Depression Flashcards
What should be the first line treatment for mild depression and moderate/severe depression?
Psychosocial treatment for mild depression.
Pharmacological and psychological treatments for moderate and severe depression.
What is something to note about people with mental illness?
Many of them also have a chronic physical illness -> important to check for DDI.
What are the risk factors for suicide in the general population?
Poor, elderly, lonely, man, physical/mental comorbidities and previous attempts.
What is the important cause of depression?
- monoamine theory: reduced neurotransmitters in the brain (NE, serotonin, dopamine)
What are some medical conditions that can cause depression?
- Endocrine disorders: Hypothyroidism (Low thyroid hormone), Cushing syndrome & T2DM
- cardiovascular: CAD, CHF and MI
What are some drugs that can cause depression?
- lipid soluble beta blockers
- psychotropics
- withdrawal from alcohol and stimulants
- systemic corticosteroids
- isotretinoin
- interferon beta 1A
How do we diagnose major depressive disorder?
A. At least 5 symptoms have been present during the same 2-week period and
represent a change from previous functioning.
NB: One of the symptoms must be depressed mood or loss of interest*
In: Decreased interest in normal activities
Sleep: Insomnia or hypersomnia(sleep a lot)
Appetite: Decreased appetite, weight loss
Depressed: Depressed moods in adults, may be irritable mood in children
Concentration: Impaired concentration and decision making
Activity: psychomotor retardation or agitation
Guilt: feelings of guilt or worthlessness
Energy: decreased energy or fatigue
Suicidal thoughts or attempts
B. Symptoms cause significant distress or impairment
C. Symptoms are not caused by an underlying medical condition or substance (intoxication or withdrawal)
What is important during general assessment of a patient with depression?
- check for any history of mania/hypomania -> cannot give antidepressant bc will switch pt to mania
- important to check for suicidal or homicidal ideation and risks during mental status exam (MSE)
What are some non pharmacological treatment for depression?
- sleep hygiene
- psychotherapy
- ECT (electroconvulsive treatment) - for severe/refractory cases
What is the basic principle for treating depression?
Antidepressants + adjunctive medications
What are the first line antidepressants?
SSRI, SNRI, Mirtazapine. Also bupropion (but not subsidised)
What are the phases of treatment for depression?
Acute phase treatment:
- 4-8 weeks on an adequate dose, max 12 weeks
- Delayed onset of antidepressant action is due to gradual down regulation of pre-synaptic autoreceptors -> allowing unopposed release of neurotransmitters
- Physical symptoms like poor sleep or poor appetite may improve in 1-2 weeks
- Mood symptoms may take longer to improve e.g. > 6 weeks
Continuation phase:
Additional 4-9 months (total of at least 6 months)
What are SSRI, SNRI and Mirtazapine?
SSRI - selective serotonin reuptake inhibitor e.g. fluoxetine, fluvoxamine, escitalopram, sertraline and paroxetine.
SNRI - serotonin noradrenaline reuptake inhibitor e.g. venlafaxine and duloxetine
NaSSA - noradrenergic and specific serotonergic antidepressant e.g. mirtazapine (acts directly at the pre synaptic auto receptors)
Bupropion - noradrenaline-dopamine reuptake inhibitor
What is duloxetine (SNRI) indicated for?
Duloxetine (SNRI) is indicated for diabetic peripheral neuropathy, fibromyalgia and chronic neuromuscular pain
What side effects can serotonergic agents (SSRI, SNRI, TCA and vortioxetine) cause?
GI side effects and sexual dysfunction
