DEPRESSION - Common Patterns Adults

1)      Normal Sadness

2)      Bereavement

3)      Adjustment disorders – See under somatic depressive symptom syndrome

4)      Major depression –  Drug Tx – (Initial dose-target dose-maximum dose) Fluoxetine 10-20-40 mg, Paroxetine 10-20-40 mg, Sertraline 50-100-200 mg, Citalopram 20-40-60 mg, Mirtazapine 30-45-60 mg, Duloxetine 30-60-60 mg, Bupropion 150-200-450 mg, Nortriptyline 50-75-150 mg, Imipramine 25-100-150 mg, continue treatment for 6 wees, target dose is the optimal dose, except bupropion other drugs once daily,

5)      Postpartum depression – onset of depression with 3/52 – 4/12 after delivery

6)      Baby Blues – starting a few days postpartum, feeling sad, irritable, anxiety, weeping, confusion, peak symptom intensity about 4th postpartum day and resolve by 10th day,  usually no functional disability

7)      ADHD adults – recurrent stress-induced depressive syndromes not amounting to MDE, interpersonal relationship problems, Interpersonal relationship problems, difficulties at work, poor school performance, poor work performance (due to inattention, impulsiveness, hyperactivity), low self–esteem, low chance of success, and satisfaction in many areas of life, increased risk of tobacco use, substance use, prone for injuries and accidents, symptoms must be present at least from age 7 yrs, Tx - Atomoxetine, amphetamines, dexmethylphenidate, behavior therapy, life skills training,

8)      Recurrent short-lasting depressive episodes as in premenstrual dysphoric disorder -

 

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