Depression

Question 1

What are some risk factors for depression?

Answer 1

• Gender; female during reproduction, then trend reverses
• Age; younger onset, short duration; less frequent with elderly
• Marital status; highest in separated, then widowed then divorced
• Socio-economic factors
• Ethnicity; female + highest (asian/ oriental, white, african/ west indian) lowest
  male no difference

Question 2

What are the 3 key symptoms of depression?

Answer 2

• low mood
• anergia
• anhedonia

Question 3

What are the possible causes of depression?

Answer 3

• Physical causes e.g. metabolic causes such as hypothroidism
• Iatrogenic - due to medications
• LOSS/ REGRET OF: job status, relationship, health

Question 4

Step 1 NICE guidelines for depression:

Answer 4

All known and suspected presentations of depression:
Access all those that are high risk patients:
- co morbidities e.g. HTN, DM, ms, chd
- history of depression (relapse)
- other mental health problems e.g. dementia
SCREENING QUESTIONS
‘during the last month have you felt bother by feeling down, depressed or hopeless?’ - these will explore/ assess key symptoms/ duration

Question 5

Step 2 NICE guidelines for depression:

Answer 5

• Treatment of persistent sub-threshold depressive symptoms, mild to moderate depression.
• If patient doesn’t want treatment or may recover without further intervention then reassess after two weeks,
• Manage sleep and anxiety
• Advise them to exercise for 40/60 mins 3/7, for 10- 12 weeks
• Guided self-help
• Computerised CBT
• CBT
• Cognitive Analytical Therapy
• Interpersonal therapy

Question 6

What are the step 2 NICE guidelines on antidepressant use?

Answer 6

• NOT recommended for initial treatment of mild depression because risk: benefit ratio is poor
• When mild depression persists after other interventions (see before) or is associated with psychological or medical problems consider use of an AD
• If a patient with a history of moderate or severe depression presents with mild depression consider (early) use of an AD.

Question 7

What are the step 3 NICE guidelines for depression?

Answer 7

For persistent sub threshold or mild to moderate depression that failed to respond to initial interventions or moderate/ severe patients. ADs should be offered routinely for ALL patients before psychological interventions.

Question 8

What are the step 3 NICE guidelines for AD counselling??

Answer 8

• addiction
• side effects
• withdrawal symptoms if discontinued
• delay in full benefit
  CONSIDER REFERRAL

Question 9

When a pt fails to respond to the initial AD (general SSRI) THEN

Answer 9

• check if pt has been taking as prescribed; correct frequency, dose, and duration etc.
• if response at standard dose is inadequate and side effects are tolerable then consider increase in dose
• if no response after one month then consider switching to another AD BUT if there is a partial response then delay decision to switch for another 6 weeks
• if AD is ineffective and/or poorly tolerated, switch to another AD

Question 10

What are the second line antidepressants?

Answer 10

Another SSRI
Mirtazapine
Moclobemide
TCA e.g. amitriptyline

Question 11

Monitoring risk?

Answer 11

• If patient is

Question 12

When stopping AD treatment, if patients experience mild withdrawal symptoms then…
if they experience severe then

Answer 12

reassure

re-introduce and decrement even more gradually

Question 13

MoA of ADs: Almost all ADs increase either

Answer 13

Serotonine and/ or Noradrenaline, post-synaptically

Question 14

What are the side effects of TCAs?

Answer 14

Anticholinergic; dry mouth, blurred vision, constipation
BP disturbances
High blood glucose
Sedation

Question 15

What are the side effects of MAOIs?

Answer 15

main issue is food/ drug interactions resulting in possible hypertensive crisis

Question 16

What are the side effects of SSRIs?

Answer 16

Nausea, agitation, akathisia, anxiety, GI upset, sexual dysfunction,