Presenting Symptoms

2. A 70 year old woman was recently admitted after her son informed the doctor that she had been doing very poorly. The patient reports a 30 pound weight loss, decreased concentration, feelings of helplessness and hopelessness, decreased energy, depressed mood, and decreased sleep.

3. Presenting Symptoms • Depressed mood most of the day • Anhedonia during most of the day • Significant weight loss or weight gain • Insomnia or Hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy nearly every day • Feelings of worthlessness and guilt • Diminished ability to concentrate • Recurrent thoughts about death

4. Physical Exam

8. DSM-IV Criteria for Major Depressive Episode and Major Depressive Disorder

9. Specific Components of Psychiatric Management • Performing a diagnostic evaluation • Evaluating safety of the patient and others • Evaluating the level of functional impairments • Determining a treatment setting • Establishing and maintaining a therapeutic alliance • Monitoring the patient’s psychiatric status and safety • Providing education to patients and families, enhancing treatment adherence • Working with patients to address early signs of relapse

10. Components of an Evaluation for Suicide Risk • • Presence of suicidal or homicidal ideation, intent, or plans • • Access to means for suicide and the lethality of those means • • Presence of psychotic symptoms, command hallucinations, • or severe anxiety • • Presence of alcohol or substance use • • History and seriousness of previous attempts • • Family history of or recent exposure to suicide

11. Factors to Consider in Choosing a First-Line Antidepressant Medication • • Anticipated side effects and their safety or tolerability • • History of prior response in patient or family member • • Patient preference • • Cost • • Quantity and quality of clinical trial data • • MAOIs: generally reserve for patients who do not respond to other treatments • • SSRIs or MAOIs: consider for patients with atypical symptoms

12. Acute Phase • Pharmacotherapy • Psychotherapy • Combination of medications plus psychotherapy • ECT

13. Choice of specific pharmacologic treatment

15. Treatment • SSRI • TCA • MAOI

16. Commonly Used Antidepressant Medications

17. Commonly Used Antidepressant Medications

18. Commonly Used Antidepressant Medications

19. Commonly Used Antidepressant Medications

20. Commonly Used Antidepressant Medications

21. Commonly Used Antidepressant Medications

22. Commonly Used Antidepressant Medications

34. Risk Factors for Recurrence of Major Depressive Disorder • • Prior history of multiple episodes of major depressive disorder • • Persistence of dysthymic symptoms after recovery from an episode • of major depressive disorder • • Presence of an additional nonaffective psychiatric diagnosis • • Presence of a chronic general medical disorder