Depression Flashcards
Define depression
- Feelings of sadness, loss of interest/pleasure, feelings of guilt or low self-worth, disturbed sleep and appetite
- Persists for > 2 weeks
- Feelings interfere with life
What is the epidemiology of depression?
- 1 : 6 in UK
- Incident rate of 3-6% of adults
What are the risk factors of depression?
Female:Male = 2:1
- More willing to come forward
- Pregnancy and postpartum depression
Middle aged men
PHx/FHx Mental illness/chronic illness
Refugee/asylum seeker
MSE: Appearance & Behaviour of depressed patient
Possibly unkempt
Lack of interest in looks and hygiene
Tearful
Minimal eye contact
Hard to engage
MSE: Speech of depressed patient
speech rate = reduced volume = soft tonality = monotonous quantity = minimal ease of conversation = possibly hard
MSE: Mood of depressed patient
Subjective - how patient feels
Objective - how patient seems
Low mood = Dysphoric
MSE: Thoughts of depressed patient
Form
- Maybe preoccupation of thought
- Delusion - obsessive thoughts
Content
- Feelings of low self worth
- Feelings of guilt
- Feelings of self harm/suicide
- Lack of future plans
MSE: Perceptions of depressed patient
Should not be any unless deteriorated into acute psychoses
MSE: Cognition
- Should be intact
- Can orientate to time, place, person
MSE: Insight of depressed patient
?Acknowledgement of condition
Awareness of pathological events - suicidal impulses
What are the 2 useful screening questions for depression?
- In the last month have you often been bothered felt down, depressed or hopeless?
- In the last month have you often been bothered by having little interest or pleasure in doing things?
YES TO EITHER = FURTHER ASSESSMENT
What further assessments can be used for depression?
- HOSPITAL ANXIETY AND DEPRESSION SCORE (HAD)
- 7 Qs for depression + 7 Qs for anxiety
- Produces score out of 21 for both depression and anxiety
- Severity: 0-7 = normal, 8-10 = borderline, 11 + = positive conditions - PATIENT HEALTH QUESTIONNAIRE
- 9 items inc. self-harm assessment
- Severity: 0-4 = none, 5-9=mild, 10-14 = moderate, 15-19 = moderately severe, 20-27 = severe
How does the ICD-10 rank depressive episodes?
Has 2 categories for symptoms
1) MAIN
- Depressed mood
- Anadonyia (loss of interest)
- Reduced energy and activity
2) ACCESSORY
- Reduced concentration
- Reduced self-esteem
- Ideas of guilt and self-worth
- Pessimistic thoughts
- Disturbed sleep
- Diminshed appetite
- Ideas of harm
F32.0 Mild episode
-2 or 3 symptoms but can continue activities
F32.1 Moderate episode
>+4 symptoms - difficulty in activities
F32.2 Severe depression w/o psychosis
-Several symptoms, debilitating, suicidial thoughts and acts common
F32.3 Severe depression w/ psychosis
F33 Recurrent depression
What other subtypes of depression can occur?
Atypical depression
Psotnatal depression
Seasonal affective disorder
Premenstrual dysphoric disorder
How is depression diffierentially diagnosed from dementia?
- Short Hx & rapid onset
- Biological symptoms e.g. weight loss, sleep disturbances
- Pt worried about memory loss (rather than no insight into memory loss)
- Reluctance to take tests, disappointed with results
- Mini mental test score variable
- Global memory loss
What are the various treatment options for depression?
GENERAL
-sleep hygiene, remain physically healthy, active monitoring
PSCYHOLOGICAL INTERVENTIONS
-CBT (One on one, computerised, group)
MEDICAL
- SSRI
- SNRI
- TCAs
- MAOis
- Noradrenergic & specific serotenergic antidepressants
What is the drug profile for SSRIs
SELECTIVE SEROTONIN UPTAKE INHIBITORS
e.g. fluoxetine, citalopram, sertraline (1st line)
MOA: Increase extracellular serotonin by limiting reabsorption
SE: sexual dysfunction, withdrawal, insomnia, hyponatraemia
CONTRA: warfarin (use mirtazapine instead)
How should taking SSRIs be communicated?
- 1 tablet everyday
- Will take 4-6 weeks before feeling the effects
- Reports of anxiety in first 2 weeks so keep people around you
- standard course 3-6 months AFTER FEELING BETTER
- Must taper dose so if feel better need guidance to reduce otherwise withdrawal
What is the drug profile of SNRIs?
SEROTONIN NORADRENALINE REUPTAKE INHIBITORS
E.g. duloxetine, venaflexaine
MOA: Increases extracellular serotonin and noradrenaline by limiting reabsorption
SE: sexual dysfunction, withdrawal, insomnia, hyponatraemia, may increase BP
What is the drug profile for TCAs?
TRICYCLIC ANTIDEPRESSANTS
e.g. amitriptyline
MOA: Blocks serotonin and Na+ transporters resulting in elevation in their synaptic connections
SE: Anti-muscarinic (dry mouth, constipation, blurred vision, urinary retention), hyponatraemia
Notes: dangerous in overdose
What is the drug profile for MOAs?
MONOAMINE OXIDASE INHIBITORS
e.g. moclobemide, phenelzine, selegine
MOA: Inhibits monoamine oxidase (enzyme) the breaks down monoamines
SE: HTN (hypertensive crisis esp. when eating cheese), hepatocellular jaundice, hyperthermia
What is the drug profile for NaSSAs?
Noradrenergic & specific seroternergic antidepressants
e.g. Mitazapine
- GI Problems
- Can be sedating but good for sleep
