Depression Flashcards
Manic patients have grandiose delusions, what does that mean?
Over inflated sense of worth, power, knowledge, or identity.
Usually gravity intervenes..
Whatbare some ways of presenting with depression?
Examople. Depressive explanation
Old man who forgets: poor concentration
Panic attacks. Anxiety sx 2o to depression
Woman scared she will get AIDs. Obsessional rumination 2o to D
Martial conflict. About sex, due to husb depression and libido loss
In casualties after failed hangingbattempt
Mother unable to cope- post natal depression
What is the categorization of depression?
Mild, moderate, severe, psychotic
If more than 1 episode: recurrent depressive episode
What is dysthymia?
Free of depressive sx, but long standing low mood of insufficient severity for mild depressive disorder.
Lack of pleasure in things being an effort.
Exacerbations at times of stress.
Can be treatable.
Debate whether its a result of depressive personality or chronic depressive disorder. Genetics as well.
What are the factors affecting management decisions in depression?
- Suicidal risk? Give SSRIs and not TCA as less toxic in overdose.
- Psychotic sx? Add antipsychotic to antidepressant, or ECT
- What are the predominant sx? If insomnia- sedative antidepr ss.
- Is there a past hx of depression? Use tx that worked last time
- Past hx of mania? ❌❌‼️ CAUTION w/ antidepressants, may cause mania.
- Are there medical probs? Avoid trycyclics after MI ! ❌
Management of depressive disorders??
- Better recognition by sufferers and doctors
Gps must be confisent.
Tricyclic TCA or selective serotonin reuptake inhibitor: SSRI for a depressive episode.
‼️ educate- 14 days to work
Adequate dose- Amitriptyline at least 100mg/day. Citalopram 20mg.
Chech adherence- apparent non response
Give drug long enough- therapeutic trial 2M
Attend to psychosocial aspects: restore hope, educate about depression, practical advice.
Amitriptyline- 50mg first dose, and then increase to 150 over a week.
There is evidence for prolonged use of antiD in prophylactic role, and none that long term use.
So, continue tx for 6M before tappering off in several weeks- reduced high risk of relapse in Months after a depressive episode.
So, in ppl who relapse, reinstitute the tx that worked, but use it for longer this time.
What happens when non responsive to 1st line tx?
Usually 60% do respond.
- adherence
Increase to max recommended tolerated dose.
Review case, is dx right?
Could there be powerful precipitating factors?
Cushings? Extra cortisol ie stress?
Martial strife, alcohol abuse? Can their impact be reduced?
Swticth meds?ssri or tca? Not enough evidence.
Add Lithium? Or tri-iodothyroine to antiD if D severe. Caution.
MOA inhibitor? Esp if phobic anxiety sx
Referals to psychiatrist.
When do we refer ?
Unresponsive to rx 2nd opinion Specialist drug use combos For acces to social + psych therapy For admission- suicide risk or ECT needed.
Some psychological tx for depression
CBT
Interpersonal psychotherpy
Evidence that reduce relapse
Whats the prognosis?
> 50% with depressive episode will have another.
The more severe the worst.
Most ppl with psychotic D will have multiple episodes and 10% never fully recover.
Suicide: 1/8.
Possible aetiology?
40-50% genetic predisposition but social + psych factors.
Genes overlap with anxiety disorders.
They work directly to increase risk of depression
Major environmental fx: bad childhood experiences (poor parenting, parental loss, traumatic event) , + cuttent psychosocial adveristy.
–> lack of social support
D assc with neuroticism (anxiety, obsessional ability, poor stress coping) , low self estem.
Main dysfx: monoamine neurotransmitter systems: 5-HT3, noradrenaline.
Lesions of subcortical white matter are assc with late onset depressive disorder.
Possible aetiology?
40-50% genetic predisposition but social + psych factors.
Genes overlap with anxiety disorders.
They work directly to increase risk of depression
Major environmental fx: bad childhood experiences (poor parenting, parental loss, traumatic event) , + cuttent psychosocial adveristy.
–> lack of social support
D assc with neuroticism (anxiety, obsessional ability, poor stress coping) , low self estem.
Main dysfx: monoamine neurotransmitter systems: 5-HT3, noradrenaline.
Lesions of subcortical white matter are assc with late onset depressive disorder.
Whats dysthamia?
Persistent mild depression
Can be more than 2 yearls
Low self esteem
Tiredness
When is it commoner?
Female, nomchange with age or ethnic group,
Childhood trauma
Abuse
Social fx
RFs: more common in the prescence of:
Physical illness, esp chronic and stigmatising, painful,
Exs chronic drinking- prbs the most depressive drug used by humans
Social stress, bereavement, seperation, redundancy
What are some sx?
Miserable, irritable mood Anhedonia Lethargy Psychomotor retardation? Slow monotonous talk, Feelings of guilt (past), worthlessness now, hoplessness future, Suicidal thoughts or plans Anxiety Hypochondrial preocupations Impaired learning and concentration !!
