Types:

• Psychotic depression
• Persistent depression: 2 years (mnemonics: think nursing school!)
• PMDD: dysthymia, erratic mood swings before menstruation

Etiology: genetics + biological + environmental + psychological
Epidemiology:

• Women: attempt more suicides (keep trying again and again, unable to complete the suicide like men)
• Men: choose ETOH & Drugs
• Elderly: usually mistaken grief for depression

Timing:

• Postpartum blues: 1 fortnight 

S/s:

Test: PHQ9
Tx:

  Psychotherapy:

	Goal	Population	Caution
Cognitive Behavioral Therapy (CBT)	Change behavior
InterPersonal Therapy (IPT)	relationship issues
Problem Solving Therapy (PST)	realistic solutions	Good for elderly
Internet-Computer based therapy	CBT + IBT	Homebounds, teens, LGBTQ, rural	Viz-a-viz still preferable

Meds:

• Adolescents: suicidal thoughts
• Onset: 1-2 fortnights (2-4 weeks) or up to 1/2 year (6 mo.) to work
• SSRIs, SNRIs, TCAs should NOT be used with MAOI
• Common antidepressant side effects: 
• Monitor Liver/Renal function (cleared thru hepatic and renal chanels)
• Decreased libido
• St John Wort: bleeding side effects (due to being an anticoagulant)
• Need to wean before stopping antidepressant

•  SSRI - Serotonin:
• 
  

• Generic	Brand	Dosage	Elderly***
  Citalopram	Celexa	20-40mg qd*	20mg max (QTc)**
  Escitalopram***	Lexapro	10mg qd
  Fluoxetine	Prozac	20-60mg 90mgqweek Extended Release AM 20mg PM20mg	10mg initial
  Paroxetine	Paxil	20-50mg	10mg initial
  Sertraline	Zoloft	25-50mg
  Vilazodone	Viibryd	20-40mg Start @ 10mg initial

   

Others: ECT, rTMS, VNS