Depression Flashcards
Epidemiology of depression
incidence 1.6/100 new cases per year
prevalence 15%
2F:1M
What are the biological symptoms of depression
Loss of interest or pleasure (anhedonia)*
Lack of emotional reactivity
Loss of energy, fatigue*
Insomnia, with early morning wakening* (or hypersomnia)
Diurnal variation of mood
Psychomotor retardation*
Somatic symptoms of depression
Loss of appetite* (or increased& weight gain)
Loss of weight
Constipation
Amenorrhoea
Loss of libido
Psychomotor agitation*
Psychological symptoms of depression
Poor concentration and attention*
Indecisiveness
‘Negative’ or pessimistic thoughts
Poor self-esteem* & low self-confidence*
Guilt* and worthlessness
Hopelessness*
Thoughts of self-harm or suicide*
What is somatisation
When psychological symptoms develop and present like biological symptoms
such as headache or back pain in a depressed individual
How to assess depression
History
PMH
Mental state examination
Risk - social mostly
Screening tools
PHQ-9
Geriatric Depression Scale (GDS)
Hospital Anxiety and Depression Scale (HAD)
What social factors to look into for a depression history
isolation, relationship breakdowns, housing, finances, loss of job etc.
Patient Health Questionnaire (PHQ-9)
Over the last two weeks how often have you been bothered by any of the following
Little interest or pleasure in doing things
Feeling down, depressed, or hopeless
Trouble falling or staying asleep, or sleeping too much
Feeling tired or having little energy
Poor appetite or overeating
Feeling bad about yourself—or that you are a failure or have let yourself or your family down
Trouble concentrating on things, such as reading the newspaper or watching television
Moving or speaking so slowly that other people could have noticed. Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead, or of hurting yourself in some way
What is ICD-10
International Statistical Classification of Diseases and Related Health Problems 10th Revision
How does ICD-10 classify depression
Core symptoms of
Low or depressed mood
Loss of interest and enjoyment
no longer doing hobbies, not looking forward to anything
Loss of energy
increased fatiguability and reduced activity
Subjective tiredness, may be mental and physical
Duration:
more than 2/52
Shorter durations may just be reactive to life events
What do you need to always ask for a patient with suspected mental health problem
Suicide or self harm
Any past attempts to harm yourself?
any current attempts?
Risk to self
Did you think of harming anyone around you?
R u able to cope at home? and managing basic living skills? intoxication?
When to refer a depressed patient to mental health profesionals
inadequate / incomplete response to two or more interventions
recurrent episode within 1 year of last one
history suggestive of bipolar disorder
patient with depression or relatives request referral
more persistent suicidal thoughts
self-neglect.
When do patients need to be urgently refered to mental health specialists
actively suicidal ideas or plans
psychotic symptoms
severe agitation accompanying severe symptoms
severe self-neglect.
supportive Treatment of depression
MANAGE UNDERLYING PHYSICAL DISORDERS / ALCOHOL & DRUG MISUSE
Psychological→ “talking therapies”
IAPT in primary care
Problem focussed, counselling, guided self help
Cognitive Behavioural Therapy - Looks at interactions between thoughts, mood, behaviours and physiological reactions
Medical treatment of depression
Biological → Antidepressants
Selective serotonin reuptake inhibitors (SSRI) e.g. fluoxetine, citalopram, sertraline
Tricyclics e.g. amitriptyline, nortriptyline, lofepramine
Noradrenergic and specific serotonergic antidepressants (NaSSA) e.g. mirtazapine
Serotonin–norepinephrine reuptake inhibitor (SNRI) e.g. venlafaxine, duloxetine
