Conditions Flashcards
Name the 3 core symptoms of depression?
Low mood, anhedonia (loss of pleasure in activities) and anergia (loss of energy)
How would you describe the low mood?
Constant, diurnal variation (worse in morning, better at night)
Name 8 other (non-core) symptoms of depression?
Lack of libido, lack of sleep, lack of appetite, weight loss, lack of concentration, feelings of hopelessness for future, feelings of guilt, loss of confidence
How do you describe the sleep pattern in depression?
Early morning wakening (waking up 3/4 hours before alarm) and not getting back to sleep. Or initial insomnia
How would you diagnose mild depression?
2 out of 3 core symptoms. and 2-3 other symptoms. Very mild impact on functioning
How would you diagnose moderate depression?
2 out of 3 core symptoms and 4 other symptoms. Marked impact on functioning
How would you diagnose severe depression?
3 out of 3 core symptoms and 5 other symptoms. Severe impact on functioning.
What are important negatives to rule out before diagnosing depression?
Bipolar?- any episodes of elated mood etc. Drug/alcohol induced? Psychosis?- any hallucinations etc
Name 5 risk factors for depression
Unemployed, chronic physical illness, genetic, childhood trauma eg. abuse/loss of parental care, personality- anxious, obsessional, low self esteem
Name 5 risk factors for depression?
Unemployed, chronic physical illness, genetic, childhood trauma eg. abuse/loss of parental care, personality- anxious, obsessional, low self esteem
What is the cause of depression?
Decreased serotonin function (& GABA, dopamine, noradrenaline)
What is the first line treatment of depression (& mild depression)?
CBT, self help, group therapy, IAPT
What is the 2nd line treatment of depression (& moderate depression)?
psychological therapies AND antidepressants
What is the first line anti-depressant used? and why? and give 3 examples
SSRIs eg. citalopram, sertraline, fluoxetine. They are first line because they are the safest in an overdose.
What is the mechanism of action of SSRIs?
They stop the re-uptake of serotonin by inhibiting the re-uptake pumps leaving more free serotonin in the synapse
Name 4 side effects of SSRIs?
sexual dysfunction, weight loss, D&V, hyponatraemia
What is the main thing to tell patients before starting them on anti-depressants?
That they will feel worse initially before they get better
What are the 2nd line anti-depressants used? (2) and give examples
Mirtazipine, SNRIs - venlafaxine, duloxetine
How does mirtazipine work?
It’s a NASSA (noradrenergic and specific serotonergic antidepressant). Antagonist to adrenergic and serotonergic receptors to increase it’s neurotransmission (adrenergic receptors are inhibitory)
How long does it generally take anti-depressants to work?
Around 4 weeks.
How do SNRIs work?
Selective noradrenaline reuptake inhibitors- Inhibit the re-uptake pumps and noradrenaline transporter increasing the amount of free noradrenaline in the synapse
Name 3 side effects of mirtazipine.
Drowsiness, weight gain, dry mouth
Name 3 side effects of SNRIs
Sexual dysfunction, nausea, insomnia
Name 3 TCAs
Amitryptilline, nortryptilline, clomipramine