Depression Flashcards
What are the clinical features of depression?
Depressed mood or irritability
Anhedonia
Weight change or change in appetite
Sleep alterations
Activity changes
Fatigue
Guilt or feelings of worthlessness
Cognitive issues
Suicidality
What are the criteria for a diagnosis of depression?
Need to have 5 out of the 9 symptoms for a minimum of 2 weeks, occuring almost every day
What are the differentials of depression?
Biopolar disorder
Anxiety disorders
Adjustment disorder
PMDD
Grief/bereavement
Dementia
Substance induced mood disorder
What are the possible organic causes of depression?
Parkinson’s
Dementia
Multiple sclerosis
Hypothyroidism
Hyperadrenalism
Substance misuse
Medication side effects
Cancers
Chronic conditions e.g diabetes
What investigations are carried out to rule out organic causes of depression?
FBC
TFT
U&E
LFT
Glucose
B12/folate
Cortisol levels
Toxicology screen
Imaging of CNS
What clinical questionnaires are used in the diagnosis of depression?
Patient Health Questionnaire 2
Patient Health Questionnaire 9
What is the first line management of depression?
Low intensity psychological intervention or CBT
What is the first line pharmacological management of depression?
SSRI such as sertraline
What are the treatment options for refractory depression?
Lithium
ECT - electroconvulsive therapy
What is the first line management of moderate to severe depression?
CBT + pharmacological therapy
What is ECT for depression?
The brain is stimulated with short electric pulses to cause a seizure lasting less than 2 minutes
What are the side effects of ECT?
Memory loss
Headache
Muscle aches
Confusion
Nausea
Cardiac arrhythmia
How long should antidepressant therapy be continued after remission of symptoms?
6 months
What is serotonin syndrome?
High levels of serotonin
What are the symptoms of serotonin syndrome?
Altered mental state
Autonomic nervous system overactivity
Neuromuscular excitability
