Specifiers for MDD cont'd
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*If mania or hypomania, then BIPOLAR
*with melancholic features (1 of following):
* loss of pleasure in all or almost all activities
* Lack of reactivity to pleasurable stimuli + 3 or more: despondent, worse
depression in am, early am waking, psychomotor agitation or retardation,
anorexia or weight loss, excessive guild
*with atypical features (mood reactivity + weight gain, hypersomnia, leaden
paralysis, interpersonal rejection sensitivity)
DMS 5 specifiers for MDD
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, *Single episode or recurrent
*Mild, moderate, severe (degree of functional disability, number of
symptoms, severity of symptoms)
*With psychosis (hallucinations, delusions)
*Partial or full remission in 2 months
(you do not stop medication for 6-9 months so that brain can fully recover
and lessen chance of recurrence)
MAOI
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CAUSE hypertension
NO Tyramine - chocolate, cheese, chocolate
3rd line antidepressant
Must be off of other meds 1-2 weeks first
Dysregulation due to Circadian Rhythms
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*Delayed sleep onset
*Shortened REM latency
*Increased length of 1st REM period
*Abnormal delta sleep
*May be reported as lack of sleep or
atypical feature of hypersomnia
*Antidepressant meds treat circadian
dysregulation and can restore normal
sleep architecture
, Deplin
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food group
order by mail
boosts serotonin
effectively helps depression
omega 3 fatty acids helps
NaSSa
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Mirtazapine (Remeron) - used to increase appetite and for sleep; lower the
dose, the more sleep, more appetite improvement; higher does better for
depression - 7.5 mg for sleep and appetite; 15 mg for depression - can use
for a brief time then use another med
SEROTONIN SYNDROME
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*TOO MUCH
MEDICAL EMERGENCY
*confusion, mental status change
*Myoclonus - muscle twitching
*shivering
*hypomania
*hallucinations
*headaches
*hyperthermia - 101 - 103