Depression

Question 1

Core ICD10 symptoms of depression? (3)

Answer 1

Low mood (worse on mornings) 
Anhedonia 
Tiredness + fatigue

Question 2

Other symptoms include? (7)

Answer 2

Reduced concentration 
Reduced libido 
Reduced confidence 
Reduced appetite 
Sleep disturbances 
Suicidal thoughts
Guilt

Question 3

Define mild depression?

Answer 3

2 core symptoms + 2 other symptoms

Question 4

Define Moderate depression

Answer 4

2 core symptoms + 3 other symptoms

Question 5

Define Severe depression

Answer 5

3 core symptoms + 4 other symptoms

Question 6

How long does the symptoms have to last be defined as depression?

Answer 6

> 2 weeks and not secondary to the effects of drug/alcohol misuse, organic illness or bereavement

Question 7

In primary care what is used to screen for depression?

Answer 7

PHQ-9 (Patient Health Questionnaire)

Question 8

1st line Biological Mx of depression? (1)

Answer 8

SSRI e.g. fluoxetine, citalopram

Question 9

How many weeks for review if >30 yrs or increase suicide risk?

Answer 9

1 week

Question 10

When should dose of SSRI being increased or

changed? And why?

Answer 10

After 4-6 weeks
Initial increased motivation until clinical improvement usually after 4-6 weeks. Therefore importance of suicide risk assessment.

Question 11

Review patients every …. weeks after starting A/D Rx?

Answer 11

1-2 weeks

Question 12

2nd line drugs include? (3)

Answer 12

SNRI - Venlafaxine
TCA - Amitryptaline, Lofepramine
MAO-I

Question 13

Which two drug should you NEVER combine?

Answer 13

SSRI + TCA/MAO-II

Question 14

3rd line drugs? (2)

Answer 14

Lithium + NASSA

Question 15

4th line?

Answer 15

ECT (severe refractory depression)

Question 16

What is the Monoamine Theory of depression?

Answer 16

Depression is associated with: NAd (noradrenaline) +5HT (serotonin) (Monoamines)

Question 17

Mechanism of A/D?

Answer 17

Antidepressants rapidly block NAd and 5HT uptake but clinical improvement takes 4-6 weeks

Question 18

Side effects of A/D? (5)

Answer 18

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

Question 19

Common complications? (3)

Answer 19

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

Question 20

Which A/D is the best/worst if hyponatraemia present ?

Main S/E of this drug?

Answer 20

Best: Mirtazapine (NASSA)
Worst: SSRI

Weight gain

Question 21

How to prevent treatment withdrawal?

Answer 21

Wean off slowly (4 weeks)

Question 22

What is the high risk A/D’s for this? (2)

Answer 22

Paroxetine (SSRI) and Venlafaxine (SNRI)

Question 23

How does ECT work?

Answer 23

Induces a seizure (under GA)

Question 24

How responsive is it?

Answer 24

70-80%

Question 25

Duration of treatment?

SE? (3)

Answer 25

x2 weekly for 12 weeks

Headache, nausea, muscle pain

Question 26

1st line psychological Mx?

Answer 26

Sleep hygeine

Question 27

2nd line?

Answer 27

Regular exercise

Question 28

3rd line? What grade used for?

Answer 28

CBT (Moderal to severe depression)

Question 29

4th line?

Answer 29

IPT (interpersonal therapy)

Question 30

What grade of depression is this used for?

Answer 30

Moderate to severe

Question 31

5th line?

Answer 31

Behavioural action

Question 32

Social Mx? (2)

Answer 32

Food banks & support groups

Carers

Question 33

Organic causes? (5)

Answer 33

neuro - CVA, epilepsy, PD, brain tumour, MS
Infection - HIV, EBV
Endocrine - hypothyroidism, cushings, Addison’s, parathyroid disease
CV - MI, CHF
Rheumatoid arthritis