{"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":"


\nPathophysiology<\/strong><\/p>\n

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
\n
\nInheritance\/Epidemiology<\/strong><\/p>\n

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
\n
\n<\/p>\n

Related Posts<\/strong><\/p>\n

Obsessive Compulsive Disorder<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Pathophysiology 1) depressed mood daily for a minimum of 14 days 2) not associated with general medical condition or bereavement Signs and Symptoms 1) diminished pleasure or interest in daily activities 2) sadness, thoughts of death, suicidal ideation 3) irritability 4) feelings of hopelessness or worthlessness 5) insomnia or hypersomnia 6) early morning awakening 7) […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[63],"tags":[1265,1271,1264,1267,1270,1268,1266,1269],"yoast_head":"\nMajor Depression - 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