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MDD lifetime prevalence


monoamine hypothesis

reduction in concentration and/or dysfunction of receptors of NE, 5HT, DA

MDD dx requirements

5+ symptoms must present for at least 2 weeks (suicidal ideation, diminished interest, guilt, loss of energy, low concentration, appetite changes, psychomotor agitation or retardation, sleep changes)

fraction of patients who recover fully from MDD


acute phase of treatment of MDD

6-12 weeks, goal: remission

continuation phase of treatment of MDD

4-9 months, goal: eliminate residual symptoms, prevent relapse

maintenance phase of treatment of MDD

>1 year, lifelong, goal: precent recurrence

first line therapy for MDD

SSRIs, SNRIs, buproprion, mirtazapine (if one doesn't work, try another 1st line)

second line therapy for MDD

augmentation and combination therapies, TCAs

third line therapy for MDD



insomnia, activation/anxiety, GI upset, headache, sexual dysfunction


SSRI ADR + elevated BP

bupropion ADR

insomnia, decreased appetite, anxiety, may reduce seizure threshold, minimal to no sexual dysfunction

mirtazapine ADR

sedation, weighty gain, elevated triglycerides, may HELP with GI upset

trazodone ADR

sedation, orthostasis, priapism (rare)


anticholinergic, antihistaminic, antiadrenergic, cardiac conduction abnormalities, sexual dysfunction, can be fatal in OD


orthostasis, weight gain, sexual dysfunction, hypertensive crisis (stroke, death)

MAOI diet/drug restrictions

aged cheeses, cured meat, tap beer, sauerkraut, pseudoephedrine, dxm, stimulants

serotonin syndrome

overstimulation of 5HT1A receptors, occurs within 24 hours after OD or beginning of tx, can be fatal, DC TX

serotonin syndrome triad of symptoms

mental: altered consciousness, elevated mood
autonomic: diaphoresis, hyperthermia, tachycardia
neurological: tremors, chills, rigidity, hyperreflexia

Black box warning on antidepressants

increased risk of suicide

augmentation agents

lithium, buspirone, triiodothyronine, antipsychotics (aripiprazole, quetiaprine, olanzapine/fluoxetine)

first week of treatment

improvements in physical symptoms

several weeks after treatment initiation

improvements in depressed mood, anhedonia

time when remission is reached

up to 12 weeks

major counseling point

avoid alcohol and recreational drugs

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