Depression Flashcards

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1
Q

What are the core features of depression? and how do you define severity?

A

Use DSMV
Core sx - (if 1> present for most days, for at least 2 weeks)
Lack of energy,Low mood, anhedionia

adjuncts -
FICASAG
Fatigue, insomnia, (poor) concentration, (increased/decreased) appetite, Suicidal thoughts, Agitation (or slowing), Guilt (or self blame

Severities are -subthreshold, mild, moderate, severe
subthreshold -2-5sx but no functional impairment (for over 2 years)
Mild - about 5sx, and mild functional impairment
Moderate - number of sx not relevant (more than mild), and functional impairment mild to severe)
Severe -most sx and functional impairment severe +/- psychotic sx

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2
Q

What are the subtypes of depression

A

Seasonal affective disorde -episodes that recur annualy at the same time with remission in between
Atypical depression - somatic sx -like weight gain, hypersomnia
Anxiety induced insomnia -low sleep causing low mood
Agitated depression -agitated rather than slow
Depressive stupor -so slow it stoms

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3
Q

What are the causes/factors in depression

A

Biosocial -
very commmon 1 in 5 get it, women 5x more then men

NA-mood and appetite
5HT-sleep, appetite, memory, mood
DA-psychomotor, reward

Biological causes/RF
Genetics (eg serotonin receptor gene)
neurochemical (deficiency in monoamins (MA, NT, 5HT)
Endocrine -chronic stress
Illness - direct (cushings) or indirect (cancer)
Medication ( Steroids, COCP, Bblocks, statins<

psychosocial-
childhood events (abuse, critics, etc)
vulnerability (reduce resilience)
Life event (death, divore, jail -LOSS events)
Substance abuse

becks negative cognitive triad - negative views on self -> neg on world -> neg future-> cycle

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4
Q

Investigations of depression

A

FULL HX with physical exam and MSE (and make sure to check for mood elevation)
A-Negecly, dehydration, miserable, disinterested, poor eye contact, tearful
S-slow, quiet, mute
E- restricted affect, nihilism (can be delusions)
P-when severe -hallucination, nihilitic or persecutory desilution, guilt
T-becks neg triad
I -fine -part of risk assessment
C-psychommotor retardation mimics cognitive

Bloods -FBC, TFT, Glucose
Scales -PHQ0, HADs,BDI. CDO

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5
Q

What are the differentials to exclude with depression

A

Physical -hypothyroid, hedinjury, quiet delirium
adjustment disorder -if mild
Bereavement -normal grief -6m
BPAD, Schizo- previous mania or psychotic features
Substance withdrwal
Postnatal
dementia -alzheimers

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6
Q

How do you manage mild depression in children and young people?

A

very rarely use medication in children

Mild -treated in primary care
watchful wait -2 weeks then follow
Self help (mind.org, youngminds.org)
lifestyle -sleep, diet, exercise

2nd line CBT (group)

if after 2-3 motnhs - refer to CAMHS

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7
Q

How to manage moderate to severe depression in children and young people

A
Moderate to severe--treated with CAMHS
5-11y/o
family based IPT (interpersonal (target themes of unresolved loss, social skills, relationship) 
OR family therapy
OR invididual CBT

12-18
individual CBT

needs not met- fam therapy, IPTA, Psychodynamic psychotherapy (try to get kid to see therapy in better light)

depression not responding - camhs and intensive thearpy

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8
Q

how do manage subthreshold and mild depression in adults

A

always check suicude risk - plan making, protective factors, RF

Step 1/subthreshold -
watchful waiting with follow in 2 weeks
Education -sleep hygene, exercise, self help, etc

Step 2/mild-
Low instenisty psychosocial intervention -
Group CBT
Computersied CBT (online material with practitioner review)
Guided self help (based on CBT - written materaial with practitioner review 6-8 session)
Stuctured group phsyical activity program - delivered in groups with support
3x per week for 10-14 weeks

MEDICATIONS only if -hx of moderate to severe depression
subthreshold lasting over 2years
Mild complicating care of other problems -like cancer

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9
Q

How do you manage moderate and severe depression in adults

A

Moderate –
high intensity pyshchosocial invterventions
-individual CBT -16-20 sessions over 3-4months
IPT (identify how interaction with other affect modd etc) - IPT>CBT if due to death

medication and review every 2 weeks for 3months (every week if suicidal)

Severe–
high intensity interventions
medications and ECT if needed
1st line -SSRI - (sertraline, citalopram, fluoxetine)
sertraline step increase from 50 to 200 (increase every 2 weeks, over 6 weeks)
try 2 ssri before 2nd line

2ndline - taper down SSRI, and SNRI (duloxetine, venlafaxine)
Venlafaxine -stepped from 37.5BD to 75BD to 75 morn, 150 eve

3rd line - resistant, so augment treatment with-
Antipsychotic, lithium
other antidepressents

4th line ECT

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10
Q

What are the side effects of the main depression medications and thei indication

A

Mirtazapine - insomnia and appetitte reduction very severe
sertralin -lowest side effect profile
Fluoxetine -children
paroxetine -major depressive episode

SSRI can increase suicidal thoughts initial
5s
suidcide, stomach (NV, Diarrhoea), sex dysf, Sleep (insomia), Seritonin syndrome_

be careful of contraindication like pregnancy, any tryptans,

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11
Q

what are the antidepressants used in pregnancy

A

no one specifically licensed from it but–none have shows significant negative effects

paroxetine - risk in 1st trimester to have congenital heart defects
3d trimerster - PPH

always use lowest dose
mild to moderate -
switch to faciliated self help
always try and encourage stopping
switching to high intensity CBT

severe -continue antidepressant or siwtch to drug with less SE

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12
Q

Complications of depression

A

Psychotic depression -coatrd sx -belief that one is dead

Serotonin sx

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