Depression Flashcards
What is depression?
Disorder causing persistent feelings of :
- Low mood
- Low energy
- Anhedonia
What is the pathophysiology of depression?
Disturbance in neurotransmitter activity in CNS
Particularly serotonin (5-HT)
What causes depression?
Life events
No apparent triggers
Genetic, psychological, biological and environmental factors
Family history
Physical health conditions
What are the core symptoms of depression?
Low mood
Anhedonia
Low energy
How are the different grades of depression diagnosed?
PHQ9
OR
Mild
2 core + 2 others (able to function!)
Moderate
2 core + 3 (or 4) others
Severe
3 core + at least 4 others
Severe
With psychotic symptoms
What is cyclothymia?
Mild periods of elation/depression
Early onset, chronic course
Common in relatives of BPD
What is dysthymia?
Chronic low mood not fulfilling depression criteria
What are the emotional symptoms of depression?
Anxiety
Irritability
Low self-esteem
Guilt
Hopelessness about the future
What are the cognitive symptoms of depression?
Poor concentration
Slow thoughts
Poor memory
What are the physical symptoms of depression?
Low energy
Abnormal sleep
Poor appetite or overeating
Slow movements
What environmental factors contribute to depression?
- Potential triggers (stress, grief or relationship breakdown)
- Home enviornment
- Relationships with family, friends, partners
- Work
- Financial difficulties
- Safeguarding issues
When taking a history what essential factors must be explored?
Caring responsibilities
Social support
Drug use
Alcohol use
Forensic history
What should a risk assessment look for?
Self-neglect
Self-harm
Harm to others
Suicide
What is used to assess severity of depression?
PHQ-9 questionnaire
What is used to assess depression and what do the different scores mean?
PHQ-9 questionnaire
5-9 - Mild
10-14 - Moderate
15-19 - Moderately severe
20-27 - Severe
What are the management options for depression?
Active monitoring and self-help
Address lifestyle factors
Therapy
Antidepressants (SSRIs are first line)
When should antidepressants be offered first line?
If the patient has a preference for them
Otherwise not a first-line treatment
How are patients with severe or psychotic depression managed?
Specialist input and management
Crisis resolution and home treatment team- offers intense support without patient being admitted
When is admission to hospital required for depression?
High risk of self-harm
Suicide risk
Self-neglect
Immediate safeguarding issues
What specialist treatments can be trialled for unresponsive or severe depression?
Antipsychotic medications (olanzapine and quetiapine)
Lithium
Ectroconvulsive therapy
rTMS
tDCS
What is electroconvulsive therapy?
Very effective treatment
Under general anaesthesia electrodes placed on patient’s head
Short electrical current administered, triggering a short generalised seizure lasting 30 seconds
What are the side effects of electroconvulsive therapy?
Headache
Muscle aches
Short-term memory loss
What is rTMS?
Repetitive transcranial magnet stimulation
Placing electromagnetic coil against head, sends repetitive pulses of magnetic energy at fixed frequency
What is tDCS?
Transcranial direct current stimulation
Small battery-operate stimulator to deliver constant current by 2 electrodes on head
What does psychotic depression generally indicate?
Severe depression
What is psychotic depression?
Involves symptoms of psychosis
- Delusions
- Hallucinations
- Thought disorder
What conditions is ECT licensed for?
Severe life-threatening depression
Treatment resistant depression
Catatonia
Prolonged manic episodes
What are the spectrum of postnatal depressive disorders?
Baby blues
Postnatal depression
Puerpal psychosis
What is the baby blues?
Affects 50% of women in first week post birth
Particularly first-time mothers
- Mood swings
- Low mood
- Anxiety
- Irritability
- Tearfulness
What causes baby blues?
Significant hormonal changes
Recovery from birth
Sleep deprivation
Increased responsibility
Difficulty with feeding
Mild symptoms which usually resolve within 2 weeks
What is postnatal depression?
Depression similar to that outside of pregnancy
Classic triad of :
- Low mood
- Anhedonia
- Low energy
Affects women 3 months after birth
Can develop up to 1 year after birth of baby
How long should symptoms of postnatal depression last before diagnosis?
At least 2 weeks
Treat as you would normal depression
What is puerperal psychosis?
Rare, severe illness 2-3 weeks post delivery
Women experience psychosis
- Delusions
- Hallucinations
- Depression
- Mania
- Confusion
- Thought disorder
Where do mothers with puerperal psychosis get admitted to?
Mother and baby unit
Specialist unit for pregnant women and women who have given birth in past 12 months
Designed to allow mothers to continue to build bond with baby while being treated
What happens in birth trauma/PTSD?
Flashbacks, nightmares or intense upsetting memories of birth
Anxiety, anger, depression, guilt in relation to birth
Not wanting to think about it or thinking about it obsessively
What is tokophobia?
Pathological phobia of birth and pregnancy
1- Never experienced birth before
2- Following traumatic birth
What are the consequences of tokophobia?
Can affect obstetric decisions
Affected bonding with baby
Mental wellbeing during pregnancy
How is tokophobia managed?
CBT
Hypnobirthing
Elective CS
What tool is used to assess postnatal depression?
Edinburgh postnatal depression scale
- How mother has felt over past week
- 10 questions
- Score out of 30
- 10 or more indicates postnatal depression
What SSRI is preferred in postpartum depression?
Paroxetine
Low milk/plasma ratio
Avoid fluoxetine, long half-life
What are some potential risks of SSRIs in pregnancy?
First trimester - small risk of congenital heart defects
Third trimester- can cause persistent pulmonary hypertension of the newborn
Setralline preferred
What SSRI has the highest risk of malformations during pregnancy?
Paroxetine
Particularly first trimester
What are the risks of lithium in pregnancy?
Low risk of ebstein’s anomaly
What can benzodiazepine use lead to in pregnancy?
Possible risks of defects in 1st trimester
Risk of neonatal withdrawals in 3rd trimester (floppy baby syndrome)
What can antipsychotic use lead to in pregnancy?
Prolactin increase can affect fertility
DM risk causing macrosomia
What is Beck’s cognitive triad for depression?
Negative views about the world
Negative views about the future
Negative views about oneself
What is the simplified maintenance cycle?
Feel low
Avoid activity
No reward
What are the key ideas of CBT?
- Socratic questioning
- Formulation
- CBT models of disorder
- Problems and targets
- Collaboration
- Homework
- Make the patient their own therapist
What does appraisal mean in CBT?
People are upset not by the events but the personal meaning that these events have for them
