Depression Flashcards
What is a depressive episode
almost daily low mood, low energy, or loss of interest in usual activities for at least 2 weeks
What is atypical depression
Core symptoms + increased appetite, increased sleep fatigue, leaden paralysis
What is dysthymia/chronic depressive symptoms
Symptoms which continually meet the diagnostic criteria of a major depressive episode for at least two years, or have persistent subthreshold symptoms for at least two years, or who have persistent low mood with or without concurrent episodes of major depression for at least two years
What is seasonal affective disorder
episodes of depression which recur annually at the same time each year with remission in between (usually appearing in winter and remitting in spring)
What are the risk factors for depression
Age >65
Female sex
Postnatal status
Personal, social, environmental factors e.g. relationship issues, bereavement, stress, poverty, unemployment et.
FHx depression or suicide (first degree 3x)
Co-existing medical conditions (DM, MI, Cancer, Stroke, obesity)
Personality disorder
Substance abuse
What is the 1 year and lifetime prevalence of major depression
1 year: 5.3%
Lifetime: 13%
What are some theories for aetiology of depression
Monoamine hypothesis: reduced levels of 5-HT (serotonin), epinephrine, dopamine
Dopamine and noradrenaline
HPA axis dysregulation (patients will not have a cortisol surge in the morning)
What are the biological symptoms of depression
Poor sleep - insomnia or early morning wakening (or hypersomnia)
Reduced appetite → weight loss (or gain)
Concentration impairment
Loss of libido
Functional impairment (social, occupational)
Psychomotor retardation (slowed thoughts AND movement)
What are the cognitive symptoms of depression
Hopelessness
Helplessness
Worthlessness
Guilt
What are the psychotic symptoms of depression
Mood congruent delusions e.g. nihilistic
Hallucinations
Catatonia
What is pseudodementia
Those of an older age may present with physical symptoms or a deterioration in cognitive functioning due to depression
What are the core symptoms of depression
Low mood: irritability, anxiety, tearfulness. May show diurnal variation (typically mornings are worse) - may be irritable/flat in adolescents
Anhedonia: inability to feel enjoyment or pleasure
Anergia: feeling ‘tired all the time’, ‘worn out’, or struggling to do everyday activities
What are the differentials for depression
Non-organic: bipolar disorder | acute stress reaction | dementia | Schizoaffective disorder | anxiety
Organic: Substance misuse | hypothyroidism | Cushing’s syndrome |Addison’s | menopause | hyperparathyroidism | hypocalcaemia | anaemia |
Which medications can cause depression
Antihypertensives (beta blockers, methyldopa, CCBs)
Steroids
H2 blockers
Sedatives
Muscle relaxants,
Retinoids
Chemotherapy
Oral contraceptive pill
Gabapentin
Omeprazole
Opioids
What questionnaires can be used for depression
Patient Health Questionnaire (PHQ-9): 9 items, max score 27
Hospital Anxiety and Depression Scale (HADS): 14 items max score 21
Beck-Depression Inventory-II (BDI-II): 21 items, max score 63