depression Flashcards
What is the definition of a depressive episode?
Depressed mood, loss of interest (anhedonia) and reduced energy for at least two weeks.
What is persistent depressive disorder?
A chronic form of depression lasting for at least two years.
What are the clinical features of depression?
Need at least 5 of the following 9 symptoms:
Depressed mood or irritability,
Anhedonia,
Sleep alterations,
Activity changes,
Fatigue,
Guilt or feelings of worthlessness,
Cognitive issues,
Suicidality.
In severe depression there can be psychotic features or a depressive stupor
What are the investigations for depression?
Bloods - Look for organic cause (TFTs, B12/folate, glucose, cortisol levels)
Questionnaires eg, Patient Health Questionnaire
What is the management of persistent subthreshold depression/mild-mod depression?
1st line - low intensity psychological intervention (self help or online CBT)
2nd line = High intensity CBT (individual CBT)
3rd line = Consider antidepressants
What is the treatment of mod-severe depression or mild depression unresponsive to treatment?
1st line = High intensity CBT and SSRI.
2nd line = Switch antidepressants and then use adjuncts.
What is the treatment for severe depression with poor oral intake/psychosis/stupor?
1st line ECT
What is the treatment for recurrent depression?
Antidepressant + lithium.
First line is SSRI (sertraline), SNRIs like venlafaxine can also be used but higher risk of damage from overdosing
What are the side effects of electroconvulsive therapy?
Short term - Headaches, nausea, short term memory impairment, memory loss of events prior to ECT, cardiac arrhythmia
Long term - Impaired memory
Describe features of mirtazapine
Antidepressant which blocks alpha 2 adrenergic receptors.
Has fewer side effects so useful in older patients.
Side effects = Sedation (so take at night) and increased appetite.
What are the adverse side effects of SSRIs?
Gastrointestinal (increased risk of bleed),
Hyponatraemia,
Citalopram can prolong QTc
What are some drugs which interact with SSRIs
NSAIDs,
Warfarin/hepatin (consider using mirtazapine instead)
Aspirin,
Triptans
What are the discontinuation symptoms with SSRIs?
Increased mood changes,
Restlessness,
Difficulty sleeping,
Unsteadiness,
Sweating,
GI symptoms,
Parasthesia
Name some examples of SNRIs
Venlafaxine or duloxitine
What is the mechanism of action of tricyclic antidepressants?
Inhibit reuptake of serotonin and noradrenaline
