Depression - 1 Flashcards
what are depression types recognised by ICD11?
Single depressive Episode
Recurrent Depressive Disorder
Dysthymic Disorder
Mixed depressive and anxiety disorder
What are depression types recognised by DSM-5?
Disruptive mood dysregulation disorder (temper outburst)
Major Depressive disorder
Persistent depressive disorder (dysthymia)
Premenstrual Dysphoric disorder
Where is “Mixed depression with anxiety disorder is located in DSM-5?
It is coded by the ‘with anxious distress’ qualifier.
Biological Symptoms of depression?
Neurovegetative
Somatic
Vital
Melancholic
Endogenomorphic
what is difference between dsm5- and icd 11 when it comes to psychotic symptoms of depression?
In ICD-11, only moderative and severe can have psychotic symptoms
In DSM-5 psychotic symptoms are independent of severity
How long ICD-11 requires Depressive episodes and DSM 5 requires MDD to last?
2 weeks at least
Symptom clusters in ICD-11 depressive episodes
Affective
Cognitive behavioural
Neurovegetative
Symptoms in affective cluster of ICD 11 depressive episode
Depressed mood
Lack of interest or inability to experience pleasure ( including sex)
Symptoms in cognitive behavioural cluster of the ICD 11 depressive episode
Self worthless ness
Lack of concentration
Hopelessness
Suicidal ideation and thoughts of dying
Symptoms in neurovegetative cluster of the ICD 11 depressive episode
sleep disturbance
appetite disturbance
aggitation/irritability
lack of energy
how many symptoms are required in total to qualify in icd 11 depressive disorder
5 at least
one must be from affective
Difference between DSM 5 and ICD 11 for MDD/Depressive episodes?
Almost the same, although ICD 11 uses clusters for the same nine symptoms on DSM 5.
Difference between DSM 5 and ICD 11 for recurrent depressive disorder
ICD 11 requires at least 2 episode of depressive episodes separated by several months (not specified) without significant mood disturbance
DSM -5 requires at least two episodes separated by precisely two consecutive months without meeting criteria for MDD
Dysthymic disorder in ICD11
- Recurrent depressive mood (feeling down) for at least 2 years with individual 9 symptoms of depressive episode without having 2 weeks of sufficient symptoms to meet depressive episode criteria.
- No longer than 2 consecutive months of symptom-free reported.
Dysthymic disorder difference between ICD 11 - DSM 5
DSM 5 - specifies 1 year for children and adolescents (both say it this group there is more irritability for mood)
Mixed depressive and anxiety disorder
at least 2 weeks of several symptoms of depression and anxiety, but none meet the criteria for depressive episodes or anxiety or fear-related disorders.
How does NICE guidlines (ng222) grades derpession?
MOre severe and less severe
should you offer antidepressant for less severe cases routinely?
no, unless preferred by patient
what are first line of antidepressants for less severe cases who request medication?
SSRIs
for less severe depression what antidepressant should be avoided and why?
TCA (except lofepramine) because they’re easy to overdose
which TCA is not easy to overdose?
Lofepramine
what if there was no response to first SSRI?
1st - switch to another medication in the same class or another like SNRI ( or TCA and MAOIs in 2ndary care)
2nd - vortioxetine
or
3rd- antipsychotic + SSRI, Or Mirtazapine + SSRI or Lithium + SSRI
4th- Consider augmentation of SSRI with ECT or lamotrigine
when can a clinician consider vortioxetine?
when two antidepressant did not work at all or properly
Treatment based on PHQ- 9 <16 (Less severe; Mild and subthreshold)
- Self-help (Guided)
-Group or indie CBT
-Group or indie Behavioural activation
-Group Exercise
-Group Mindfulness and meditation
-IPT
-SSRI
-Counselling
-STPP (short term psychodynamic psychotherapy)
-Combined CBT + Antidepressant
Treatment based on PHQ- 9 >16 (Less severe; Moderate and severe)
-Combined CBT plus antidepressant
-Individual CBT
-Individual behavioural activation
-Antidepressants
-Individual problem solving
-Counselling
-Short-term psychodynamic psychotherapy (STPP)
-Interpersonal psychotherapy (IPT)
-Guided self-help
-Group exercise
after the prescription of antidepressants, when should the treatment be reviewed?
if 18-25 in 1 week
or if there is a concern about suicide.
Otherwise in 2 weeks
how long antidepressants should be taken after remission achieved?
6 months to prevent relapse
Or longer if there is higher risk for relapse
How long you should wait before considering changing the meds?
4-6 weeks
suitable antidepressant for patient on NSAIDs?
Mirtazapine
Reboxetine
Trazodone
Moclobemide
antidepressant that should be avoided in patient on NSAIDs?
SSRIs/ SNRIs due to GI bleeding
when can SSRI/SNRI be used in patients on NSAIDs and how?
when there is no suitable alternative
Use gastroprotection e.g. PPIs
Suitable antideprssant for patients on warfarin
Mirtazapine
Reboxetine
Trazodone
antidepressant that should be avoided in patient on Warfarin?
SSRI/SNRI, TCAs
Suitable SSRIs for patients on Heparin
Citalopram, Sertraline and escitalopram
other suitable antidepressant for patients on heparin?
Mirtazapine
Trazodone (SARI)
Reboxetine (SNRI)
antidepressant that should be avoided in patient on Heparin?
Other SSRIs and SNRIs (except citalopram, escitalopram and sertraline ::: Reboxetine and Trazadone)
antidepressant that should be avoided in patient on Anti-epileptic drugs?
all antidepressants reduce seizure threshold
Suitable antideprssant for patients on anti-epileptic drugs
SNRI: Duloxetine
Suitable antideprssant for patients on Clozapine/Methadone/Tizanidine/Theophyline
citalopram or sertraline
Antidepressant that should be avoided in patient on Clozapine/Methadone/Tizanidine/Theophyline
Fluvoxamine
Suitable antidepressant for patients on atomoxetine
Not Fluoxetine, Paroxetine, Citalopram or escitalopram …so any otherr
antidepressant that should be avoided in patient on atomoxetine
Fluoxetine, Paroxetine, Citalopram or escitalopram
rate of 2nd episode after 1st depression episode?
half of the cases
rate of 3rd episode after 2nd depressive episode
70%
Rate of further episodes after 3rd depressive episode
90%
Risks for recurrent in depression?
Female
Lack of confiding relationship
Cyclothymic episodes
Family history
Longer episode duration
Chronic medical illness
non-affective psychiatric comorbidity
Risk for relapse of depression
Older age at onset
Hx of recurrent episodes
Incomplete response to Rx
Unhelpful coping styles
Hx of severe depression
chronic mental or physical illness
ongoing personal, social or environmental factors
what is refractory depression?
two successive failed attempts at treatment despite good compliance and adequate doses
Options to treat refractory derpession
- Add lithium
- quetiapine and ssri/SNRI
-Olanzapine and Fluoxetine
-aripiprazole to antidepressant
-bupropion + SSRI
-SSRI 0r venlafaxine + Mianserin or mirtazapine
NICE guidline on refractory depression?
- Vortioxetine
Or
-Combination
+++ Mirtazapine or trazodone to SSRI
+++ combined antidepressant to 2nd generation antipsychotic (olan + fluoxetine e.g)
+++ augmenting antidepressant with ECT, Lamotrigine or triiodothyronine)
which medication is considered to have lowest risk of causing manic switch in depression?
Bupropion
Which medication is considered to have highest risk of causing manic switch in depression
TCAs
MAOI
Venlafaxine
Medications that cause depression
RIBLeD SHOc
Rerserpin
Interferon alpha
Beta Blockers
Levadopa
Digoxin
Steroid, anabolic
Oral contraceptives
acronym for medications that cause depression
RIBLeD SHOc
Drug abuses cause depression
Alcohol
Amphetamine
Cocaine
Hypnotic
criteria for post-schizophrenic depression in ICD 11
Patient met schizo criteria within past 12 month
Positive symptoms might remain but less dominant
Depressive symptoms are distressing and prominent
Depressive symptoms meet the criteria for depressive symptoms
Present for at least 2 weeks
