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Depression Management Special Circumstances

Aka: Depression Management Special Circumstances, Depression Management in Cardiovascular Disease, Major Depression Management after Myocardial Infarction
  1. See Also
    1. Major Depression
    2. Depression Management
    3. Depression Medical Management
    4. Depression with Psychotic Features Management
  2. Epidemiology
    1. Major Depression after Myocardial Infarction occurs in up to 50% of patients
    2. Major Depression after Myocardial Infarction is associated with increased cardiac events and higher mortality
  3. Management: Pregnancy
    1. See Psychiatric Medications in Pregnancy
    2. Avoid medications during first trimester
    3. Electroconvulsive Therapy for severe Depression
  4. Management: Cardiovascular Disease (e.g. Coronary Artery Disease)
    1. SSRI (Selective Serotonin Reuptake Inhibitor) preferred
      1. Sertraline (Zoloft)
      2. Escitalopram (Lexapro) 10 mg daily (avoid higher doses due to QT Prolongation risk)
      3. Citalopram (Celexa) max dose 20 mg (avoid higher doses due to QT Prolongation risk)
    2. Other agents to consider as adjunctive to SSRI
      1. Bupropion (risk of Hypertension)
      2. Venlafaxine (risk of Hypertension, esp. if dose >225 mg/day)
      3. Mirtazepine
    3. Adverse effects
      1. SSRI may increase GI Bleeding risk for those on Antiplatelet Therapy
        1. Consider GI prophylaxis (e.g. Prevacid) if other risks
    4. SSRIs to avoid
      1. Avoid Fluoxetine (Prozac) with Beta Blockers
    5. Avoid Tricyclic Antidepressants
      1. Risk of hypotensive effect
      2. Potentially pro-arrhythmic effect
        1. Similar effect to Class I Antiarrhythmics
      3. Significant Drug Interactions
  5. References
    1. (2018) Presc Lett 25(10): 55-56
    2. (2012) Presc Lett 19(10): 59
    3. Guck (2001) Am Fam Physician 64(4):641-8 [PubMed]
    4. Pathare (1997) BMJ 315:661-4 [PubMed]

Major Depressive Disorder (C1269683)

Definition (MSH) Marked depression appearing in the involution period and characterized by hallucinations, delusions, paranoia, and agitation.
Definition (PSY) Affective disorder marked by dysphoric mood, inactivity, lack of interest, insomnia, feelings of worthlessness, diminished ability to think, and thoughts of suicide. Use DEPRESSION (EMOTION) for nonclinical depression.
Definition (CSP) one or more periods of depression in the absence of history of manic or hypomanic episodes; chronic type lasts 2 or more years; melancholic type is more severe, has vegetative signs, and responds well to somatic therapy.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D003865
ICD10 F32.9
SnomedCT 370143000, 35489007
English Disorder, Major Depressive, Disorders, Major Depressive, Major Depressive Disorders, MDD, MAJOR DEPRESSIVE DISORDER, DEPRESSIVE DIS MAJOR, MAJOR DEPRESSIVE DIS, Major depressive disorder NOS, Major depressive illness, Major depression NOS, Depressive Disorder, Major [Disease/Finding], major depressive illness, major depressive disorder, major depression, Major depressive disorder (diagnosis), Major depression, Major depressive disorder (disorder), Major depressive disorder, Major depression, NOS, Major depressive disorder, NOS, Depressive Disorder, Major, Depressive Disorders, Major, Major Depressive Disorder, Major Depression
Dutch depressieve ziekte, depressieve stoornis NAO, major depression, Depressieve stoornis, ernstige, Ernstige depressieve stoornis, Involutiepsychose, Melancholie, involutionele, Parafrenie, involutionele, Psychose, involutionele, Involutiedepressie, Involutionele depressie
French Syndrome dépressif majeur SAI, Épisode dépressif majeur, Dépression grave, Grave dépression, Dépression majeure, Trouble dépressif majeur
German Major Depression NNB, schwere depressive Krankheit, Endogene Depression, Involutionsdepression, Melancholie, Involutions-, Paraphrenie, Involutions-, Psychose, Involutions-, Depressive Störung, majore, Majore depressive Störung
Italian Depressione maggiore NAS, Malattia depressiva maggiore, Depressione maggiore, Disturbo depressivo maggiore
Portuguese Doença depressiva major, Perturbação depressiva major NE, Depressão grave, Transtorno Depressivo Maior
Spanish Trastorno depresivo mayor NEOM, Enfermedad depresiva mayor, depresión mayor, trastorno depresivo mayor (trastorno), trastorno depresivo mayor, Depresión mayor, Trastorno Depresivo Mayor
Japanese 大うつ病NOS, オオウツビョウ, ダイウツビョウ, ダイウツビョウNOS, うつ病-退行期, 大うつ病性障害, 大鬱病, うつ病-更年期, 大うつ病, 初老期うつ病, 更年期うつ病, 更年期鬱病, 精神病-更年期, 退行期うつ病, 退行期パラフレニー, 退行期メランコリア, 退行期精神病, 鬱病-更年期, パラフレニー-退行期, 更年期うつ状態, 更年期メランコリー, 更年期精神病, 更年期鬱状態, 精神病-退行期, 退行期鬱病
Swedish Involutionsdepression
Czech psychóza involuční, deprese involuční, depresivní porucha unipolární, melancholie involuční, parafrenie involuční, Velké depresivní onemocnění, Velká deprese, Velká depresivní porucha NOS
Finnish Laaja-alainen masentuneisuushäiriö
Polish Wielkie zaburzenie depresyjne, Zaburzenie depresyjne wielkie, Ciężkie zaburzenie depresyjne, Depresja wielka, Parafrenia inwolucyjna, Depresja głęboka, Epizod depresji dużej, Depresja inwolucyjna
Hungarian Major depressiós betegség, Major depressio, Major depressiós zavar k.m.n.
Norwegian Depresjon, alvorlig, Markert depresjon, Depresjon, markert, Alvorlig depresjon, Markant depressiv forstyrrelse
Derived from the NIH UMLS (Unified Medical Language System)

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