Depression & Dysthymia Mnemonics (Memorable Psychiatry Lecture)
Summary
TLDREl 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
🌿 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.
👩⚕️ 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.
🌱 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.
Mindmap
Keywords
💡Depresión
💡Episodios depresivos mayores
💡Sigi-CAPS
💡Anhedonia
💡Antidepressivos
💡Terapia cognitivo-conductual (TCC)
💡Depresión postparto
💡Depresión estacional
💡Depresión psicótropa
💡Distemia
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
浏览更多相关视频
NEUROBIOLOGÍA DE LA DEPRESIÓN
¿Qué es la depresión?
La VERDAD sobre la DEPRESIÓN y los ANTIDEPRESIVOS | ¿FUNCIONAN? ¿Nos han ENGAÑADO?
Decoding Depression: How AI is Revolutionizing Mental Health | Mariam Khayretdinova | TEDxBoston
¿El origen de la depresión es como nos lo habían contado?
Trastorno Depresivo Mayor
5.0 / 5 (0 votes)