incidence increases with age 4)<\/strong> 45% concordance rate in identical twins<\/p>\n Treatment<\/strong><\/p>\n 1)<\/strong> selective serotonin reuptake inhibitors (fluoxetine, sertraline, paroxetine) 2)<\/strong> tricyclic antidepressants (nortriptyline) 3)<\/strong> monoamine oxidase inhibitors (no longer first-line treatment owing to hypertensive crisis that arises with ingestion of tyramine-containing substances 4)<\/strong> psychotherapy 5)<\/strong> electroconvulsive therapy in drug-resistant cases<\/p>\n Tips for USMLE<\/strong><\/p>\n if a 50 year-old woman has lost 25 pounds from “losing her appetite”, reports “feeling like her life has been a waste” and is thinking of suicide, and reports waking up at 4 am each morning without being able to get back to sleep, think depression
\nPathophysiology<\/strong><\/p>\n
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