Depression Flashcards
How long do depression symptoms need to be present for to make it depression?
2 weeks
What are the three core symptoms of depression?
Persistent low mood
Anhedonia
Fatigue
What are the common side effects of antidepressants?
GI upset Sleep effects Agitation Sexual dysfunction Hyponataemia GI bleed (antiplatelet activity) Suidical risk
With MAOI inhibitors what foods can you eat and why?
Tyramine rich foods so cheese, red wine, bovril
Can cause a hypertensive crisis
What factors might suggest that CBT should be used over pharmacological methods?
Pt has mild/moderate depression
Pt is willing to think about psych issues
Willing to engage and carry out homework (motivated)
Pt would prefer psych treatment over pharma
All the standard antidepressants used in psych are
monoamine reuptake inhibitors
or
monoamineoxidase inhibitors?
Mono amine reputake inhibitors
Name some mono amines
Histamine Dopamine Noradrenaline Adrenaline Melatonin
Name some catecholamines?
Noradrenaline
Adrenaline
Dopamine
How long should someone stay on antidepressant treatment after they have recovered from their first episode?
6-9 months
If someone has multiple episodes how long should they stay on antidepressant therapy for?
2 years
Why does someone need antidepressant therapy after they have recovered?
How effective is this?
To reduce the rate if relapse
Cuts relapse rates by 50%
If the therapy isn’t working what are the first things you should do?
Compliance
Increase to max dose
Review the case for correct diagnosis and ask about perpetuating factors eg social issues/ alcohol / drugs etc
If he antidepressant therapy still doesn’t work what are your options?
Switch drug to SSRI or mirtrazapine then
Add lithium in severe depression
Add mirtrazapine
Add antipsychotic ( (psychotic symptoms/ agitated/ insomnia)
Add CBT
If the depression is multi drug resistant what treatment options are there?
ECT
When else might ECT be the best form of treatment?
When you need a quick response to treatment
If someone has had one depressive episode what is the likelyhood that they will have another?
50%
Is the management of depression in bipolar disorder the same a unipolar depression?
No
What are the features of serotonin syndrome?
1)Autonomic dysfunction, 2)neuromuscular hyperactivity,
3) altered mental state
So
Tachycardia
Sweating
Shivering
Hyperthermia
Hyperreflexia
Name some seretonergic drugs?
MAOI
Ltryptophan
Lithium
St johns wort
What do SSRIs do?
Block the reputake transporters in the pre synapse to leave more seretonin in the cleft
Name some SSRIs
Citolopram Escitalopram Fluoxetine Fluvoxamine malfeate Paroxetine Sertraline
What are SNRIs?
Seretonin and noradrenaline reputake inhibitors
Name an SNRI?
Venlefaxine
What are SSRIs better that TCAs
Less side effects and less toxic in an overdose
What is the antidepressant most likely to cause hyponatraemia?
And in which patient group?
SSRI
Elderly
Which of the SSRIs is most likely to give withdrawal effects?
Paroxcitine
What is the medical name of at johns wort?
Hypericum
Why do doctors advice against at johns wort?
Less well researched
Various strengths for sale
Interferes with other medications eg COCP
What is the trade name of fluoxetine?
Prozac
How do tricyclic antidepressants work?
Inhibit presynaptic noradrenaline and and seretonin transporters
What other conditions are tricyclics used to treat?
Neuropathic pain
Bladder instability
Migraine prophylaxis
TCAs can have an antimuscurinic effect. Name some antimuscurinic side effects?
Dry mouth
Blurrd vision
Constipation
Urinary retention
TCAs may interact with alpha 1 adrenergic receptors, what sideeffects can this cause?
Postural hypotension
Drowsiness
Sexual dysfunction
What is the benefit about lofetramine (a TCA)?
Less side effects than the other
Relatively nonsedating
Name three other receptors that tricyclics block
Muscurinic
Alpha 1adrenergic
Histamine
Two main side effects of mirtrazapine (can be useful)
Weight gain
Sedative
What is the therapeutic window for lithiumv
0.5-1mmol/L
How often should lithium levels be measured?
At first weekly then every three months
How soon after taking a lithium dose should levels be measured?
12 hours
What are the side effects of lithium?
Tremor Dry mouth Polydipsia/polyuria Weight gain Hypothyroid
What are the indications for lithium?
Bipolar
Mania
Recurrent depression
Agressive self harming behaviour
In tricyclic overdose will the pupils dilate or constrict?
Constrict
What are the main two organs that lithium affects?
Kidneys and thyroid
What are the signs of lithium toxicity?
Vomiting/ diarrhoea
“Being drunk” ataxia in coordination slurred speech
Course tremor
If someone suspects lithium toxicity what should they do?
Drink lots of water
Stop the lithium
See GP/A&E
If someone is taking lithium and it is working really well for their mood but they have a tremor, what drug can be added?
Beta blocker
What common drug should you advise people taking lithium to avoid?
Ibruprofen
What is the best SSRI in breast feeding?
Paroxitine- very small amounts in breast milk
What is the risk of using SSRIs in pregnanacy?
In first tried ester chance of congenital heart defects
In third risk of withdrawal symptoms in baby
