Source / episode info

• **Episode:**462
• **Title:**Divine Intervention Episode 462: USMLE Step 2/3 Rapid Review Series 96
• **Published:**2023-06-13
• Source:Episode page

One-liner

This episode provides a rapid review of Major Depressive Disorder diagnosis criteria (Ciggy Caps), management strategies using various antidepressant classes (SSRIs, SNRIs, MAOIs, TCAs), and critical differentiations from bipolar disorder, adjustment disorder, and atypical depression.

High-yield summary

• MDD Diagnosis: Requires 5 or more of 9 symptoms for a duration exceeding two weeks; postpartum blues is distinct from bona fide PPD (which requires meeting full criteria).
• Antidepressant Selection: First-line agents are SSRIs/SNRIs, but alternatives like Bupropion (NDRI) and Mirtazapine (_2 antagonist) should be considered to mitigate common side effects like sexual dysfunction.
• Drug Toxicity Pearls: TCAs cause cardiotoxicity (widened QRS) due to sodium channel blockade; MAOIs risk hypertensive crisis from tyramine ingestion, requiring alpha-blockers (e.g., phentolamine) for acute management.
• Atypical Depression: Characterized by hypersomnia, hyperphagia, and leaden paralysis; this presentation warrants consideration of an MAOI due to its unique pathophysiology.
• Differential Diagnosis: Always differentiate MDD from Bipolar Disorder (which requires manic elements) and Adjustment Disorder (symptoms linked to a recent stressor but not meeting full criteria).

Learning objectives

• State the diagnostic criteria for Major Depressive Disorder (MDD), including the distinction between postpartum blues and PPD.
• Compare and contrast the mechanisms of action and side effect profiles of major antidepressant classes (SSRIs, SNRIs, MAOIs, TCAs).
• Differentiate clinically between MDD, Bipolar Disorder, Adjustment Disorder, and Atypical Depression based on symptom presentation.
• Identify specific drug contraindications related to co-morbidities (e.g., seizure history with Bupropion; pregnancy with Paroxetine).
• Recognize the pathophysiology of antidepressant-induced crises (e.g., hypertensive crisis from MAOIs; QTc prolongation from TCAs).

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