Depression Flashcards
Core ICD10 symptoms of depression? (3)
Low mood (worse on mornings) Anhedonia Tiredness + fatigue
Other symptoms include? (7)
Reduced concentration Reduced libido Reduced confidence Reduced appetite Sleep disturbances Suicidal thoughts Guilt
Define mild depression?
2 core symptoms + 2 other symptoms
Define Moderate depression
2 core symptoms + 3 other symptoms
Define Severe depression
3 core symptoms + 4 other symptoms
How long does the symptoms have to last be defined as depression?
> 2 weeks and not secondary to the effects of drug/alcohol misuse, organic illness or bereavement
In primary care what is used to screen for depression?
PHQ-9 (Patient Health Questionnaire)
1st line Biological Mx of depression? (1)
SSRI e.g. fluoxetine, citalopram
How many weeks for review if >30 yrs or increase suicide risk?
1 week
When should dose of SSRI being increased or
changed? And why?
After 4-6 weeks
Initial increased motivation until clinical improvement usually after 4-6 weeks. Therefore importance of suicide risk assessment.
Review patients every …. weeks after starting A/D Rx?
1-2 weeks
2nd line drugs include? (3)
SNRI - Venlafaxine
TCA - Amitryptaline, Lofepramine
MAO-I
Which two drug should you NEVER combine?
SSRI + TCA/MAO-II
3rd line drugs? (2)
Lithium + NASSA
4th line?
ECT (severe refractory depression)
What is the Monoamine Theory of depression?
Depression is associated with: NAd (noradrenaline) +5HT (serotonin) (Monoamines)
Mechanism of A/D?
Antidepressants rapidly block NAd and 5HT uptake but clinical improvement takes 4-6 weeks
Side effects of A/D? (5)
Can't see (blurred vision), can't pee (urinary retention), can't spit (dry mouth), can't shit (constipation) GI disturbances Sexual dysfunction/loss of libido Drowsy Weight gain QTc prolongation
Common complications? (3)
Serotonin syndrome - increased 5HT (occurs in SSRI’s, TCA, MAOI, St Johns Wart, Ecstasy)
Symptoms: fever, restless, tremor arrhythmias, confusion, seizures,
Hyponatraemia - anorexia, nausea, malaise, headache, confusion, seizures (all A/D but SSRI’s the worst)
Suicide
Which A/D is the best/worst if hyponatraemia present ?
Main S/E of this drug?
Best: Mirtazapine (NASSA)
Worst: SSRI
Weight gain
How to prevent treatment withdrawal?
Wean off slowly (4 weeks)
What is the high risk A/D’s for this? (2)
Paroxetine (SSRI) and Venlafaxine (SNRI)
How does ECT work?
Induces a seizure (under GA)
How responsive is it?
70-80%
Duration of treatment?
SE? (3)
x2 weekly for 12 weeks
Headache, nausea, muscle pain
1st line psychological Mx?
Sleep hygeine
2nd line?
Regular exercise
3rd line? What grade used for?
CBT (Moderal to severe depression)
4th line?
IPT (interpersonal therapy)
What grade of depression is this used for?
Moderate to severe
5th line?
Behavioural action
Social Mx? (2)
Food banks & support groups
Carers
Organic causes? (5)
neuro - CVA, epilepsy, PD, brain tumour, MS
Infection - HIV, EBV
Endocrine - hypothyroidism, cushings, Addison’s, parathyroid disease
CV - MI, CHF
Rheumatoid arthritis
