Depression Flashcards
What had happened since Amy’s last GP visit?
Injunction against ex
Still feels rubbish
Has being seeing her mum a bit and they are getting on
She texts her friends
Not bothered to get out much - feels like too much effort
Works part-time at the salon
Not taken much time off work which is an improvement
What more medical things does Amy discuss with the GP?
Sleep isn’t great, still wakes up early but is still tired
Eats when she feels low - junk food
Has had thoughts about harming herself (but hasn’t)
On medication
Has had some psychotherapy in the past
What is depression?
Feeling persistently sad for weeks or months
What are some symptoms of depression?
Unhappiness Hopelessness Losing interest in things you used to enjoy Feeling very tearful Constantly tires Sleeping badly No appetite or sex drive Various ached and pains
What can severe depression lead to?
Suicidal thoughts
What causes depression?
Life-changing events e.g. bereavement, losing job, giving birth
Family history
Sometimes there is no obvious reason
How is depression treated?
Lifestyle
Talking therapies e.g. CBT
Medicine
What lifestyle changes can improve depression?
Exercise
Less alcohol
Giving up smoking
Eating healthily
Give more detailed psychological symptoms of depression
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
feeling anxious or worried
having suicidal thoughts or thoughts of harming yourself
Give more detailed physical symptoms of depression
moving or speaking more slowly than usual
changes in appetite or weight (usually decreased, but sometimes increased)
constipation
unexplained aches and pains
lack of energy
low sex drive (loss of libido)
changes to your menstrual cycle
disturbed sleep – for example, finding it difficult to fall asleep at night or waking up very early in the morning
Give more detailed social symptoms of depression
avoiding contact with friends and taking part in fewer social activities
neglecting your hobbies and interests
having difficulties in your home, work or family life
What are the different severities of depression?
mild depression – has some impact on your daily life
moderate depression – has a significant impact on your daily life
severe depression – makes it almost impossible to get through daily life; a few people with severe depression may have psychotic symptoms
What is the difference between grief and depression?
Grief is an entirely natural response to a loss, while depression is an illness.
What are the different types of depression?
Postnatal
Bipolar
SAD
What is postnatal depression?
sometimes new mothers, fathers or partners develop depression after they have a baby
What is bipolar disorder?
“manic depression”, in bipolar disorder there are spells of both depression and excessively high mood (mania); the depression symptoms are similar to clinical depression, but the bouts of mania can include harmful behaviour, such as gambling, going on spending sprees and having unsafe sex
Summarise the causes of depression
Personality Family history Giving birth Loneliness Alcohol and drugs Illness
What illnesses can cause depression?
Coronary heart disease
Cancer
Both long term
Severe head injury can trigger mood swings and emotional problems
Minor head injury can damage pituitary gland
Hypothyroidism
What is the aim of CBT?
aims to help you understand your thoughts and behaviour, and how they affect you
How does CBT work?
ecognises that events in your past may have shaped you, but it concentrates mostly on how you can change the way you think, feel and behave in the present
What is IPT?
interpersonal therapy
focuses on your relationships with others and problems you may be having in your relationships, such as difficulties with communication or coping with bereavement
What is psychodynamic psychotherapy?
Encouraged to say whatever is going through your mind
What is counselling?
form of therapy that helps you think about the problems you’re experiencing in your life so you can find new ways of dealing with them
What are SSRIs?
Selective serotonin reuptake inhibitors
antidepressant
Give examples of SSRIs?
paroxetine (Seroxat), fluoxetine (Prozac)
citalopram (Cipramil).
What are withdrawal symptoms (antidepressants)?
an upset stomach flu-like symptoms anxiety dizziness vivid dreams at night sensations in the body that feel like electric shocks
What are other treatments for depression?
Mindfulness
St John’s wort (herbal treatment)
Brain stimulation
Transcranial direct current stimulation (tCDS)
Repetitive transcranial magnetic stimulations
Electroconvulsive therapy
Lithium
How does cannabis affect your mental health?
make your depression symptoms worse
feel more tired and uninterested in things
are more likely to have depression that relapses earlier and more frequently
will not have as good a response to antidepressant medicines
are more likely to stop using antidepressant medicines
are less likely to fully recover
What are symptoms of psychosis?
delusions – thoughts or beliefs that are unlikely to be true
hallucinations – hearing and, in some cases, feeling, smelling, seeing or tasting things that are not there; hearing voices is a common hallucination
What signs of depression does Amy show?
Slow speaking Disturbed sleep Social withdrawal Eating more junk food when low (stress eating) Low mood Apathy Nervous fiddle (agitation) No longer takes pleasure in things she used to enjoy (anhadonia?) Feelings of worthlessness Not going out much
What questions could we ask Amy?
Persistens sadness Slowing of movements Weightloss Relationships? Suicidal thoughts?
How can we diagnose depression?
DSM
ICD
What is the DSM?
Linked to NICE guidelines
Diagnostically and statistical measures of medicine?
What does the DSM say are key symptoms?
Persistent sadness or low mood
Marked loss of interests of pleasure
What is the timeframe for diagnosis?
most days, most of the time for at least two week
What is the criteria for DSM diagnosis?
1 or more key symptoms
5 or more associated symptoms
What are the three risk factors that can manifest as thoughts or actions?
Self harm
Suicide
Harm to others
In what group is self-harm most common in?
Females 17-19
In what group is suicide most common in?
Males 50-59
What factors can influence someones likelihood to self-harm/commit suicide?
Demographic (cultural, sex, etc.)
Where in the world
Occupation
Define suicide
Suicide is a fatal act of self-harm initiated with the intention of ending one’s life
What is a history of self harm associated with?
Higher risk of suicide
What is parasuicide?
Apparent attempted suicide without the actual intention of killing oneself
What forms of injury can be classified as self harm?
Punching wall Banging head Cutting Scratching Hair pulling
Why do people often self harm?
Self-harm is usually a way of coping or expressing difficult feelings
What are the biological factors to consider with depression?
Genetic variability
Physical health
Sleep
Diet and Lifestyle
What are the psychological factors to consider with depression?
Sleep
Self-esteem
Trauma
Attitude/beliefs
What are the social factors to consider with depression?
Family circumstance
Financial security
Diet and Lifestyle
Trauma
What are ACEs?
Adverse childhood experiences
What are Adverse childhood experiences ?
Potentially traumatic events that can have long-lasting affects
What behaviours in adult life can ACEs influence?
Binge drinking Heavy drinking Smoking Disability caused by poor health Depression High risk HIV behaviour Use of special equipment because of disability
What is BRFSS?
Questionnaire that asks about traumatic events in childhood
Comprised of 11 questions
What is bias?
A form of error
What must you bear in mind when looking at research?
This is just one piece of research
The fact that there is/is not statistical significance in this study does not mean that it is consistently true
Also something may not be statistically significant but clinically significant
you can make associations without establishing causality
What is the difference between heavy and binge drinking?
In the UK, binge drinking is drinking more than:
8 units of alcohol in a single session for men
6 units of alcohol in a single session for women
What is the difference between statistical and clinical signifcance?
Something may be statistically significant without being clinically
e.g. a combo of drugs is seen to statistically improve survival
Clinically this is not as important as it only extends life by a few days
What drugs can have an anti-depressant affect?
SSRIs
Serotonin auto-receptor antagonist
Post-synaptic Serotonin receptor agonist
How does a SSRI work?
Prevents reuptake of Serotonin so it remains in the bloodstream
= anti-depressant affect
most commonly used medications in depression
How do MAO inhibitors work?
Serotonin builds up in presynaptic terminal
Conc. gradient impacted and serotonin leaves synapse at far lower rate
What does the Serotonin auto-receptor do?
Receptor decreases serotonin release
so the antagonist drug works as an anti-depressant
What is the monoamine hypothesis?
Drug for TB was discovered to anti-depressant properties
Block monoamine oxidase
Which began the theory that serotonin is involved in depression
Over time we have realised that monamines are involved but is not the whole story
Give points that patients should be told before given medication
Drugs tell several weeks to work
May get worse initially
Need to continue for 6 months after remission
Need to wean the drugs gradually
Interact with many commonly prescribed drugs
What are some potential side effects of anti-depressants?
Suicidal thoughts Serotonin syndrome (high levels) - Tremors Nausea Drowsiness Sexual dysfunction Insomnia
What might Amy’s GP suggest in terms of social prescribing?
Support group
Local art group (re-start a previous interest)
Exercise group
Community cooking class
Online educational engagement
Volunteering
Building strong networks
What is social prescribing?
Enabling health care professionals to refer people to a range of local, non-clinical services
Recognised that many factors determine health
Aims to support individuals to take better control of their health
Give examples of Monoamine neurotransmitters
Serotonin
Adrenaline
Noradrenalin
Dopamine
What are the three classes of anti-depressants?
MAOIs
TCAs
SSRIs
What are MAOIs?
Monoamine oxidase inhibitors
What are TCAs?
Tricyclics
What are SSRIs?
Selective Serotonin Reuptake Inhibitors
How do MAOIs work?
Monoamine oxidase breaks down Its not stored in vessicles
Increases amount of NT that can be released in to synapse
How do TCAs work?
3 ring structure
Increase the levels of noradrenaline and serotonin
Work by interfering with reuptake
Block reuptake channels
NT stays in synapse longer
Increases likelihood NT will dock onto receptor on the postsynaptic membrane and trigger an action potential
How do SSRIs work?
Block reuptake channels for serotonin
But for selective (specific) serotonin receptors
How do doctors know which anti-depressant to prescribe?
Depends on side effects
MAOIs and TCAs are first gen so have many side effects
What are examples of side effects from MAOIs?
Stops medication metabolism in the liver
Can lead to build up of drugs in body
Long list of foods people on MAOIs cannot eat
What are the side effects of TCAs?
Can effect histamines leading to fatigue and sluggishness
Overdose of TCAs can lead to cardio problems due to toxicity
Why are TCAs often given to those with bipolar disorder?
Often prescribed for those with bipolar disorder as other medication can trigger manic episodes
What are side effects of SSRIs?
Sleeping problems
Weight gain
Sexual dysfunction
Can have negative affect on QoL
Serotonin Syndrome which can be life-threatening
What are new treatments now on offer?
SSRI and SNRI
Selective serotonin and noradrenaline reuptake inhibitors
NDRIs
Selective noradrenaline and dopamine reuptake inhibitors
NDRAs
Selective noradrenaline and dopamine releasing agents
What is CBT?
Cognitive behavioural therapy (CBT) is a type of talking treatment which focuses on how your thoughts, beliefs and attitudes affect your feelings and behaviour, and teaches you coping skills for dealing with different problems
What is CBT based on?
CBT is based on the idea that the way we think about situations can affect the way we feel and behave
What happens if your negative interpretation of situations goes unchallenged?
These patterns in your thoughts, feelings and behaviour can become part of a continuous cycle
How does CBT work?
Teaches you coping skills
Identify and challenge any negative thinking patterns and behaviour which may be causing you difficulties
Who is involved with social prescribing?
GP
Link worker or navigator who works with people to access local sources of support
What is limited with regards to social prescribing schemes?
robust and systematic evidence on the effectiveness of social prescribing is very limited
studies are small scale, do not have control groups, focus on progress rather than outcomes
What must be considered re social prescribing?
cost-effectiveness
Bristol study found that positive health and wellbeing outcomes came at a higher cost than routine GP care over the period of a year
