123 - Depression Flashcards

1
Q

What are the core symptoms of depression?

A
Low mood
Loss of interest
Reduced energy
Tiredness - after minimal effort
More than 2 weeks
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2
Q

What other symptoms does depression have/

A
Irritability
Lack of concentration
Loss of pleasure
Trouble sleeping
Feeling of hopelessness
Reduced self-esteem
Loss of appetite
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3
Q

What are the ‘somatic’ / biological symptoms of depression?

A
Early morning wakening
Weight loss / loss of appetite
Anhedonia
Loss of libido
Worse in morning
Loss of emotional activity
Psychomotor retardation
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4
Q

What is depression associated with/

A

Anxiety
Disorders of experience
OCD
Psychotic symptoms

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5
Q

What are the stages of managing depression?

A

Screening - primary care
Recognised depression - mild/moderate - CCBT?
Further investigations - + antidepressant
Complex + severe - Refer to mental health services

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6
Q

What is the basis of antidepressants?

A

The monoamine hypothesis - depression is due to a lack of transmitters of serotonin, noradernaline or dopamine.
- so antidepressants act to inhibit reuptake/breakdown of these neurotransmitters

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7
Q

What are the classes of antidepressants?

A

SSRI - Selective Serotonin Reuptake Inhibitor
MAOI - Monoamine oxidase inhibitors
TCAs - Tricyclic antidepressants
Others - receptor blockers, reuptake inhibitors

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8
Q

How do SSRIs work?

A

Inhibit serotonin reuptake
eg. Citalopram, Fluoxetine, Paroxetine, Sertraline

  • Side effects: N+V, GI disterbences + bleeding (avoid NSAIDS), anorexia, insomnia, QT prolongation, Serotonin syndrome, Hyponatraemia.
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9
Q

How do MAOIs work?

A

Mono amine oxidase inhibitors - Inhibit the enzyme MOA which breaks down the compondents of the neurotransmitters, stopping them being made and released.

eg. Moclobemide (selective to MAO-A), Phenelzine, Isocarboxazid, Tranylcypromine.

Cheese reaction!

  • Side effects: Postural hypotension, Atropine like effects, weight gain, CNS stimulation..
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10
Q

How do TCA’s work?

A

Transcyclic antidepressants

Inhibit reuptake by competitively binding to pre-synaptic neurone.

eg. Amitriptyline, Imipramine, Nortriptyline, Lofepramine.

Side effects:
Sedation, confusion, motor uncoordination
Weight gain
Tachycardia - arrthymias
Atropine-like effects
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11
Q

What are atropine like effects?

A
Anatgonist of muscarinic receptors - counters the parasympathetic NS so:
Blurred vision/dilated pupils
dry mouth - reduced secretions
Urinary retention
Increased HR
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12
Q

How do receptor blocker antidepressants work?

A

eg. Mirtazapine - enhances release of noradrenaline and serotonin.
eg. Trazodone - Blocks reuptake of serotonin, and blocks serotonin receptors

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13
Q

How do non-selective reuptake inhibitors work/

A

Eg. Venlafaxine - serotonin reuptake inhibitor

Duloxetine - Inhibits noradrenaline and serotonin.

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14
Q

What do benzodiazepines work?

A

Hypnotics - help with insomnia
Anxiolytics - Help anxiety

Agonist of GABAa - increases inhibitory neurotransmission - sedation + reduce anxiety

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15
Q

Examples of benzodiazapines?

A

Hypnotics:
Temazepam
Nitrazepam
Z-related

Anxiolytics:
Diazepam
Chlordiazepoxide
Lorazepam
Oxazepam
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16
Q

What issues do people have with benzodiazepines?

A

Addiction - within 3 days!

17
Q

What types of neurotransmitters are there?

A

Glutamate, Serotonin, GABA, Glycine, Opioids, Histamine, Noradrenaline, Dopamine, Acetylcholine.

18
Q

What are Glia?

A
Non neuronal cells in the NS.
- Astrocytes - Neuronal support and repair
Oligodendrocytes - Myelination
microglia - Macrophages
Ependymal cells - make CSF

And help reputake of excess neurotransmitters.
Involved in GABA-Glutamate synthesis

19
Q

What different models/theories of depression are there?

A
Bio-psycho-social
Evolutionary
Stress-vulnerability / resilience
Cognitive
Hopelessness depression model
20
Q

How does CBT work?

A

Cognitive behaviour therapy

Try to disrupt the cycle of thoughts linked to a situation, build up resilience.