Depression

Question 1

What is unipolar depression

Answer 1

Depression is a disorder characterised by low mood and loss
of interest in previously enjoyed activities

Question 2

Diagnosing Depression

Answer 2

DSM (depressed mood, loss of interest and pressure and at least 3 more from list) or ICD - 11 (depressed mood or diminished interest in activities with other symptoms from list)

Question 3

What is psychotic depression

Answer 3

occurrence of psychosis during an episode of severe depression

Question 4

Difference between schizophrenia and psychotic depression

Answer 4

Schizophrenia has no mood symptoms and symptoms must last at least 2 weeks

Question 5

Risk factors of depression

Answer 5

• Older age
• females
• recent childbirth
• adverse life events
• medications e.g. steroids, hormonal contraceptive, propanolol, L dopa
• co-morbidities e.g. parkinson’s, cardiac disease, hypo/hyperthyroidism, cushing’s, addisons’s, cancer, autoimmune conditions e.g. lupus

Question 6

Depression management

Answer 6

Antidepressants - SSRI, SNRIs, TCA (tricyclic antidepressants), MAOIs (monoamine oxidase inhibitors)

Lithium if psychotic

ECT - elctroconvulsive therpay

CBT
Lifestyle advice
Mindfulness and meditation

Question 7

Examples of SSRIs

Answer 7

sertraline, citalopram, fluoxetine, escitalopram

Question 8

MOA of sertraline

Answer 8

inhibition of reuptake of serotonin (5-HT) at the presynaptic neuronal membrane, thereby increasing serotonergic activity  increased synaptic concentration of
serotonin in the CNS

Question 9

Side effects of SSRIs

Answer 9

gastrointestinal disturbance, appetite changes, tiredness, headaches, bleeding

Question 10

Examples of SNRIs

Answer 10

venlafaxine, duloxetine

Question 11

Side effects of SNRIs

Answer 11

nausea, tiredness, headache, sexual dysfunction, dizziness, appetite increase
(mirtazapine)

Question 12

Examples of TCA

Answer 12

amitriptyline, trazodone, nortriptyline, lofepramine

Question 13

MOA of tricyclic antidepressants

Answer 13

inhibition of monoamine neurotransmitter reuptake in presynaptic neuron,
increasing serotonin and noradrenaline in the synaptic cleft; increase dopamine in prefrontal
cortex; further action at histaminergic, alpha-adrenergic and muscarinic receptors

Question 15

Side effects of TCAs

Answer 15

dry mouth
slight blurring of vision
constipation
problems passing urine
drowsiness
dizziness
weight gain
excessive sweating (especially at night)
heart rhythm problems (arrhythmia), such as noticeable palpitations or a fast heartbeat (tachycardia)

used less as very toxic when overdosed