Depression (2)

Question 1

What is used to assess it?

What are its core symptoms?

What are its other symptoms?

What is needed for a diagnosis?

The addition of which symptoms would indicate Psychotic depression?

Answer 1

➊ PHQ-9 questionnaire

➋ ↓Mood, ↓Energy, Anhedonia

➌ • Disturbed Sleep
• ↓Appetite
• ↓Concentration, Memory
• ↓Self-esteem and Self-confidence
• Guilt, Worthlessness
• Self-harm or suicidal thoughts
• ↓Libido
• Headache
• Weight Loss

N.B. Early morning waking is a pathognomonic for depression

➍ 2 core + > 2 other symptoms that are present nearly every day for 2+ weeks

➎ Delusions and Hallucinations

Question 2

What are its organic differentials?

What are its psychiatric differentials?

Answer 2

➊ • Neurological - Parkinson’s, Dementia and Multiple sclerosis
• Endocrine - Thyroid disease, Cushing’s, Addison’s
• Drugs - Steroids, Alcohol, Drug abuse, Isotretinoin, B-blockers, Benzos
• Chronic conditions - Diabetes, OSA
• Cancer

➋ • Dysthymia - Chronic, low grade depressive symptoms
• Bipolar disorder - Episodes of mania and depression
• Schizophrenia
• Dementia
• Seasonal affective disorder
• Bereavement
• Anxiety

Question 3

Which investigations should be done?

Answer 3

• Careful hx
• Ruling out other potential differentials:
‣ Bloods - FBC, TFTs, Cortisol, Glucose, Toxicology screen
‣ MRI/CT Head

Question 4

Management:
What is typically 1st line?

What is given if the 1st line option wasn’t effective?
→ How is it given if pt benefits from it?

What are the side-effects of SSRIs?

What are the side-effects of TCAs?

Answer 4

➊ * Group-based CBT
* Interpersonal therapy

➋ SSRI e.g. Sertraline, Citalopram, Fluoxetine
→ Continue SSRI for at least 6+ months following remission of symptoms to reduce the risk of relapse, and the dose should be gradually tapered down
* Mirtazapine is a NaSSA, which is generally given as 2nd line if an SSRI is inappropriate/ineffective

N.B. Fluoxetine is the only one to be used in children.

➌ * Prolonged QT interval
* GI upset (diarrhoea, n+v)
* Gastric Ulcer
* Anxiety and agitation
* Sexual dysfunction
* Hyponatraemia

➍ Anti-cholinergic activity: Can’t see (blurred vision), Can’t pee (urinary retention), Can’t spit (dry mouth), Can’ s*** (constipation)
* Constipation
* Dry mouth
* Urinary retention
* Blurred vision
* Drowsiness