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Depression Flashcards

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1
Q

prevalence

A

10-20% lifetime

12month 2-5%

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2
Q

mean age of onset

A

27

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3
Q

gender distribution

A

M:F 1:2

equal out with older age over 55yrs

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4
Q

urban vs rural

A

more urban

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5
Q

types of depressive episode

A

mil or moderate +/- somatic syndrome

severe +/- pyschotic symptoms

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6
Q

ICD 10 criteria for dx depression

A

Major:

  1. low mood most days most of the time for >2wks
  2. loss of interest in activities previously found enjoyable
  3. low energy

Minor:

  1. loss of confidence, low self esteem
  2. inappropriate guilt
  3. thoughts of death or suicide
  4. poor concentration/indecisive
  5. psychomotor change
  6. poor appetite
  7. sleep problems
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7
Q

what is mild depression

A

2 major + 2 minor criteria

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8
Q

what is moderate depression?

A

2 major + 4 minor criteria

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9
Q

what is a severe depressive episode?

A

3 major + five minor criteria
somatic always present
+/- psychosis

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10
Q

what is somatic syndrome in unipolar depression

A

four + of the below:

  1. anhedonia
  2. lack of reaction to enjoyable events
  3. early morning waking
  4. depressed mood with diurnal variation
  5. psychomotor change
  6. appetite loss, wt loss
  7. loss of libido
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11
Q

causes of depression

A
  1. genetics

2. structural brain changes

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12
Q

genetics of depression

A

relatives: 9.1% risk
MZ concordance 40-50%
serotonin transporter gene

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13
Q

Structural brain changes in depression

A

reduced volume in hippocampus and caudate nuclei

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14
Q

blood flow in brain in depression

A

altered in

  1. prefrontal cortex
  2. anterior cingulate gyrus
  3. amygdala
  4. basal ganglia
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15
Q

what is the monoamine theory?

A

depression due to probs with serotonin, dopamine and NA levels in brain

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16
Q

evidence for serotonin theory?

A
  1. decreased tryptophan (serotonin precursor) foundin depressed patients
  2. tryptophan low diet - depression like syndrome
  3. antidepressants work on serotonin
  4. low serotonin and precursors in autopsy depressed patients
  5. platelet serotonin binding is decreased in depression§
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17
Q

evidence for NA involvement depression?

A
  1. depression in people who are given NA depleting agents
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18
Q

evidence for dopamine involvement

A
  1. in animals antidepressants increase dopamine

2. dopamine metabolites low in depressed patients

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19
Q

where is dopamine increased with antidepressants?

A

nucleus accumbens

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20
Q

aside from monoamines/genetics - biological causes of depression?

A
  1. endocrine - HPA axis -50% with cushings are depressed + 50% depressed are non suppressed on dexa test
  2. thyroid - 25% depressed patients have blunted TSH response to TRH
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21
Q

Aside from biological causes - causes of depression?

A
  1. social

2. psychological

22
Q

social theories depression?

A
  1. brown + harris
  2. marriage
  3. life events
23
Q

brown + harris?

A

increased depression in women who:

  1. > 3 kids under age of 14
  2. no confiding relationships
  3. not working outside home
24
Q

marriage + depression?

A

lower rates

25
Q

life events and depression?

A

6x increase in life events 6 months before depressive episode - loss events. Threat events = anxiety

26
Q

psychological theories of depression?

A
  1. psychodynamic
  2. cognitive
  3. seligman
27
Q

psychodynamic theories of depression?

A

freud, bowlby + klein

link w/ loss + interpersonal problems in childhood

28
Q

cognitive theories of depression?

A

Beck (developer of CBT) says latent dysfunctional assumptions learned through early experiences activate events which lead to cycle of negative thinking and depressed mood

29
Q

seligman theory depression

A

learned helplessness

30
Q

treatment for depression is guided by?

A

NICE guidelines for stepped care

31
Q

tx for all presentations?

A

Assess
Support
Psychoeducate
active monitoring and refer for any further interventions

32
Q

tx for mild depression

A

Guided self-help
CBT
Activity scheduling
Medication trial if no work

33
Q

tx for moderate and severe depression?

A

SSRI 1st line
increase dose
Use in combo with treatment like CBT/IPT

34
Q

resistant depression tx?

A
  1. Change antidepressant class eg SNRI, TCA, MAOI
  2. augmentation strategies
  3. ECT
35
Q

depression + psychosis tx?

A

antidepressant + antipsychotic

ECT

36
Q

what are the augmentation strategies

A
  1. lithium - effective in 50%
  2. antipsychotics -olanzapine, risperidone, quetiapine
  3. T3 - well tolerated
  4. antidepressant - SSRI + mirtazapine
37
Q

ECT indications?

A
  1. treatment resistant depression
  2. emergency relief of depressive symptoms eg post partum/refusing oral intake
  3. antidepressant meds c/i
38
Q

how likely to relapse?

A

if one episode - 50-85% chance of another

if 2 then 80-90% chance 3rd

39
Q

how long stay on meds after 1st episode?

A

6-9 months from remission of symtpoms

40
Q

how long stay on meds if >2 episodes in recent past?

A

at least 2 years

41
Q

how long do episodes last?

A

average 6 months
25% >1yr
10-20% chronic relapsing remitting course

42
Q

px of depressive episode?

A

average no of epsiodes over 25 years = 5
25% will have 5 years no symptoms
80% risk recurrence

43
Q

suicide risk depression?

A
  1. 15% completed rate
  2. x12 than general population
  3. higher risk earlier in disease
  4. all cause mortality is x2 general public
44
Q

risk factors for future episodes?

A
  1. previous episodes
  2. incomplete remission
  3. bipolar
  4. poor social support
  5. poor physical health
  6. substances
  7. personality disorder
  8. unemployment
  9. poor compliance
45
Q

what is dysthymia?

A
  1. chronic low mood but subthreshold for depression

2. may feel well for periods but chronic brooding, tiredness, sleep probs and insecurity

46
Q

prevalence of dysthymia?

A

lifetime 6%

47
Q

treatment dysthymia?

A

guided selfhelp
CBT
group actiity programmes
Treat with SSRIs if persistent

48
Q

px dysthymia?

A

poor with ongoing symptoms

49
Q

what is seasonal affective disorder?

A

controversial

  1. recurrent depressive episodes with seasonal pattern related to length of daylight
  2. possibly linked to melatonin abnormalities
50
Q

tx for seasonal affective disorder?

A

light therapy in winter time

specific light box with sunlight wavelength light - not tanning beds!

51
Q

What is atypical depression?

A
  1. depression sub-type
  2. depressed mood which is reactive
  3. hypersomnia (>10 hours)
  4. hyperphagia
52
Q

tx atypical depression?

A

similar to depression

possibly better response to MAOIs than others

Psych (23 decks)

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