Which of the following statements regarding clinical depression is true?
Correct Answer D:
Over the past century, the sharp increase in the dietary intake of W-6 (omega) fatty acids and a rapid decline of dietary W-3 (omega) fatty acids has paralleled the increased rate of depression in the U.S. Interestingly there has been a progressive earlier age of onset, as well, while the condition remains more prevalent in women compared to men. DSM IV diagnostic criteria include a depressed mood or decreased interest for at least two weeks with the associated symptoms of sleep and appetite changes, energy disturbance, guilt, poor concentration, and suicidal ideation. Clinical depression is thought to affect 11 million Americans yearly.
A 33-year-old male has had a one-month history of depressed mood. He tells you he had an increase in his appetite with an 8-pound weight gain. He is sleeping most of the day. He reports the evenings being the most difficult time of day for his mood. His concentration is impaired, and he no longer enjoys watching television or reading like he used to. He feels guilty about how his work has suffered, and is hopeless about being able to recover from this in time to save his job. He denies feeling suicidal, but has had more thoughts of death in the past week.
You diagnose him with atypical depression based on which of the following symptoms being present?
Correct Answer E:
Other findings would be mood reactivity to positive events, leaden paralysis, and a pattern of interpersonal rejection sensitivity. Increased appetite and sleep don’t distinguish atypical depression, though they are often present. In typical depression the patients describe feeling the worst in the morning and better as the day progresses, which is termed a diurnal variation. This patient shows a reversal of that pattern. Diagnosing atypical features can be helpful because it is one of the few indications to specially choose a monoamine oxidase inhibitor. All of the other answers are findings in “typical” depression.
A 23-year-old unemployed female who is four months pregnant is brought to an emergency room by police after they had found her standing on a bridge over a freeway threatening to jump. She tells the doctor that for the last six weeks she has felt severely anxious and depressed, waking in the early hours of the morning. She has not eaten or drunk for four days because she is extremely worried that demons have poisoned her food and water. She admits to frequent use of IV heroin and cocaine until four weeks ago. She is dehydrated and disheveled, wearing soiled clothing and displays considerable psychomotor retardation.
Which of the following is the most appropriate treatment option to initiate at this time?
Correct Answer B:
Electroconvulsive therapy (ECT) is considered by many clinicians to be the treatment of choice for severely depressed pregnant women, especially if they are putting themselves and their fetus at high risk by refusing oral intake. ECT is also considered to be particularly effective for psychotic depression, for patients who are acutely suicidal, and for patients with marked psychomotor agitation or retardation.
A. This would be likely to worsen the patient’s psychomotor retardation. It would also interfere with ECT, because of its anticonvulsant activity.
C. This is inappropriate for the same reason as clonazepam. Additionally, both carbamazepine and clonazepam are known teratogens.
D & E. A patient this ill is not likely to be able to participate in these therapies. They would be useful as part of her continuing care, however.
A 49 year old male presents with depressed mood that has been going on for three months now. He has lost interest in the things he used to enjoy, feels sleepy all the time and skips work frequently. He admits that this mood change impairs his ability to function daily.
What is this patient's condition most likely related to?
Correct Answer A:
Depression has been linked to problems or imbalances in the brain with regard to the neurotransmitters serotonin, norepinephrine, and dopamine.
The neurotransmitter serotonin is involved in regulating many important physiological (body-oriented) functions, including sleep, aggression, eating, sexual behavior, and mood. Current research suggests that a decrease in the production of serotonin can cause depression in some people, and more specifically, a mood state that can cause some people to feel suicidal.
Deficiency of the neurotransmitter norepinephrine in certain areas of the brain was responsible for creating depressed mood. More recent research suggests that there is indeed a subset of depressed people who have low levels of norepinephrine.
Dopamine plays an important role in regulating our drive to seek out rewards, as well as our ability to obtain a sense of pleasure. Low dopamine levels may in part explain why depressed people don't derive the same sense of pleasure out of activities or people that they did before becoming depressed.
Histamine is a biogenic amine related to allergies.
Heparin is an anti-coagulant.
A 64-year-old white male appears to be depressed 2 weeks after hospital discharge for a myocardial infarction. He experienced short runs of ventricular tachycardia during his hospitalization, and echocardiography revealed an ejection fraction of 40% at the time of discharge, with no symptoms of heart failure. He has a history of depression in the past. His current symptoms include depressed mood, fatigue, sleep disturbance, feelings of hopelessness, and anhedonia. He denies suicidal ideation.
Which one of the following would be most appropriate at this point?
Several studies have demonstrated that SSRIs are safe and effective in treating depression in patients with coronary disease, particularly those with a history of previous episodes of depression. Medications have performed significantly better than intensive interpersonal psychotherapy in this setting. Electroconvulsive therapy is not considered first-line therapy in the absence of severe symptoms. While it may be effective for sleep disturbance, amitriptyline has potential cardiac side effects and is unlikely to be effective for the treatment of depression in low doses.
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