Depression Flashcards
What are the three most common types of depression?
Major depressive disorder (clinical depression)
Atypical depression
Seasonal affective depression
What is major depressive disorder (clinical depression)?
Patient has a loss of pleasure in almost all activities or a lack of reactivity to usually pleasurable stimuli for two weeks or longer, and at least 3 of the following: continuous low mood or sadness, feeling hopeless and helpless, having low self-esteem, feeling tearful, feeling guilt-ridden, feeling irritable and intolerant of others, having no motivation or interest in things, finding it difficult to make decisions, not getting any enjoyment out of life, having suicidal thoughts or thoughts of self-harming
What is Atypical depression?
share some or all symptoms of clinical depression plus one or all of the following; increased appetite or significant weight gain, increased sleep or feelings of heaviness in the arms or sensitivities of the legs that extend far beyond the mood disturbance episodes and result in significant impairment in social or occupational functioning.
What is seasonal affective disorder depression?
To diagnose a seasonal mood disorder, a regular temporal relationship should exist between the depression and a particular time of year. An individual should demonstrate at least 2 episodes of depressive disturbance in the previous 2 years, and seasonal episodes should substantially outnumber non-seasonal episodes. Patients with seasonal affective disorder are more likely to report atypical symptoms such as hypersomnia and increased appetite.
How is depression diagnosed?
ICD-11 classification system- requires at least four out of ten depressive symptoms
DSM-IV system- requires at least five out of nine for a diagnosis of major depression
Both diagnostic systems require at least one (DSM-IV) or two (ICD-11) key symptoms (low mood [in both ICD-11 and DSM-IV], loss of
interest and pleasure [in both ICD-11 and DSM-IV] or loss of energy [in ICD-11 only]) to be present.
Also, PHQ-9 and GAD7
Which symptoms are used to diagnose depression?
- At least one of: depressed mood or irritability or loss of interest or pleasure.
- Plus three or four of the following to make 5 in total: appetite or weight loss, sleep loss or change in pattern, psychomotor agitation or retardation, fatigue/energy loss, worthlessness or guilt, poor concentration, recurrent suicidal thoughts / thoughts of death.
- Somatic Syndrome, 4 or more of: anhedonia (loss of pleasure), Loss of emotional reactivity, early waking (>2 hours early), psychomotor retardation or agitation., marked loss of appetite, weight loss >5% of body mass in one month, loss of libido.
Non-pharmacological treatment of depression?
CBT
ECT
Brief anaesthesia.
Transcranial magnetic stimulation.
Vagus nerve stimulation.
Bright light therapy.
Deep brain stimulation and direct cortical stimulation.
In what situation is ECT used?
In severe depression that is life threatening, where a rapid response is needed and drug therapies have failed
What should be done in an assessment of resistant depression?
Should include- adequacy of medication dose, duration of treatment, and adherence, accuracy of diagnosis and possible co-morbid medical and/or psychiatric conditions such as substance abuse, anxiety disorders, or personality disorders.
What are the possible interventions of resistant depression?
Increasing the therapy to the maximum tolerated, changing to a different antidepressant, adding psychotherapy, augmenting the current medication or considering the use of ECT.
Which drug class of medication used for depression is not suitable for the paediatric and why not?
SSRIs are not suitable for use by persons younger than 18 years for treatment of depressive illness except for fluoxetine.
They are not suitable for children as there has been reports of suicidal ideation and attempts from clinical trials.
What are the dietary requirements for MAOIs?
Foods high in tyramine, can produce a hypertensive crisis. These foods include include soy sauce, sauerkraut, aged chicken or beef liver, aged cheese, fava beans, air-dried sausage and similar meats, pickled or cured meat or fish, overripe fruit, canned figs, raisins, avocados, yogurt, sour cream, meat tenderizer, yeast extracts, caviar, and shrimp paste. Beer and wine also should be avoided.
Long teem monitoring for depression patients?
Medications should be re-evaluated for drug-drug or drug-disease state interactions at every visit, as well as re-evaluated for efficacy every 8-12 weeks.
Non-response to treatment should raise the possibility of alternative diagnoses (e.g. bipolar or dementia).
The patient’s functional status and ability to perform activities of daily living should be evaluated every visit.
Suicidal ideation should be evaluated at each visit and between visits when indicated.
