Depression Flashcards
What are some risk factors for depression?
- Traumatic experiences e.g. bereavement, losing your job, bullying
- Genetic susceptibility i.e. family history
- Having a physical/ chronic disorder
- Having characteristic negative patterns of thinking, deficits in coping skills, impaired emotional intelligence
- Upbringing
- Lack of social support
What guidelines are used in the UK, to diagnose depression?
DSM-V (Diagnostic and Statistical manual of mental disorders)
What is the criteria to diagnose someone with Major Depressive Disorder?
≥ 1 key symptom AND ≥ 5 total symptoms
What are the key symptoms?
- persistent sadness/ low mood
- marked loss of interests or pleasure (anhedonia)
What are the associated symptoms?
- Tearfulness
- Feeling constantly tired
- disturbed sleep
- decreased/ increased appetite or weight
- anergia
- agitation or slowing down of movements + speech (psychomotor retardation)
- reduced libido
- poor concentration
- poor self-esteem
- Suicidal ideation
Which group has the highest incidence of self harm?
17-19 yr females
Which group has the highest incidence of suicide?
40-59 yr males
What is suicide?
A fatal act of self-harm initiated with the intention of ending one’s own life.
What model describes factors which contribute to depression?
Biopsychosocial model
What are some social factors which contribute to depression? (overlap)
- financial security
- family circumstances
- culture
- work/school
- social support
- traumatic life events
- interpersonal relationships
- diet/lifestyle
- drug effects
What are some psychological factors which contribute to depression? (overlap)
- attitudes and beliefs
- self-esteem
- personality
- coping skills
- traumatic life events
- interpersonal relationships
- emotions
- cognitive factors
- sleep
What are some biological factors which contribute to depression? (overlap)
- genetic vulnerability
- physical health
- neurochemistry
- immune/ stress response
- metabolic disorders
- diet/lifestyle
- drug effects
- emotions
- cognitive factors
- sleep
What are ACEs?
Adverse Childhood Events are potentially traumatic events experienced during childhood that can have negative, lasting effects on health and well-being.
Which behaviours/ morbidities have been shown to have a significant association with ACE scores (0- ≥4)?
- Binge drinking
- Heavy drinking
- Smoking
- High risk HIV behaviour
- Depression
- Disability caused by ill health
What is bias?
When systematic error is introduced into sampling or testing by selecting or encouraging 1 outcome or answer over others.
What is the monoamine hypothesis?
It suggests that a deficiency of monoamine neurotransmitters is the cause of depression.
Name some monoamine neurotransmitters.
- serotonin
- dopamine
- Noradrenaline
Name some groups of anti-depressants prescribed for those with moderate to severe depression.
- Monoamine oxidase inhibitors
- Tricyclics
- Selective Serotonin Reuptake Inhibitors (SSRIs)
- Serotonin- NA Reuptake Inhibitors (SNRIs)
- Post-synaptic serotonin receptor agonists
- Serotonin autoreceptor antagonist
How do MAOIs (first generation antidepressants) work?
They inhibit monoamine oxidase enzyme that break down monoamine neurotransmitters - this means that more neurotransmitter is available in the synapse.
Why do MAOIs have so many side effects?
They are not specific since they just target monoamine oxidase in presynaptic neurones. These are found all over the body and therefore interferes with liver metabolism and digestion.
How do tricyclics (TCAs -> first generation) work?
They block serotonin and NA reuptake channels which increases levels of the neurotransmitters in the synapse.
Why are TCAs rarely first line anti-depressants?
They are toxic if too much is taken
When are TCAs prescribed?
- bipolar disorder
- severe depression which hasn’t responded to other anti-depressants.
How do SSRIs work? (first line anti-depressants, 2nd generation anti-depressants)
They increase levels of serotonin in synapse by blocking specific serotonin reuptake channels.
Name some SSRIs.
- Prozac (Fluoxetine)
- Citalopram
- Sertraline
What are some of the side effects of using SSRIs?
Few due to high selectivity. They may include…
- weight gain
- sexual dysfunction
- sleeping problems
- increased risk of peptic ulcers
- serotonin syndrome (too much serotonin)
How are SNRIs (e.g. venlafaxine) different to SSRIs?
Rather than just targeting serotonin reuptake channels, they also block NA reuptake channels (lower selectivity but still effective).
How do serotonin autoreceptor antagonists work?
These inhibit the autoreceptor so that the presynaptic neurone doesn’t reduce the amount of serotonin it is producing (no negative feedback).
Drugs alone are not effective. What else is prescribed?
- CBT
- social prescribing
What is CBT?
Short term talking therapy helps people to deal with negative thinking and teaches coping strategies.
It combines 2 types of therapy to help you deal with these thoughts and behaviours:
- cognitive therapy, examining the things you think
- behaviour therapy, examining the things you do.
How are people with mild depression managed? (stepped mental health care)
- ‘watchful waiting’
- CBT
- lifestyle changes
What is social prescribing?
It is a means of enabling health professionals to refer people to a range of local, non-clinical services to help them take greater control of their own health.
How does social prescribing work?
Each person is assigned a line-worker who directs them to local sources of support.
What are some examples of social prescribing?
1) Link worker or navigator
2) Local activities: volunteering, exploring hobbies
3) Support groups: correcting habits
4) Lifestyle advice: exercise
5) Online educational programmes
After the person has gone into remission (symptoms of depression have gone), are the anti-depressants stopped immediately?
NO -> they continue for 6 more months and must be weaned gradually
Why is a tryptophan hydroxylase inhibitor not a suitable anti-depressant?
Tryptophan is the precursor to serotonin so inhibiting the synthesis of serotonin will actually reduce the amount of available serotonin.
Name a TCA.
Amitriptyline
Name a MAOI.
Isocarboxazid
