Depression Flashcards
What are the core symptoms of depression?
Persistent low mood for two weeks
Anhedonia
Lack of energy
Give some somatic symptoms of depression
Early morning wakening Reduced appetite Weight loss Psychomotor retardation Loss of libido
Give some examples of depressive cognitions
Low self esteem Guilt and self blame Hypochondrial thoughts Poor concentration or attention Suicidal thoughts
How is depression diagnosed?
Mild = 2 core + 2 other symptoms
Moderate = 2 core + 3/4 other symptoms
Severe = 3 core + at least 4 other symptoms
All have to be present for at least 2 weeks
What are some risk factors for depression?
Female Past history of mental illness Concurrent chronic illness/pain Ethnicity Genetic
What are some predisposing factors for depression?
Stressful life events
Prolonged adversity e.g. marriage difficulties, problems at work
What investigations would you do for someone presenting with depression?
FBC, TFTs, U&Es, CRP, LFTs
CT/MRI if indicated to rule out an organic cause
What is the management for someone with depression?
1st line = non-pharmacological. 6-8 session intervention such as CBT
2nd line = medication
What are the medication options for someone with depression?
1 = SSRIs 2 = SNRIs 3 = TCSs 4 = MAOIs
What would be the indication to start medication in someone with depression?
Moderate to severe depression
Give some SSRI side effects
Nausea and vomiting Loss of appetite Abdominal pain Insomnia Sweating Fatigue
How do SSRIs work?
Block re-uptake of 5-HT, therefore increasing serotonin levels in the synaptic space to bind to postsynaptic receptors
Give some examples of SSRIs
Sertraline
Citalopram
Paroxetine
Fluoxetine
How do SNRIs work?
Prevent the re-uptake of noradrenaline and serotonin
Give some examples of SNRIs
Venlafaxine
Duloxetine
Give some side effects of SNRIs
Nausea Dry mouth Headache Dizziness Sexual dysfunction
How do TCAs work?
Inhibit the re-uptake of noradrenaline and serotonin in the synaptic cleft
Give some side effects of TCAs
Anticholinergic side effects Drowsiness Tachycardia Hypotension Prolong the QT and PR interval Weight gain Rashes
Give some anticholinergic side effects
Dry mouth Urinary retention Constipation Blurred vision and dilated pupils Increased body temperature
Give some examples of TCAs
Amitriptyline
Dosulepin
Clomipramine
Lofepramine
How do NASSAs work?
Noradrenergic and specific serotenergic antidepressants act to prevent the reuptake of noradrenaline, as well as being an alpha1 and alpha2 blocker
Give some side effects of NASSAs
Weight gain
Increased appetite
Sedation
Dry mouth
Give an example of a NASSA
Mirtazapine
How do MAOIs work?
Act to inhibit the action of monoamine oxidase enzymes which prevents the breakdown of monoamine neurotransmitters
When would you use ECT to treat depression?
Depression which refuses to respond to medication. It seems to be particularly useful in treating patients who have the following factors.
- Psychomotor retardation
- Early-morning wakening
- Psychotic features
- Weight loss
