Case Study 3- Depression

Question 1

What are the common symptoms of depression?

Answer 1

• Low mood
• Lack of energy
• Anhedonia (loss of interest in everyday activities)
• Early morning wakening)
• Impairment of social or occupational functioning

Question 2

For depression to be diagnosed, how long should patients present with symptoms before confirming depression?

Answer 2

2 weeks

Question 3

Beside pharmacological treatment, what alternative help/treatments can be given to someone suffering with mild/moderate depression?

Answer 3

• Cognitive behavioural therapy (CBT)- Group or Individual
• Lifestyle advice- Exercising, balanced diet, reducing alcohol and smoking etc
• Practicing mindfulness or meditation

Question 4

What factors can be the cause of depression?

Answer 4

Relationship breakdown
Job loss
Bereavement
Stress
Social Isolation
Alcohol
Substance misuse
Prescription medication
Lack of support structure
Carer pressure
Chronic illness
family history (genetics)
Early life experiences

Question 5

What is a SSRI? Give 2 examples.

Answer 5

Selective serotonin reuptake Inhibitor (SSRI)

1. Sertraline
2. Citalopram

Question 6

What is the mechanism of action of sertraline (SSRIs)?

Answer 6

1. Works in the brain by
2. Inhibiting the reuptake of serotonin in the pre-synaptic neurone
3. By blocking the seritonin transporters in the pre-synaptic cleft (5HTT or SERT)
4. Increasing serotonin levels within the synaptic cleft
5. Increasing neurotransmitter binding to the post-synaptic neurone
6. Increases neuronal activity which depression symptoms of depression

Overtime there will be a decrease of 5HT1A (serotonin receptors)

Question 7

What is depression thought to be associated with chemically?

Answer 7

Depletion of serotonin within the brain

Question 8

What is the first line treatment of depression and why?

Answer 8

SSRIs
- Better adverse effect profile than other antidepressants

• Less toxic in overdose than other antidepressants
• Less sedating
• Fewer antimuscarinic and cardiotoxic effects

Question 9

What are the common side effects associated with SSRIs?

Answer 9

Anxiety
agitation
weight gain/ weight loss
Nausea

Question 10

How long do SSRIs take to work?

Answer 10

2-6 weeks because the downregulation of serotonin receptors takes time (changing of genes)

Question 11

What is serotonin syndrome?

Answer 11

Too much serotonin within the body/brain

Linked to the use of SSRIs and SNRIs

Question 12

What are the signs and symptoms of serotonin syndrome/toxicity?

Answer 12

seizures (fits)
irregular heartbeat (arrhythmia)
unconsciousness
confusion
agitation
muscle twitching
sweating
shivering
diarrhoea

Call 999 or 111 depending on severity of symptoms

Question 13

How would you switch from one antidepressant to another?

Answer 13

Do not stop abruptly- Wean patient off slowly (normally over 4 weeks) to reduce the risk of relapse or withdrawal symptoms

Question 14

What are the withdrawal symptoms of antidepressants

Answer 14

Restlessness
Trouble sleeping
Unsteadiness
Sweating
Stomach problems
Electric shock in head
Irritable, anxious or confused

Question 15

Why should we advice patients to not take st johns wort?

Answer 15

It is a herbal medicine
Limited scientifically evidence to back up that it is effective in depression

some evidence that it helps but not recommended by doctors
(amount of active ingredients varies between batches)

Interacts with a wide range of drugs therefore it is best to avoid

Question 16

What advice should we give to patients who want to take st johns wort?

Answer 16

worth talking to your GP before starting treatment

If taking with other medicine be aware that St johns wort may interact with these medicines