Depression Flashcards
A 47 year old male presents to the GP with a 12 month history of low mood. This started following a work-related injury that has meant he’s been unable to continue his occupation. He was an avid musician, but has lost interest in music and not been to the theatre for the last 8 months.
Which of the following best describes his symptoms?
Anhedonia
The lack of enjoyment out of normally pleasurable activities is referred to as anhedonia.
Anhedonia is one of the hallmark symptoms of depression and usually occurs alongside low mood. There is a loss of interest in, or desire for, previously pleasurable activities.
Nihilism refers to a rejection of traditional beliefs. It argues that life is without objective meaning or value. Rumination is a repetitive, frequent focus on previous events or feelings, usually negative. They are a key component of patients experiencing a depressive episode. Paraesthesia refers to an abnormal sensation or feeling related to the peripheral nerves.
A 19 year old boy recently broke-up with his boyfriend. He has low mood and sees his GP for further advice. The GP suspects this could be depression based on the symptoms he describes.
Which of the following symptom most supports a diagnosis of depression?
A Early morning waking B Loss of interest in socialising with friends C Relationship ended yesterday D Weight loss E Fatigue
Depression can present with a number of symptoms but the major features are low mood and loss of interest or pleasure.
Early morning waking, weight loss and fatigue are all features of depression. These may occur alongside psychomotor agitation (purposelessness motion and restlessness associated with emotional distress), poor concentration and feeling of worthlessness. However, it is low mood and loss of interest/pleasure in normal activities, which are the hallmark features of depression.
In the diagnostic criteria ≥5 symptoms for ≥2 weeks are required for the diagnosis of depression, but one of the symptoms must be low mood or loss on interest/pleasure.
A 41 year old female is seen by the GP with recurrent low mood. After discussion, they agree to trial a course of citalopram. The GP warns her that it may take some time before she sees a beneficial effect.
What is the approximate timeframe before seeing a beneficial effect from antidepressants?
A Immediately B 1 day C 2 weeks D 1 month E 6 months
2 weeks
Patients should be advised that it takes, on average, two weeks to see a beneficial effect from antidepressants like citalopram.
As part of good prescribing of antidepressants patients should also be warned that suddenly stopping the medication can lead to withdrawal symptoms. In addition, it will need to be continued for a minimum of six months to prevent recurrence.
Based on the DSM-V, how many clinical features of depression are required to the make the diagnosis?
A 1 B 2 C 3 D 4 E 5
The diagnosis of depression requires five typical symptoms, for at least two weeks, one of which should be low mood or loss of interest/pleasure.
The symptoms of depression include:
- Low mood
- Loss of interest or pleasure
- Significant weight change
- Insomnia or hypersomnia (sleep disturbance)
- Psychomotor agitation or retardation
- Fatigue
- Feelings of worthlessness
- Diminished concentration
- Recurrent thoughts of death or suicide without a specific plan, or a suicide attempt or specific plan for committing suicide
A 24 year old female was recently started on medication for a moderate depressive episode by her GP. In addition, she self-referred for cognitive behavioural therapy and made a significant improvement in her symptoms after 3 months. She doesn’t like having to take a tablet every morning so decided to stop as she felt so much better. She subsequently sees the GP as an emergency consultation because she has developed a whole constellation of new symptoms. These include dizziness, headaches, myalgia, nausea, pins and needles affecting all limbs, and insomnia.
What is the most likely medication that was prescribed?
Antidepressant withdrawal syndrome usually begins within a few days (1-4) of suddenly stopping the antidepressant or tapering it too rapidly. Typical symptoms include headache, dizziness, fatigue and nausea. Other symptoms may include paraesthesia, agitation, anxiety, chills, insomnia, irritability, myalgia and tremor.
SSRIs are typical culprits of withdrawal syndrome and the risk depends on the drug half-life. Paroxetine has the highest risk followed by citalopram, escitalopram, and sertraline, which all have intermediate risk. Newer serotonin-norepinephrine reuptake inhibitors (SNRIs) also risk withdrawal syndrome, especially with venlafaxine.
Most cases of withdrawal syndrome are associated with mild symptoms lasting 1-2 weeks, but more severe symptoms and a more extended period of time can be seen. Management depends on severity and usually involves reassurance and watchful waiting. More severe symptoms can be managed with reintroduction of the drug and a slow taper or choosing a different agent to initiate (i.e. alternative SSRI). If there is complete opposition to restarting an antidepressant a short course of benzodiazepines can be prescribed.
What has the highest risk of withdrawal syndrome? (SSRIS)
SSRIs are typical culprits of withdrawal syndrome and the risk depends on the drug half-life. Paroxetine has the highest risk followed by citalopram, escitalopram, and sertraline, which all have intermediate risk. Newer serotonin-norepinephrine reuptake inhibitors (SNRIs) also risk withdrawal syndrome, especially with venlafaxine.
What is cyclothymia?
The DSM-V recognises cyclothymia as a chronic mood disorder with depressive and hypomanic symptoms that do not meet criteria for a full episode.
