Depression & Dysthymia Mnemonics (Memorable Psychiatry Lecture)

Summary

El video aborda la depresión, una enfermedad mental común y significativa que afecta al 10% de la población mundial. Se explica cómo diagnosticar la depresión mayor a través de síntomas como el humor depresivo, la falta de interés y la disminución de energía. Se discuten las diferentes formas de tratamiento, incluyendo la terapia cognitivo-conductual y los antidepresivos. Además, se mencionan subtipos como la depresión melancólica, atípica, postparto y estacional, así como la distimia, una forma crónica de depresión.

Takeaways

• 🌟 La depresión es una condición clínica grave y afecta al 10% de la población mundial en términos de discapacidad y mortalidad.
• 🔍 Para diagnosticar la depresión, se debe buscar un estado de ánimo deprimido y al menos cinco síntomas adicionales durante dos semanas o más.
• 🌱 La depresión puede manifestarse de diferentes maneras, pero se enfoca principalmente en el trastorno depresivo mayor unipolar episódico y sus subtipos.
• 💤 Los síntomas de la depresión incluyen trastornos del sueño, disminución de interés en actividades, culpa o desesperanza, agotamiento de energía, dificultades para concentrarse, cambios en el apetito, retraso psicomotor y pensamientos suicidas.
• 👩‍⚕️ El diagnóstico de depresión se puede hacer rápidamente preguntando por dos síntomas principales: ánimo deprimido y anedonia.
• 🌐 La depresión es la trastorno psiquiátrico más común, afectando a más del 20% de las personas en su vida.
• 👵 La depresión puede comenzar en cualquier edad, pero es más común en la adultez temprana, y las mujeres son diagnosticadas con mayor frecuencia que los hombres.
• 🔁 Después de un episodio de depresión, el riesgo de recurrencia es del 50%, y aumenta con cada episodio subsiguiente.
• 💊 El tratamiento de la depresión incluye psicoterapia, medicamentos o una combinación de ambos, siendo la combinación más eficaz que cualquiera de ellos por sí solos.
• 🌱 Los subtipos de la depresión, como la melancólica, atípica, postpartum, estacional y la depresión psicótropa, requieren un enfoque de tratamiento específico.

Q & A

¿Qué es la depresión según el texto proporcionado?

La depresión es un trastorno clínico grave que, si pudiera eliminarse, eliminaría el 10% de todas las muertes y discapacidades en todo el mundo.

¿Cuál es la forma más común de depresión que se discute en el guion?

El guion se centra principalmente en la forma de depresión conocida como trastorno depresivo mayor unipolar episódico y sus subtipos.

¿Cuáles son algunos de los síntomas adicionales de la depresión que se mencionan en el guion?

Los síntomas adicionales incluyen trastornos del sueño, reducido interés o disfrute en actividades, culpa o desesperanza, baja energía, dificultades para concentrarse, cambios en el apetito, retraso psicomotor y pensamientos suicidas.

¿Cómo se puede recordar los síntomas de la depresión mencionados en el guion?

Los síntomas de la depresión se pueden recordar mediante el acrónimo CIGGY CAPS, que representa: sueño, interés, culpa, energía, concentración, apetito, retraso psicomotor y suicidio.

¿Cuál es la duración típica de un episodio de depresión si no se trata?

Un episodio de depresión no tratado generalmente dura entre 6 y 12 meses.

¿Cuál es la tasa de recurrencia de la depresión después de un episodio único?

Después de un episodio único de depresión, el riesgo de desarrollar otro episodio es del 50%.

¿Cómo se relaciona la depresión con la mortalidad y las enfermedades médicas?

La depresión tiene una tasa de mortalidad significativa, con la mayoría de las personas que se suicidan teniendo un episodio depresivo en ese momento. También empeora los resultados para diversas enfermedades médicas, reduciendo la expectativa de vida en hasta 10 años.

¿Cuáles son las opciones de tratamiento para la depresión mencionadas en el guion?

Las opciones de tratamiento para la depresión incluyen psicoterapia, medicamentos o una combinación de ambos.

¿Qué es la depresión melancólica y cómo se trata?

La depresión melancólica es una forma severa de depresión que a menudo no está relacionada con eventos de la vida y se caracteriza por síntomas neurovegetativos graves. Se puede considerar tratamientos más intensos como la electroconvulsivo terapia (ECT) temprano.

¿Qué es la depresión atípica y cómo se diferencia de la depresión típica?

La depresión atípica tiene características únicas, como la reactivación del humor y la sensibilidad a la rechazo interpersonal. Se trata con medicamentos específicos como los inhibidores de la monoamina oxidasa (IMAO).

¿Qué es la distimia y cómo se diferencia de la depresión mayor?

La distimia es una forma crónica y sub-sintomática de depresión que dura la mayor parte del tiempo durante al menos dos años. Se trata de la misma manera que la depresión mayor, con terapia y/o medicamentos.

Outlines

00:00

🌿 Diagnóstico y características de la depresión

El primer párrafo aborda la importancia de la depresión desde una perspectiva clínica, destacando su impacto significativo en la salud mundial. Se menciona que erradicar la depresión podría reducir en un 10% todos los casos de discapacidad y muerte. Se enfatiza la necesidad de reconocer y tratar la depresión siguiendo las mejores prácticas basadas en la evidencia. La explicación se centra en la forma 'textbook' de la depresión, es decir, el trastorno depresivo mayor unipolar episódico y sus subtipos. Se describen las características principales de la depresión, como el humor depresivo, junto con los síntomas adicionales que se pueden recordar mediante el acrónimo 'CIggy CAPS', que abarca trastornos del sueño, disminución de interés o placer, culpa o sensación de inutilidad, agotamiento energético, dificultades para concentrarse, cambios en el apetito, retraso psicomotor y pensamientos suicidas. Para diagnosticar un episodio depresivo mayor se requiere al menos cinco de estos nueve síntomas durante dos semanas o más.

05:00

👩‍⚕️ Epidemiología y tratamientos de la depresión

El segundo párrafo profundiza en la epidemiología de la depresión, señalando que es el trastorno psiquiátrico más común, con más del 20% de las personas experimentando al menos un episodio depresivo en su vida. La depresión puede desarrollarse en cualquier edad, aunque es más común en la edad adulta temprana. Se discute la recurrencia de la depresión y cómo la probabilidad de nuevos episodios aumenta después de los primeros episodios. También se explora la relación compleja entre eventos de la vida y la depresión, así como las consecuencias mortales y la empeoración de otros trastornos médicos debido a la depresión. Se presentan los tratamientos para la depresión, incluyendo psicoterapia, medicamentos o una combinación de ambos, y se menciona que el tratamiento reduce significativamente la duración de un episodio depresivo.

10:02

🌱 Subtipos y consideraciones especiales de la depresión

El tercer párrafo cubre los subtipos de la depresión, como la depresión melancólica, atípica, postpartum, estacional y psicopática, así como el trastorno deprimente persistente o distimia. Se describen las características únicas de cada subtipo y se discuten las consideraciones especiales en el tratamiento, como la elección de medicamentos en la depresión postpartum o la terapia de luz brillante en la depresión estacional. Además, se menciona la distimia, que se caracteriza por síntomas crónicos y menos severos que los de la depresión mayor, y cómo el tratamiento para la distimia es similar al de la depresión. Finalmente, se menciona la 'depresión doble', que es la presencia simultánea de distimia y depresión mayor, y se enfatiza la importancia de un enfoque terapéutico integral, independientemente de la complejidad del caso.

Keywords

💡Depresión

La depresión es un trastorno clínico grave que afecta significativamente la calidad de vida de las personas. En el guion, se menciona que la depresión es una de las condiciones que, si pudiera eliminarse, reduciría en un 10% la tasa mundial de muerte y discapacidad. La depresión es un eje central del video, ya que se discute cómo diagnosticarla y tratarla utilizando prácticas basadas en la evidencia.

💡Episodios depresivos mayores

Los episodios depresivos mayores son un tipo específico de depresión que se caracteriza por síntomas severos y persistentes. En el guion, se enfatiza en aprender a identificar y tratar esta forma común de depresión, que a menudo se presenta en episodios y requiere tratamiento especializado.

💡Sigi-CAPS

Sigi-CAPS es un acrónimo mneumónico utilizado para recordar los síntomas adicionales de la depresión, que incluyen trastornos del sueño, reducido interés o placer, culpa o desesperanza, agotamiento de energía, dificultades para concentrarse, cambios en el apetito, retraso psicomotor y pensamientos suicidas. Este acrónimo es crucial para el diagnóstico de la depresión, como se describe en el video.

💡Anhedonia

La anhedonia se refiere a la incapacidad de experimentar placer o satisfacción en actividades que normalmente serían gratas. En el contexto del video, es un síntoma clave de la depresión que contribuye a la sensación de apatía y desinterés en las actividades diarias y sociales de una persona.

💡Antidepressivos

Los antidepressivos son medicamentos utilizados para tratar la depresión, actuando generalmente aumentando los niveles de neurotransmisores en el cerebro. El guion destaca la importancia de estos fármacos en el tratamiento de la depresión, aunque también se menciona que pueden tomar hasta dos meses para ser completamente efectivos.

💡Terapia cognitivo-conductual (TCC)

La terapia cognitivo-conductual es una forma de psicoterapia que se centra en las conexiones entre pensamientos, emociones y comportamientos. En el video, se presenta como una de las terapias psicológicas más estudiadas y efectivas para tratar la depresión, enseñando a los pacientes habilidades específicas para superar el ciclo depresivo.

💡Depresión postparto

La depresión postparto es un subtipo de depresión que se desarrolla en alrededor del 15% de las mujeres poco después de dar a luz. Aunque el guion no profundiza en los detalles, se menciona como una forma de depresión que requiere tratamiento similar al de otros episodios depresivos, pero con consideraciones adicionales si la madre está amamantando.

💡Depresión estacional

La depresión estacional, también conocida como trastorno afectivo estacional, es un subtipo de depresión cuyos episodios están claramente vinculados a los cambios de estación, generalmente empeorando durante los meses de invierno. El tratamiento puede incluir terapia de luz brillante, como se sugiere en el guion.

💡Depresión psicótropa

La depresión psicótropa es un subtipo de depresión en el que los síntomas incluyen alucinaciones, delirios o paranoia, además de los síntomas típicos de la depresión. El tratamiento para esta forma de depresión debe incluir una combinación de antidepressivos y antipsicótico, según se describe en el video.

💡Distemia

La distemia, o trastorno depresivo persistente según el DSM-5, es un trastorno del estado de ánimo que se caracteriza por síntomas depresivos persistentes durante al menos dos años. A diferencia de la depresión mayor, la distemia es crónica y no episódica, y aunque los síntomas son menos severos, pueden ser igualmente invalidantes. El tratamiento para la distemia es similar al de la depresión mayor, como se menciona en el guion.

Highlights

Depression is a significant clinical issue, potentially eliminating 10% of all death and disability worldwide if eradicated.

The focus is on episodic unipolar major depressive disorder and its subtypes for clarity in understanding depression.

Depression is characterized by a depressed mood, described as sad, empty, hopeless, and more.

The mnemonic 'CIGGY CAPS' is introduced to remember the additional signs and symptoms of depression.

Sleep disturbances are experienced by over 90% of people with depression.

Anhedonia, or reduced interest in activities, is a hallmark symptom of depression.

Depression often involves feelings of guilt, worthlessness, or hopelessness.

Energy levels are severely depleted in depression, affecting daily activities.

Concentration difficulties are common in depression, impacting various aspects of life.

Appetite changes, often leading to weight loss, are typical in depression.

Psychomotor retardation, a slowing of speech and movement, can be an objective sign of severe depression.

Suicidal thoughts are a serious symptom of depression, with a clear link to suicide.

A major depressive episode is diagnosed with at least five of the nine symptoms for two or more weeks.

Depression is the most common psychiatric disorder, affecting over 20% of people at some point in their lives.

Depression can develop at any age, with a median age of onset at 32.

Women are diagnosed with depression about twice as often as men.

Depression episodes are often discrete and untreated episodes last between 6 to 12 months.

After a single episode, the risk of recurrence is about 50%, increasing with subsequent episodes.

Depression can be precipitated by life events, especially those disrupting social circumstances.

Depression has a significant mortality rate, with mood disorders linked to most suicides.

Treatment for depression includes psychotherapy, medications, or a combination, reducing episode length significantly.

Cognitive Behavioral Therapy (CBT) is a well-studied and effective form of psychotherapy for depression.

Antidepressants increase neurotransmitter levels in the brain, aiding in the treatment of depression.

Treatment response in depression often follows a rule of thirds: complete recovery, some improvement, or no improvement.

Electroconvulsive therapy (ECT) is considered for treatment-resistant depression and is highly effective.

Melancholic depression is a severe form with pronounced neuro-vegetative symptoms and may require more intensive treatment.

Atypical depression is characterized by mood reactivity and increased appetite, responding well to MAOIs.

Postpartum depression affects around 15% of women after childbirth, with treatment similar to other depression cases.

Seasonal depression is linked to seasons, especially winter, and can be treated with bright light therapy.

Psychotic depression includes symptoms of paranoia, delusions, and hallucinations, requiring a combination of treatments.

Dysthymia is a chronic, milder form of depression, treated similarly to major depressive disorder.

Double depression refers to the co-occurrence of dysthymia and major depressive disorder, which is challenging to treat.

Transcripts

so let's talk about depression

depression is in the soberest clinical

terms a pretty big deal

it's estimated that if you could snap

your fingers and make depression

disappear you would instantly eliminate

10 percent of all death and disability

worldwide

while doing that is unfortunately not

possible what is doable is to recognize

and treat depression using the best

evidence-based practices when working

with patients so that's what we're going

to be focusing on in this video

when talking about depression it's

important to understand that what we

currently call depression is most likely

many different things for the sake of

clarity we'll be focusing primarily on

depression in its textbook form

specifically episodic unipolar major

depressive disorder and its various

subtypes

if you can learn these patterns down

cold then not only will you be equipped

to identify and treat the most common

form of depression you'll also be primed

to recognize cases that don't fit this

pattern where another approach will

likely be needed so with that in mind

let's start by learning how to diagnose

depression

the key feature of depression is

naturally depressed mood people in a

state of depression generally feel

terrible and will use words like sad

empty hopeless gloomy miserable wretched

and lonesome to describe their emotional

state

however beyond just feeling depressed

there are additional features of

depression that are often experienced as

well

these additional signs and symptoms of

depression are captured in the now

classic mnemonic ciggy caps

legend has it that siggy caps refers to

an outdated practice where a doctor

writing a prescription would write sig

for directions and then e-caps for

energy capsules which is an older term

for antidepressants

you can use this memory device to

remember that depression involves

disturbances in the following area

first is sleep with impaired sleep being

experienced by more than 90 percent of

people with depression

depression causes not only difficulty

falling asleep but also early morning

awakenings disrupting both the amount

and quality of sleep that people are

able to get

next is reduced interest or enjoyment

from activities like participating in

hobbies or socializing with others

this hallmark symptom of depression is

known formally as anhedonia

anhedonia is what makes depression a

non-reactive state meaning that

someone's mood will remain the same no

matter what's going on around them with

someone in a state of depression feeling

no joy even in situations that would

normally inspire mirth such as

celebrating a birthday or getting a

promotion at work

the g is for guilt or hopelessness

people in a state of depression often

find that their thoughts become focused

on exclusively negative thoughts like

guilt worthlessness or hopelessness

these thought patterns are often

ruminative with thoughts being chewed

over repeatedly in the mind

the e is for energy with levels of

energy and activity being severely

depleted in depression sometimes to the

point where even getting out of bed in

the morning is a major challenge

the c is for concentration people in a

state of depression often find it

difficult to concentrate leading to

impairments in work school and

relationships

the a is for appetite with the majority

of people with depression finding that

their appetite is decreased which can

result in noticeable weight loss or even

malnutrition over time

people in a state of depression often

describe food as unappetizing or

flavorless almost like eating cardboard

the p is for psychomotor retardation

while most symptoms of depression can

only be subjectively reported in some

cases depression involves signs that can

be objectively observed by others

psychomotor retardation refers to a

general slowing of speech and physical

movements and is generally considered to

be a sign of severe depression

finally the s is for suicidal thoughts

for people in the depths of depression

suicide can sometimes seem like the only

way out

over half of all people who die by

suicide were in a depressive episode at

the time of their death making the link

between depression and suicide quite

clear

having at least five of these nine

symptoms for two or more weeks is

diagnostic of a major depressive episode

if you're going by dsm-5 criteria

you can remember this by thinking that

the time frame for depression is two

blue weeks

when diagnosing depression it's helpful

to have some shortcuts to save you time

while asking about all nine of these

symptoms is the most thorough way of

going about it you can effectively rule

out a diagnosis of depression using just

two symptoms depressed mood and

anhedonia

if the patient says that they aren't

experiencing either of these things then

you can feel confident that they aren't

in an episode of depression even if you

don't ask about the other seven symptoms

so now that we've diagnosed depression

let's look at some data about depression

including who gets it what happens once

they're diagnosed with it and any

treatments to consider

depression is the single most common

psychiatric disorder with over 20 of all

people experiencing at least one

depressive episode in their lifetime

this gives depression a high base rate

in the population putting it high on

your differential for all patients

presenting with any kind of psychiatric

concern

depression can develop at any age

although it begins most often in early

adulthood with a median age of 32

however up to a quarter of people with

depression don't have their first

episode until after the age of 50 so a

lack of prior episodes in an elderly

patient does not automatically rule out

major depressive disorder

women are diagnosed with depression

about twice as often as men

across the lifespan the signs and

symptoms of major depressive disorder

tend to occur in discrete episodes

untreated an episode of depression

usually lasts between 6 and 12 months

after this time most people will

spontaneously recover and enter a period

of normal mood known as euthymia

functioning is often significantly

impaired during an episode of depression

but preserved between

episodes after a single episode of

depression the risk for developing

another episode is about 50

it's a coin flip

this means that as many as half of all

people diagnosed with depression will

only have a single isolated episode

during their life

for the other half however depression

becomes a recurrent disorder with the

risk of recurrence increasing to 80

after a second lifetime episode and

getting even higher with each additional

episode after that

many people tend to think of depression

as being caused by something but in

reality the link between depression and

life events is more nuanced than that

the best way of conceptualizing it is to

think that depressive episodes are

sometimes but not always precipitated by

life events

generally these life events involve some

form of disruption to one's social

circumstances

such as conflict with one's partner

moving geographically being forced to

change jobs or having a family member

leave home

the link between life events is clear as

to our first lifetime episode of

depression

after that depression seems to take on a

life of its own with episodes happening

more and more often without a clear link

to life events

unfortunately depression carries a

significant mortality rate

mood disorders are found in the majority

of people who die by suicide and up to

five percent of people with depression

will eventually take their own lives

depression also worsens outcomes for a

variety of medical illnesses including

cancer heart disease and stroke

leading to overall decreases in life

expectancy of up to 10 years even after

removing suicide from the equation

with all that in mind let's think about

what we can do to help

treatment for depression consists of

psychotherapy medications or a

combination of the two

while therapy and medications are both

effective the combination is better than

either one alone

with treatment the average length of a

depressive episode can be reduced from

six months to less than three months

in terms of therapy several types of

psychotherapy appear to be helpful the

most well studied is cognitive

behavioral therapy or cbt which focuses

on the connections between thoughts

feelings and behaviors and teaches

specific skills for breaking out of the

cycle of depression

medications used to treat depression are

known as antidepressants most of these

drugs work by increasing levels of

various neurotransmitters like serotonin

dopamine and norepinephrine that are

active and available in the brain

antidepressants are helpful for treating

depression although it's important to

point out that the medications can take

some time to work with a full effect

often not being seen for up to two

months after starting the drug

while treatment works for many people it

is not 100 effective

instead treatment response and

depression appears to follow a rule of

thirds with about one-third of patients

receiving treatment experiencing

complete recovery from their symptoms

one-third noticing some improvement but

not complete and one-third not getting

any better with the first treatment

tried

patients who have not received any

benefit even after multiple trials of

therapy and medications are considered

to have treatment-resistant depression

in these cases other treatments such as

electroconvulsive therapy or ect may be

considered

while ect is an invasive and complicated

procedure it is highly effective with

the largest effects seen of any single

treatment for depression

now that we have an understanding of

diagnosis epidemiology prognosis and

treatment for depression let's talk

about a few subtypes of this disorder

while each of these will introduce a few

unique wrinkles into the equation they

are all considered to be textbook

depression as well so everything we've

talked about so far will apply

the first subtype is melancholic

depression

historically the melancholic specifier

was used to describe severe episodes of

depression that seemed to come out of

the plu as opposed to being brought on

by life events

and were completely non-reactive to

external circumstances

so-called neuro-vegetative symptoms such

as psychomotor retardation severe loss

of appetite weight loss fatigue

inattention and disturbed sleep are

particularly pronounced

melancholic depression is best thought

of as a very severe form of the disorder

and you may consider more intensive

forms of treatment like ect earlier

another subtype is atypical depression

atypical depression has some unique

features compared to textbook depression

most notably mood remains reactive in

atypical depression and many people will

experience a lifting of depressive

symptoms during happy life events or

worsening of symptoms during sad life

events

patients with atypical depression often

display a long-standing pattern of

interpersonal rejection sensitivity even

when not in an episode of depression

other unique features are an increase in

appetite rather than a decrease sleeping

too much rather than too little and a

sensation that one's limbs feel too

heavy to lift a phenomenon known as lead

in paralysis

in terms of treatment a specific class

of antidepressant known as monoamine

oxidase inhibitors or maois is

particularly effective for atypical

depression

you can remember the features of

atypical depression by thinking of it as

eight typical depression a depressed

person who had mood reactivity and

became happy when they ate food would

probably start to gain weight causing

their limbs to feel heavy and becoming

sensitive to people ejecting them

because of their weight

postpartum depression develops in around

15 percent of women within a few weeks

of delivering their child

it's unclear why the postnatal state

increases the risk of depression but

many factors including hormonal changes

sleep deprivation and child care stress

are believed to play a role

treatment is the same as for other cases

of depression with the exception of

taking some additional considerations

into account when choosing medications

if the mother is breastfeeding

seasonal depression also known as

seasonal affective disorder is a subtype

of depression where episodes have a

clear link to the changing of the

seasons with depression generally

developing during the winter months most

likely due to lower levels of sunlight

treatment of seasonal depression

involves bright light therapy for at

least 30 minutes a day although standard

treatments for depression like meds and

therapy are effective as well

finally psychotic depression is

characterized by the presence of

paranoia delusions and or hallucinations

in addition to all of the sigi-cap

symptoms of depression that we talked

about already

treatment should involve a combination

of both antidepressants and

antipsychotics

before we wrap up let's talk about

related disorder known as dysthymia or

more formally as persistent depressive

disorder in the dsm-5

dysthymia is considered to be on the

spectrum of depression but differs from

major depressive disorder in two key

ways

first it is chronic rather than episodic

with symptoms being present most of the

time without a break for at least two

years

second it is sub-syndromal and that the

patient does not quite meet full

criteria for a major depressive episode

but still suffers from depressed mood

mood symptoms and dyslemia tend to avoid

those symptoms of depression that are

generally found often in more severe

cases of depression such as psychomotor

retardation or thoughts of suicide

this suggests that dysthymia can be

conceptualized as a milder but more

chronic form of major depressive

disorder

and this idea is supported by the fact

that treatment for dysthymia is largely

the same as for textbook depression

you can remember the common symptoms and

time course of dysthymia using the

mnemonic he's too sad to remind you of

the hopelessness decreased energy low

self-esteem abnormal sleep appetite

changes and impaired decision making

that are seen all for a minimum of two

years

up to a quarter of all patients with

depression have both dysthymia and major

depressive disorder a clinical situation

known as double depression

in these cases the patient spends large

portions of their life in a chronic

sub-syndromal state of dysthymia

punctuated with discrete episodes of

more severe depression

double depression is notoriously

difficult to treat but the approach to

treatment remains the same therapy and

or medications

and that's it you should now have a

solid foundation in our current

understanding of major depressive

disorder including how to both diagnose

and treat it in clinical settings

in the next video we'll talk about the

other major mood disorder known as

bipolar disorder if you're interested in

learning more about depression check out

my book memorable psychiatry which does

a deeper dive into this material

including an extensive comparison of

depression with other diagnoses with

which it is commonly confused as well as

a bunch of practice questions to put

your knowledge to the test good luck in

your studies bye for now