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Mental Health > Depression > Flashcards

Depression Flashcards

1
Q

Anthodonia

A

loss of interest in things you used to enjoy

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2
Q

Anergia

A

Loss of energy

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3
Q

How long should medication trials last at maximum tolerable dose?

A

at least 6 weeks

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4
Q

What is the maximum length of prescription for benzodiazapines or hypnotic prescription?

A

Max 2 weeks

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5
Q

What is combination treatment?

A

2+ treatments, adds extra effect and doesn’t alter action of other drugs

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6
Q

What is augmentation?

A

Adding drug that improves efficacy of antidepressant

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7
Q

Before prescribing off label or unlicensed meds need to:

A
  • The medicine is better suited to the patient/client’s needs than an appropriately licensed alternative
  • There is a sufficient evidence base and/or experience of using the medicine to demonstrate its safety and efficacy
  • The reasons why medicines are not licensed for their proposed use should be explained to the patient/client, or parent/carer
  • A clear and accurate record of medicines and the rational for use should be documented on Paris (unless the medication is included in TEWV off-label permissions) as part of the Medication Treatment Plan
  • Off-label and unlicensed medications monitoring and prescribing arrangements are likely to remain in secondary care unless transfer has been agreed
    Any drug marked with an (N) is recommended by NICE guidelines
    Any drug marked with an asterisk (*) should only be initiated by a Consultant Psychiatrist or Level 3 Non-Medical Prescriber with competency to initiate the medication.
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8
Q

Depressed symptoms in need of activation

A

Loss of interest
Oversleeping
Overeating
Poor concentration
Indecisive
General slowing

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9
Q

Depressive symptoms in need of sedation

A

Lack of sleep
Lack of appetite
Agitation/restlessness
Suicidal thoughts
Loss of libido

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10
Q

Medication for depression in need of activation

A

SSRI or low dose venlafaxine

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11
Q

Initial medication for depression in need of sedation

A

Mirtazapine

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12
Q

Side effect of mirtazapine

A

Weight gain

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13
Q

Initial dose sertraline

A

100mg OM - titrate up to this

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14
Q

Venlafaxine initial dose

A

37.5mg BD

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15
Q

Mirtazapine initial dose

A

30mg ON (15mg is more sedating)

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16
Q

What to do if partial reponse to inital treatment for depression?

A

Consider increase to maximum dose for further 6 week trial if tolerated

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17
Q

Steps 2 + 3 for depression that doesn’t respond to initial medication

A

2 trials of single drug therapy on top of initial
different drug groups
4-6 weeks at treatment dose

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18
Q

Step 2 for depression with activation needs

A

Venlafaxine and hypnotic (2 weeks for sleep) OR trazodone 50-150mg

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19
Q

Mediations ofr anxiety and depression

A

Sertraline

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20
Q

Why is fluoxatine better for people who are bad at taking medication?

A

Stays in system longer

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21
Q

What drug often add if max dose of sertraline?

A

Mirtazipine

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22
Q

Why do yuo get weight gain on SSRIs?

A

Increased appetite

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23
Q

What is a stronger SSRI?

A

Venlafaxine

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24
Q

Side effects of SSRIs

A

GI disturbance in first couple weeks then settles down
Feel more tired at first (sertraline, venlafaxine)

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25
Q

Side effect of venlafaxine

A

Sweats

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26
Q

When review in 2 weeks on antidepressants

A

Under 30

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27
Q

When review someone high risk on antidepressants

A

1 week

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28
Q

average wehn need to review on antidepressants

A

4 weeks

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29
Q

When start on Vortioxetine in depression

A

if 2 prev failed or non tolerated trials

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30
Q

When refer to secondary care

A

No recovery after maximum dose for 4-6 weeks of step 2 + 3 medications

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31
Q

Step 4 for refractory depression secondary care initiation

A

-Alternative monotherapies - moclobemide
-Combination of different antidepressants
-Augmentation of partially effective antidepressants

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32
Q

Combination of different antidepressants for step 4

A

SSRI or SNRI + Mirtazapine
Mirtazapine or SSRI + Reboxetine (2-8mg daily)
6 weeks

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33
Q

Augmentation of partially effective antidepressants

A

Quetiapine immediate release (150-300mg/day)
Lithium
Aripiprazole

34
Q

Step 5 in secondary care

A

If no recovery from step 4
-Augmentation
-Alternative monotherapies

35
Q

Augmentation partially effective antidepressants step 5

A

SSRI + buspirone (60mg/day)
Amisulpride

36
Q

Alternative monotherapies step 5

A

Agomelatine
Bupropion

37
Q

Agomelatine when use

A

step 3 of monotherapy
If 3 previous failed or non tolerated trials

38
Q

Step 6 refractory depression

A

After all medication options have failed
Consider ECT
Consider referral to tertiary service or specialist within TEWW

39
Q

NICE guidelines for depression

A

www.nice.org.uk/guidance/cg90

40
Q

DEPRESSION in adults with a chronic physical health problem guidance

A

www.nice.org.uk/guidance/cg91

41
Q

What type of drug is venlafaxine?

A

SNRI

41
Q

What type of drug is venlafaxine?

A

SNRI

42
Q

When is step 4 treatment used in depression?

A

Medication, high intensity psychological interventions, ECT, crisis service, combined treatments, multiprofessional anad inpatient care

43
Q

Steps 2 and 3 interventions depression

A

High intensity or low intensity psychological and psychosocial interventions, medications

44
Q

Depression treatments listed in order of recommendation for basic management

A

Guided slef help
Group CBT
Group behavioural action
Individual cognitive therapy
Individual behavioural action
Group exercise
Group mindfulness and meditation
Interpersonal psychotherapy
SSRI antidepressants
Counseling
Short term psychodynamic psychotherapy

45
Q

Depression treamtent in order of recommendation for more severe depressive episode

A

Individual cognitive behavioural therapy and antidepressant
Individual CBT
Individual behavioural activation
Antidepressant medication
Individual problem solving
Counselling
Short term psychodynamic psycotherapy
Interpersonal psychotherapy
Guided self help
Group exercise

46
Q

When is risk of relapse increased in depression?

A

History of recurrent episodes and/or incomplete response previously
History of severe depression
Coexisting physical or mental health problems
Unhelpful coping styles eg avoidance, rumination
Personal, social or environmental factors that contributing to depression

47
Q

What to do when low risk of relapse depression

A

Continuing treatment can reduce risk of relapse
There are risks of longer term side effects with medication
Stopping antidepressants can be difficult

48
Q

What to do if discontniuing medication

A

Explain how to withdraw safly
Advise to seek help promptly if symptoms recur

49
Q

What to do if on antidepressatns alone and high risk of relapse

A

Consider continuing with same
Consider switching group CBT or MBCT
Consider continuing with antidepressant adn adding CBT

50
Q

How often review antidepressant medication?

A

every 6 months

51
Q

Types of neurostimulation

A

ECT
Transcranial magnetic stimulation (TMS)
others:
-vagus nerve stimulation
-transcranial direct current stimulation (tDCS)
-Deep brain stimulation

52
Q

How do transcranial magnetic stimulation and aim

A

Place electrodes on head
Place against head and pass small current between them
Aim - stimulate neurons in brain

53
Q

Indications for ECT

A

Severe depression
Mania
Catatonia
Psychosis

54
Q

Caution whne using ECT with

A

MI, cardiac surgery, AAA, valvular disease

55
Q

Risks ECT short term

A

Anaesthetic risks
headaches, mylagia, nausea, retrograde/anterograde

56
Q

Long term risks ECT

A

?memory loss
1/3 autobiographical/retrograde memory loss
Research studies shows memory loss is temporary - research measures anterograde memory
Most clinics do cognitive assessment before and after treatment

57
Q

Post loading video

A

: https://youtu.be/9L2-B-aluCE

58
Q

DSM vs ICD - one basic depressive syndrome

A

DSM-5 - major depressive episode
ICD - single episode depressive disorder

59
Q

DSM vs ICD - one basic depressive syndrome

A

DSM-5 - major depressive episode
ICD - single episode depressive disorder

60
Q

More than one episode of depression ICD vs DSM

A

DSM - Major depressive disorder
ICD-11- Recurrent depressive disorder

61
Q

Specifiers you cna get with depression according to DSM 5

A

With anxious distress

With melacholic features
With atypical features
With psychotic features
Peripartum onset
Seasonal pattern

62
Q

ICD-11 specifiers with depression

A

With prominent anxiety
With panic attacks
With melacholia

With or without psychous
Ass w peripartum period
Seasonal pattern

63
Q

Types of depression according to DSM 5

A

Persistent depressive disorder
Premenstrual dysphoric disorder

64
Q

Types of depression according to ICD

A

Dysthmic disorder
Premenstrual dysphoric disorder
Mixed depression and anxiety disorder

65
Q

How does melancholia present?

A

Prominent anhedonia
Early morning wakening
Diurnal variation
Psychomotor retardation
Weight loss
Guilt

66
Q

How do psychotic symptoms present with depression?

A

Mood congruent

66
Q

How do psychotic symptoms present with depression?

A

Mood congruent

67
Q

Symptoms of atypical depression

A

Increased appetitie
Hypersomnia
Leaden paralysis

68
Q

What severity levels of depression does ICD 11 describe?

A

Mild
Moderate
Severe

69
Q

What is severity of depression based on in ICD-11?

A

Severity of symptoms
Fucntiona impairment

70
Q

Course of depression

A

Relapsing remitting
50% relapse after 1 episode, 80% after 2
Assess if patients are in - non-response, partial remission, in remission

71
Q

What tool is used to assess depression?

A

PHQ-9
Patient health questionnaire
Based on DSM criteria but NOT a diagnostic tool

72
Q

Scoring and severity on PHQ-9

A

0-5 = normalk
5-9 = minimal symptoms
10-14 = dysthmia or mild MDE
15-19 = moderate MDE
>20 = severe MDE

73
Q

What are persistent depressive disorder (DSM)/ICD dysthmic depression?

A

Sub syndromal symptoms for at least 2 years, most commonly life long

74
Q

What is double depression?

A

Dysthmia + MDD

75
Q

What is premenstrual dysphoric disorder?

A

Depression and irritability before menstruation, more severe than premenstrual syndrome

75
Q

What is premenstrual dysphoric disorder?

A

Depression and irritability before menstruation, more severe than premenstrual syndrome

76
Q

Where is mixed depression and anxiety diagnosed?

A

Primary care
Only ICD - sub syndromal

77
Q

What is considered recurrent depressive disorder?

A

History or at least two episodes sperated by at least several months without significant mood disturbance

Mental Health (57 decks)

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