Depression Flashcards
Most commonly used diagnostic tool
Patient Health Questionairre
Two Whooley Questions
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you often been bothered by having little interest/pleasure doing things?
If symptoms present most days for ≥2 weeks + “Yes” to Whooley questions, ask about
🔹 Sleep changes – Increased or decreased (CKS: Insomnia)
🔹 Appetite/weight changes – Increased or decreased
🔹 Fatigue – Loss of energy (CKS: Tiredness/Fatigue)
🔹 Psychomotor changes – Agitation or slowing down
🔹 Cognitive issues – Poor concentration or indecisiveness
🔹 Worthlessness/Guilt – Excessive or inappropriate guilt
🔹 Suicidal thoughts – Recurrent thoughts, plans, or attempts (CKS: Self-harm)
Types of depression
Subthreshold, mild, moderate, severe
Subthreshold
➡️ Fewer than 5 symptoms of depression
➡️ Symptoms cause distress but do not meet the full criteria for a depressive episode
Mild depression
➡️ Few or no extra symptoms beyond the 5 needed for diagnosis
➡️ Minor functional impairment only
Moderate depression
➡️ Symptoms or functional impairment are between mild and severe
➡️ More than 5 symptoms with clear functional impairment
Severe depression
➡️ Most symptoms present, including severe distress
➡️ Marked and significant functional impairment
➡️ May include psychotic symptoms (hallucinations or delusions)
When is depression diagnosed?
If pt has 5/9 symptoms and at least one core symptom
When is subthreshold depression diagnosed?
≥2 but <5 symptoms required for diagnosis- usually able to cope with everyday life.
Persistent subthreshold/dysthymia is diagnosed if…
pt has at least 2 years of depressed mood for more days than not (which is not the consequence of partially resolved major depression) and has ≥2 but <5 symptoms required for diagnosis.
When is seasonal effective disorder diagnosed?
if pt has episodic depression recurring annually, same time of each year, with remission between.
How to antidepressants work briefly.
Act by altering levels of monoamines (serotonin/norepinephrine)
When do antidepressants usually cause improvements?
improve after 1-2 weeks, and if no response seen at 4 weeks, a different antidepressant can be used
Types of antidepressants
Monoamine oxidase inhibitors
Trycyclic antidepressants
SSRIs
SNRIs
Monoamine oxidase inhibitors
· Increase 5-HT + NE available in the cytoplasm of presynapticneurones by inhibiting degredagation of monoamines
· ↑ Cytoplasmic monoamines Leads to increased uptake + storage of 5-HT and NE in synaptic vesicles along with some constitutive leakage of monoamines into the extracellular space
· e. g. Phenelzine + moclobemide
Tricyclic antidepressants
Derive their name from their common chemical backbone-consists of 3 rings including 2 aromatic rings attached to cycloheptate ring
· inhibit reuptake of 5HT + NE from extracellular space by blocking their transporters- do not affect DA reuptake.
· useful also for treating pain syndromes+ often used for this indication at lower doses- useful for migraine headaches, somatic pain disorders + chronic fatigue syndrome.
· Examples include imipramine + amitriptyline.
SSRIs
First line treatment for depression/anxiety in combo with CBT- higher sensitivity and reduced adverse effect profile compared to TCAs
First approved SSRI= Fluoxetine
Similar mechanism of action to TCAs except that SSRIs are significantly more selective for 5-HT transporters
· Inhibition of serotonin reuptake= ↑ serotonin in extracellular space= ↑ 5-HT receptor activation= enhanced postsynaptic responses
· Low doses= bind primarily to 5-HT receptors , higher doses= lose selectivity+ also bind to NE transporters
· Have few adverse effects- lack significant cardiotoxicity + do not bind avidly to muscarinic (cholinergic),
histamine, adrenergic or DA receptors-> so better tolerated than TCAS.
· Enhanced Selectivity-greater therapeutic index than TCAS.
Examples of SNRIs
Venflaxine and Duloxetine
