Skip to Main Content
Home Books Internal Medicine: A Guide to Clinical Therapeutics

Chapter 43. Depression and Anxiety

Phillip Lai

  • Sections
  • Print
  • Get Citation

    Citation

    AMA Citation
    Lai P. Lai P Lai, Phillip.Chapter 43. Depression and Anxiety. In: Attridge RL, Miller ML, Moote R, Ryan L. Attridge R.L., Miller M.L., Moote R, Ryan L Eds. Rebecca L. Attridge, et al.eds. Internal Medicine: A Guide to Clinical Therapeutics New York, NY: McGraw-Hill; 2013. http://accesspharmacy.mhmedical.com/content.aspx?bookid=565&sectionid=42003760. Accessed November 17, 2019.
    MLA Citation
    Lai P. Lai P Lai, Phillip.. "Chapter 43. Depression and Anxiety." Internal Medicine: A Guide to Clinical Therapeutics Attridge RL, Miller ML, Moote R, Ryan L. Attridge R.L., Miller M.L., Moote R, Ryan L Eds. Rebecca L. Attridge, et al. New York, NY: McGraw-Hill, 2013, http://accesspharmacy.mhmedical.com/content.aspx?bookid=565&sectionid=42003760.

    Download citation file:

    RIS (Zotero)
    EndNote
    BibTex
    Medlars
    ProCite
    RefWorks
    Reference Manager
    Mendeley
    © Copyright
  • Tools
  • Search Book
  • Clip
Top

Pathophysiology

  • Prevailing hypothesis is dysregulation of 5-HT, NE, &/or DA (N Engl J Med 2007;358:55)

Diagnosis & Evaluation

Favorite Table | Download (.pdf) | Print
Clinical Pearl 43-1

SIGECAPS

  • Useful acronym, to meet the dia-gnosis of major depression, a patient must have 4 of the symptoms plus depressed mood or anhedonia, for at least 2wk
  • Sleep disorder (either increased or decreased sleep), Interest deficit (anhedonia), Guilt (worthlessness, hopelessness, regret), Energy deficit, Concentration deficit, Appetite dis-order (either decreased or increased), Psychomotor retardation or agitation, Suicidality (Am Fam Physician 1998; 58:1617)
Table 43-1 Diagnosis of Major Depressive Episode
View Table|Favorite Table|Download (.pdf)
Table 43-1 Diagnosis of Major Depressive Episode

5 or more in the last 2wks & is a change from previous functioning; ≥1 symptom is either depressed mood or loss of interest or pleasure

  • Depressed mood, markedly diminished interest or pleasure, weight loss or weight gain/change in appetite, psychomotor agitation or retardation, fatigue of loss of energy, worthlessness or excessive or inappropriate guilt, ↓ concentration or indecisiveness, thoughts of death or suicide
  • Symptoms cause impairment in social, occupational, or other important areas or functioning
  • Symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism)

Data from DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision. Washington, DC: American Psychiatric Association, 2000).

Treatment & Follow-Up

  • Goal → remission of all symptoms of depression; continue medications for ≥4–9mo to prevent relapse (APA Guidelines for Major Depressive Disorder, 2010)

Figure 43-1.
image
View Full Size|Favorite Figure|Download Slide (.ppt)
image

Depression treatment algorithm (based on TMAP guidelines for depression).

Pharmacologic Treatment

  • SSRIs: inhibits 5-HT reuptake transporter
  • SNRI: inhibits 5-HT & NE reuptake transporters
  • Bupropion: inhibits DA & NE reuptake transporters
  • Mirtazapine: α2-antagonist which ↑ 5-HT & NE
  • Triazolopyridines: ↑ 5-HT, NE, & DA by 5-HT reuptake transporter inhibition & 5-HT2A antagonism
  • TCA: inhibits 5-HT & NE reuptake transporters but not 1st line due to multiple adverse effects & possibility of fatal overdose
  • MAOI: inhibits breakdown of 5-HT, NE, & DA but utilized as last line due to dietary restrictions & drug interactions

Table 43-2 Pharmacotherapy for Depression
View Table|Favorite Table|Download (.pdf)
Table 43-2 Pharmacotherapy for Depression

Drug Name & Availability

Dosing

Common Adverse Effects & Contraindications

Drug-Drug Interactions

Clinical

Notes

Selective Serotonin Reuptake Inhibitors

Citalopram (Celexa®) 10mg/5mL syrup; 10, 20, 40mg ODT; 10, 20, 40mg tabs

10–40mg daily (max 40mg daily; 20mg >60yo)

AE: headache, nausea, diarrhea, sexual dysfunction, sedation, insomnia anxiety, sweating

CI: ALL concurrent use with MAOI or linezolid

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MHE Privacy Center Close