Depression Flashcards
Lifetime prevalence of depression
13%
One year prevalence of depression
5.3%
Mean age of onset of depression
30 years
Mean number of episodes of depression in patients with lifetime major depressive disorder
5
Percentage of patients with major depressive disorder who attempt suicide
9%
Most common change of diagnosis from an initial diagnosis of depressive disorder
Schizophrenia and related disorders
Percentage of patients who have had a depressive episode who have an episode of mania within 10 years
10%
Percentage of seriously depressed hospitalised patients who develop an episode of mania within 10 years
Nearly 50%
Factors associated with an increased chance of change from unipolar depression to bipolar disorder
Younger age
Family history of bipolar disorder
Anti-depressant induced hypomania
Hypersomnia
Psychotic depression
Postpartum depression
Average length of time of an untreated depressive episode
6-13 months
Average length of time of a treated depressive episode
3 months
Percentage chance of recurrence after a depressive episode
50%
Percentage chance of recurrence after two depressive episodes
70%
Percentage chance of recurrence after three depressive episodes
80-95%
Percentage reduction in symptoms of depression for someone to have a treatment response
50%
Percentage reduction in symptoms of depression for someone to have a partial treatment response
26-49%
Criteria required to be in remission from depression
No scales can detect meaningful measure of depression
No symptoms after the natural period of a treated episode is over (3 months)
Criteria for a relapse of depression
Further depressive episode after remission has been achieved but before recovery has been achieved
Criteria for a recurrence of depression
Further depressive episode after recovery has been achieved
Treatment options for mild depression
Watch and wait
CBT or other talking therapies
Time frame for review if adopting watch and wait strategy for mild depression
Within 2 weeks
First line of antidepressants
SSRIs
First line treatment for an initial presentation of severe depression
Antidepressants along with CBT
Length of time to continue antidepressants for patients with a moderate or severe episode
At least 6 months after remission
Length of time to continue antidepressants for patients with an episode of depression who have residual symptoms
At least two years
Length of time to continue antidepressants for patients with an episode of depression who have had >2 episodes in the recent past
At least two years
Criteria for using ECT in depression
After an adequate trial of other treatments has been ineffective
OR
If the condition is potentially life threatening
Number needed to treat for an antidepressant response in adults
4-5
Three phases of depression treatment as per Hirschfield
Acute
Continuation
Maintenance
Time frame and aim of the acute phase of depression treatment
Stabilisation of acute symptoms
For up to three months
Time frame of the continuation phase of depression treatment
6-12 months, to cover the natural (if untreated) course of a depressive episode
Time frame of the maintenance phase of depression treatment
From 12 months onwards, aiming to prevent recurrences
Percentage rate of relapse of depression on placebo vs. on active treatment, once the initial episode had finished
41% on placebo
18% on active treatment
Largest antidepressant study carried out
STAR*D
Year in which the STAR*D trial was completed
2006
Level 1 treatment in the STAR*D study
Patients given citalopram for up to 12 weeks
Level 2 treatment in the STAR*D study
Four different options:
- Citalopram was switched to an alternative antidepressant (bupriopion, sertraline, or venlafaxine XL)
- Citalopram was augmented with another antidepressant (bupropion or buspirone)
- Citalopram was switched to cognitive therapy
- Cognitive therapy was added to citalopram
Level 3 treatment in the STAR*D study
Four different options:
- Patients were switched to mirtazapine
- Patients were switched to nortriptyline
- Treatment was augmented with lithium
- Treatment was augmented with thyroid medication
Level 4 treatment in the STAR*D study
Two options:
- Patients were switched to tranylcypromine
- Patients were switched to a combination of venlafaxine XL and mirtazapine
Criteria for moving patients up a level on the STAR*D study
If they had not achieved remission by 12 weeks of the previous level’s treatment
Method to decide which treatment option each patient received within each level of the STAR*D study
Patient choice
Percentage of patients on level 1 of the STAR*D study who achieved remission from their depression symptoms
37%
Cumulative remission rate of all patients in the STAR*D study
67%
Factors associated with immediate drop out of the STAR*D study
Younger age
Lower education level
Higher perceived mental health functioning
Class of antidepressants that carry a black box warning for suicidality in under 18s
SSRIs
Risk of suicidal behaviour associated with antidepressants in patients aged <25
Increased
Risk of suicidal behaviour associated with antidepressants in patients aged 25-64
Neutral
Risk of suicidal behaviour associated with antidepressants in patients aged >64
Decreased
Class of antidepressant which shows the highest toxicity in overdose
TCAs
Class of antidepressant which shows the lowest toxicity in overdose
SSRIs
‘5 As’ which can lead to an apparent resistance to antidepressant treatment
Alcoholism
Adequate dosage (lack of)
Adherence (lack of)
Axis 2 disorders (personality disorders)
Alternate diagnosis
Two classes of antidepressant which combined have the highest risk for serotonin syndrome
SSRIs and MAOIs