Depression Flashcards
What is depression?
Low moods associated with a loss of interest and enjoyment in ordinary things
What are the symptoms of depression?
Psychological - loss of interest, poor memory, suicidal thoughts
Physical- poor sleep, lack of appetite and lethargy
Emotional - anger, irritable or sadness
What are the complications of depression?
Exacerbation of conditions- pain
Risk of substance misuse
Reduced QoL
Increased morbidity
Suicidal thoughts
What is the DSM-5 criteria for diagnosing depression?
A consistent state of depressive mood continuously for 2 years in adults
1 year in children and adolescents
Not been without symptoms for more than 2 months
How should you treat mild depression?
CBT - low intensity (8 sessions), high = up to 20
Sleep hygiene
Anxiety management
Exercise
No antidepressants poor risk: benefit ratio
How should moderate depression be treated?
CBT and antidepressants
More impact on QoL
How should severe depression be treated?
Unable to function at all
CBT and antidepressants
Which antidepressant increases the risk of suicidal thoughts and what should be done?
SSRIs
Refer patient to a crisis team - mind or samaritans
Only continue treatment after 6 months of remission to prevent relapse
Review the patient
What is first line treatment for depression and why?
SSRIs - sertraline, citalopram, fluoxetine
Under 16s - fluoxetine
Sertraline less drug interactions
How should SSRIs be taken?
Take in the morning - high serotonin suppresses REM sleep
In elderly, taking NSAIDs or aspirin give a PPI
What is second line treatment for depression and why?
SNRI - duloxetine and venlafaxine
Has more side effects but has dual action
Which SNRI can be taken at night?
Mirtazapine
It is not an uptake inhibitor but an antagonist of 5HT2, H1and alpha 2
Antihistamine action at low dose
Why are monoamine oxidases not used often?
It has strong side effects but is used in dramatic decline
Hepatotoxicity
Interacts with cheese
Seizures
Hypertension
Serotonin syndrome
When will antidepressants give an effect?
It takes 4 weeks an effect
What is the plan action if antidepressant does not work after 4 weeks?
Switch to another SSRI, SNRI or mirtazapine
Cross tapering- Gradually reduce dose of 1st antidepressant and start the 2nd at a low dose, increase when lowering the first one
Same class can do a direct switch
What are symptoms of withdrawal and how should they be managed?
Relapse, restlessness, sweating and poor sleep
Reduce dose by 25% every 4-6 weeks
Withdraw over 6-8 weeks
What are the symptoms of serotonin syndrome?
Cardiac
Tremors
Jerky movements
Which drugs cause serotonin syndrome?
Triptans
Tramadol
SSRI
SNRI
What are the major drug interactions with antidepressants?
NSAIDs - in elderly
Warfarin - increases INR
Triptans
What combinations are used in treatment resistant depression?
Fluoxetine and olanzapine or aripiprazole
Antidepressant and second-gen antipsychotic
Side effects can lead to failure
When is electro-convulsive therapy used?
When patients want to commit suicide
Severe manic episodes
The pt is on constant anaesthesia
What are the issues with tricyclic antidepressants?
Strong side effects - anticholinergic burden and sedating
Weight gain
High BP
