Depression Flashcards
3 Core symptoms of depression
Lack of energy
Anhedonia
Low mood
For at least 2 weeks
Somatic symptoms of depression
Insomnia Appetite loss Early morning wakening Diurnal variations of mood Psychomotor retardation - won’t eat or go to the toilet Agitation Loss of libido
Psychological symptoms
Poor concentration Low self esteem Guilt Hopelessness Hypochondrial thoughts Suicidal thoughts
Mild depression
2 core symptoms + 2 others and able to function
Moderate depression
2 core symptoms + 3/4 others
Severe depression
3 core symptoms + at least 4 other symptoms
Psychotic depression
Always severe
Hallucinations
Delusions
Types of delusion
Hypochondriacal
Guilt
Nihilistic
Persecutory
Nihilistic delusions
Life is meaningless
Persecutory delusions
Paranoid
People out to get them
Post natal depression
Within 1 - 2 months post partum
Worries about baby’s health
Worries about maternal inadequacy
Risk factors for post natal depression
History of depression Family history of depression Older age Single mother Unwanted pregnancy Poor social support Previous post natal depression
Biopsychosocial management of depression
Biological:
- whether to admit or not
- bloods - exclude organic causes
- SSRIs
- ECT
Psychological:
- CBT
- psychoeducation
- CMHT
- CPN
Social:
- social prescribing
rTMS
Repetitive trans- magnetic stimulation
Nodes either side of the head which stimulates the areas of the brain
Non invasive
5 days per week for 6 - 8 weeks
tDCS
Transvariable direct current stimulation
Device on head
30 mins for 5 days per week for 6 - 8 weeks
Cause of depression
Depression is associated with an imbalance of 5-HT (serotonin) and noradrenaline in the brain and spinal cord
ECT
Send an electric current through the brain to trigger an epileptic seizure
Indications for ECT
- severe treatment resistant depression
- life threatening depression - dehydrated or anorexia
- prolonged and severe manic episode
- Catatonia
Length of antidepressant use
First episode - continue antidepressants for 6 - 12 months
Multiple episodes - continue antidepressants for much longer
ECT monitoring
ECT can cause retrograde amnesia therefore assess memory before and after ECT
Antidepressants should be reduced when on ECT
Management of mild depression
Low intensity psychological interventions
- sleep hygiene
- anxiety management
- computerised CBT
Management of moderate depression
Anti depressant + high intensity psychological intervention
