Depression Flashcards
Which group of conditions is depression part of?
Affective mood disorder conditions
What are other examples of affective mood disorders?
• Affective mood disorder
• Anxiety
• Bipolar Disorder
How can mood disorders present?
As a primary problem
Or they can be secondary to another condition
What can depression be secondary to?
• Cancer
• Dementia
• Drug misuse
• Medical treatment (steroids)
• Bereavement
What are differential diagnosis of depresison?
• Hypothyroidism
• Bipolar disorder
• Cancer/ terminal diagnosis
What 2 ways can depression present?
As a single episode
As an ongoing condition with periods of relapse and remission
What do depressed patients have in terms of life?
A decreased quality of life
Increase mortality
According to ICD-10, what is required for the diagnosis of mild depression?
2 core symptoms
4 additional symptoms
According to ICD-10, what is required for the diagnosis of moderate depression?
2 core symptoms
6 additional symptoms
According to ICD-10, what is required for the diagnosis of severe depression?
All 3 core symptoms
8 additional symptoms
What are the 3 core symptoms of depression?
• Depressed mood for most of the day almost everyday for two weeks, uninfluenced by circumstances
• Loss of interest or pleasure
• Decreased energy or increased fatigability
What are the additional symptoms of depression?
• Loss of confidence or self esteem
• Unreasonable feelings of guilt or self reproach or excessive guilt
• Recurrent thoughts of death by suicide or any suicidal behaviour
• Decreased concentration
• Agitation or retardation
• Sleep disturbance of any sort
• Change in appetite
What sleep disturbance can you get with depression?
Insomnia
Hyposomnia
Waking to early in the morning and not getting back to sleep
What changes in appetite can you get with depression?
Loss of appetite- weight loss
Comfort eating- Increased weight
What are the positive symptoms of depression?
• Concentration/ attention
• Self-esteem/ confidence
• Guilt/ worthlessness
• Self-harm /suicide
• Disturbed sleep/ loss of appetitive
What are the somatic symptoms of depression?
• Anhedonia
• Early morning waking
• Low mood on waking
• Psychomotor retardation
• Marked libido loss
• Weight loss
What should you do before giving an SSRI, especially citalopram?
Take an ECG
What is the management of mild depression?
• Group Based CBT
• Low intensity psychotherapy/ intervention
What is the management of moderate depression?
Therapy
Medication
What is the management of severe depression?
Medication and therapy
What is common with severe depression?
Delusions and hallucinations
What medication is commonly used with depression?
SSRI’s
What are examples of SSRI’s for depression
Sertraline
What SSRI would you give to a child with depression?
Fluoxetine
What are alternative treatments for depression?
Tricyclic antidepressants
Monoamine oxidase inhibitors
If the patient had previously had an MI, what SSRI would you give them?
Sertraline
How long would you prescribe an SSRI if this is the patients first episode of depression to prevent a relapse?
6-9 months
If this was the patients second episode of depression, how long would you treat them?
2 years
If someone had catatonic depression, how would you treat them?
With ECT
What is the main presentation of catatonic depression?
Patient is speechless and motionless-doesn’t respond to their environment
How long should people who benefitted from an antidepressant be kept on one?
6 months after remission to reduce risk of relapse
Examples of other SSRI’s?
Citalopram
paroxetine
Examples of SNRI’s
Venlafaxine
Examples of tricyclic antidepressants?
Amitriptyline
Clomipramine
A PHQ-9 score of what would suggest less severe depression?
a PHQ-9 score of < 16
A PHQ-9 score of what would suggest more severe depression?
a PHQ-9 score of > 16
