123 - Depression Flashcards
Key aspects of history taking in suspected depression
History of depression
Mood elevation
Previous treatments
Nature of social network
Core symptoms of depression
Depressed mood Anhedonia Reduced energy Tiredness after minimal effort Lasted at least 2 weeks
How does depressed mood change in depression
Varies little from day to day
Diurnal variation (worse AM)
Unresponsive to circumstances
Other symptoms of depression
Impaired concentration Reduced self esteem Ideas of guilt and unworthiness Pessimistic about future Ideas/acts of self harm/suicide Disturbed sleep Diminished appetite Irritability
Physical symptoms of depression
Anhedonia Early morning wakening Lifelessness or agitation Weight loss Loss of libido Loss of emotional reactivity
What is mild depression
2 core symptoms + 2 others
What is moderate depression
2 core symptoms + 3-4 others
What is severe depression
2 core symptoms + >4 others. Can include psychotic symptoms
Psychotic symptoms associated with depression
Delusions of sin, guilt, poverty, imminent disaster,
Hypochondira
Auditory hallucinations - defamatory or accusatory
Olfactory hallucinations of faeces or rotting flesh
Severe retardation or stupor
What do 70% of patients with depression present with
Physical symptoms only
Symptoms of anxiety
Foreboding Physical symptoms Dry mouth Palpitations Dizziness Sweating Butterflies SOB Choking May develop into panic attacks Feeling life isn't real
If depression present - also need to consider what?
Anxiety. Closely linked and rarely present separately.
When prescribing anti-depressants need to take into consideration
Overdose toxicity.
May need to increase level of support to patient
Epidemiology of depression
How common
High risk groups
4th leading cause of disability and disease worldwide. In UK - 1/10 men and 1/4 women will need treatment for depression at some point. Mean age of onset 27 but elderly, adolescents and those with chronic diseases at more risk
Hopelessness depression model
Stressor (bad event)
Attributes blame, infers consequences and inferences about self - feels cannot do anything to change it.
Hopelessness
Theory of stress vulnerability
The more vulnerable you are, the less stresses are needed to trigger depression. If remove some stresses or increase resilience then can improve threshold for depression.
Remission from depression classes as
Absence of depressive symptoms for 2 months.
How long does depression generally last?
6-8 months. If relapse - more likely to be more severe in future.
What is Beck’s triad
How you think about:
World
Future
Self
How efficient is CBT at treating depression
Can be more effective than antidepressants over long-term
How does CBT work
Underlying model - events trigger thoughts
Thoughts influence feelings, responses and actions.
CBT acts to teach the patient how to intervene to think things through and change their thoughts
When is ECT used
To treat severe depressive illness where suicide is a high risk. Usually course of 8-10 treatments with response after 2-3
What non-drug therapies can be useful for depression?
CBT - increasing levels - individual guided self help, computerised CBT, structured group therapy. Interpersonal therapy Behavioural therapy Relationship therapy ECT
Commonly prescribed antidepressants.
SSRIs as less side effects and equally effective as others. Antidepressants are non-addictive.
