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Depression Flashcards

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
life events and depression?
6x increase in life events 6 months before depressive episode - loss events. Threat events = anxiety
26
psychological theories of depression?
1. psychodynamic 2. cognitive 3. seligman
27
psychodynamic theories of depression?
freud, bowlby + klein | link w/ loss + interpersonal problems in childhood
28
cognitive theories of depression?
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
seligman theory depression
learned helplessness
30
treatment for depression is guided by?
NICE guidelines for stepped care
31
tx for all presentations?
Assess Support Psychoeducate active monitoring and refer for any further interventions
32
tx for mild depression
Guided self-help CBT Activity scheduling Medication trial if no work
33
tx for moderate and severe depression?
SSRI 1st line increase dose Use in combo with treatment like CBT/IPT
34
resistant depression tx?
1. Change antidepressant class eg SNRI, TCA, MAOI 2. augmentation strategies 3. ECT
35
depression + psychosis tx?
antidepressant + antipsychotic | ECT
36
what are the augmentation strategies
1. lithium - effective in 50% 2. antipsychotics -olanzapine, risperidone, quetiapine 3. T3 - well tolerated 4. antidepressant - SSRI + mirtazapine
37
ECT indications?
1. treatment resistant depression 2. emergency relief of depressive symptoms eg post partum/refusing oral intake 3. antidepressant meds c/i
38
how likely to relapse?
if one episode - 50-85% chance of another | if 2 then 80-90% chance 3rd
39
how long stay on meds after 1st episode?
6-9 months from remission of symtpoms
40
how long stay on meds if >2 episodes in recent past?
at least 2 years
41
how long do episodes last?
average 6 months 25% >1yr 10-20% chronic relapsing remitting course
42
px of depressive episode?
average no of epsiodes over 25 years = 5 25% will have 5 years no symptoms 80% risk recurrence
43
suicide risk depression?
1. 15% completed rate 2. x12 than general population 3. higher risk earlier in disease 3. all cause mortality is x2 general public
44
risk factors for future episodes?
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
what is dysthymia?
1. chronic low mood but subthreshold for depression | 2. may feel well for periods but chronic brooding, tiredness, sleep probs and insecurity
46
prevalence of dysthymia?
lifetime 6%
47
treatment dysthymia?
guided selfhelp CBT group actiity programmes Treat with SSRIs if persistent
48
px dysthymia?
poor with ongoing symptoms
49
what is seasonal affective disorder?
controversial 1. recurrent depressive episodes with seasonal pattern related to length of daylight 2. possibly linked to melatonin abnormalities
50
tx for seasonal affective disorder?
light therapy in winter time | specific light box with sunlight wavelength light - not tanning beds!
51
What is atypical depression?
1. depression sub-type 2. depressed mood which is reactive 3. hypersomnia (>10 hours) 4. hyperphagia
52
tx atypical depression?
similar to depression | possibly better response to MAOIs than others

Psych (23 decks)

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