Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content +++ Pathophysiology ++ Prevailing hypothesis is dysregulation of 5-HT, NE, &/or DA (N Engl J Med 2007;358:55) +++ Diagnosis & Evaluation ++Table Graphic Jump Location | Download (.pdf) | PrintClinical Pearl 43-1SIGECAPSUseful 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 2wkSleep 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 Graphic Jump LocationTable 43-1 Diagnosis of Major Depressive EpisodeView Table||Download (.pdf)Table 43-1 Diagnosis of Major Depressive Episode5 or more in the last 2wks & is a change from previous functioning; ≥1 symptom is either depressed mood or loss of interest or pleasureDepressed 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 suicideSymptoms cause impairment in social, occupational, or other important areas or functioningSymptoms 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.Graphic Jump LocationView Full Size||Download Slide (.ppt)Depression treatment algorithm (based on TMAP guidelines for depression). +++ Pharmacologic Treatment ++ SSRIs: inhibits 5-HT reuptake transporterSNRI: inhibits 5-HT & NE reuptake transportersBupropion: inhibits DA & NE reuptake transportersMirtazapine: α2-antagonist which ↑ 5-HT & NETriazolopyridines: ↑ 5-HT, NE, & DA by 5-HT reuptake transporter inhibition & 5-HT2A antagonismTCA: inhibits 5-HT & NE reuptake transporters but not 1st line due to multiple adverse effects & possibility of fatal overdoseMAOI: inhibits breakdown of 5-HT, NE, & DA but utilized as last line due to dietary restrictions & drug interactions ++Table Graphic Jump LocationTable 43-2 Pharmacotherapy for DepressionView Table||Download (.pdf)Table 43-2 Pharmacotherapy for DepressionDrug Name & AvailabilityDosingCommon Adverse Effects & ContraindicationsDrug-Drug InteractionsClinicalNotesSelective Serotonin Reuptake InhibitorsCitalopram (Celexa®) 10mg/5mL syrup; 10, 20, 40mg ODT; 10, 20, 40mg tabs10–40mg daily (max 40mg daily; 20mg >60yo)AE: headache, nausea, diarrhea, sexual dysfunction, sedation, insomnia anxiety, sweatingCI: ALL concurrent use with MAOI or linezolidFluoxetine/paroxetine/fluvoxamine with ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth