Depression Flashcards
What is it
- Both NEGATIVE AFFECT (low mood) and/ or ABSENCE of POSITIVE AFFECT (loss of interest and pleasure in most activities)
- usually accompanied by emotional , cognitive, physical + behavioural symptoms
How common is it
Most common psychiatric disorder
2.6-15%
Who is affected
- Mid 30s F>M (2:1)
- Low S/EC + unemployed
What are the risk factors for depression
- Female (increased w/ pregnancy + post-natal)
- Past Hx
- Significant illness cuasing disability/ pain
- Other mental health problems e.g. dementia
- Afro-caribbean, Asian, refugee, asylum seekers
What is the clinical presentation of depression
CLASSIFICATION – to diagnose major depression (DSM-IV)
• Need to have at least 1 or core symptoms (persistent for at least 2 weeks)
- Persistent sadness/ low mood nearly every day
- Loss of enjoyment or interest in activities (ANHEDONIA)
• Plus some of following symptoms
- Fatigue or loss of energy.
- Worthlessness, excessive or inappropriate guilt.
- Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts.
- Diminished ability to think/concentrate or increased indecision.
- Psychomotor agitation or retardation.
- Insomnia/hypersomnia.
- Changes in appetite and/or weight loss
May just present with somatic symptoms
What are the different stages of depression
- Subthreshold depressive symptoms = <5 symptoms
- Mild = +5 symptoms w. only minor functional impairment
- Mod = Symptoms + function impairment between mild + sev
- Sev = most symptoms present + interfere w. normal function - can occur w. or w/out psychotic symptoms
What are some DDx
- Organic causes e.g. back pain
- Dementia
- Grief
- Sleeping pills
What investigations do you perform
- Used to exclude biological reasons for symptoms
- -> BLOODS
- -> IMAGING - where presentation atypical + cranial lesion indicated
- Mental state exam
- Screening tools: PHQ-9, geriatric depression scale (GDS), hospital anxiety + depression scale (HAD)
ALWAYS ASSES SELF-HARM RISK
- Suicide + self-harm - past-attempts, current thoughts
- Risk to self –> able to cope at home, basic living skills, intoxication
- Risk to identify –> forensic evidence, impulsivity, any identified targets
What is involved in the PHQ questionnaire
“Over the last 2 weeks, how often have you been bothered by any of the following problems?” Each item rated 0-3 Total Score Depression Severity • 0-4 None • 5-9 Mild depression • 10-14 Moderate depression • 15-19 Moderately severe depression • 20-27 Severe depression
- 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 the treatment for depression
Biological –> antidepressants
- SSRI e.g. fluoxetine, citalopram, sertraline (lower risk interactions)
- Tricyclics e.g. amitriptyline
- NaSSA e.g. mirtazapine
- SNRI e.g. venlafaxine
CBT
Do not use antidepressants to treat mild depression
What is important to tell the patient about antidepressants
- Advise pt. to be vigilant about suicidal thoughts at start of treatment, it takes 2-4 weeks to improve, should be taken at least 6 months in order to recover
- Antidepressants aren’t addictive
- Take medication as prescribed and not stop suddenly to avoid discontinuation symptoms (dizziness, nausea, paraesthesiae, anxiety, diarrhoea, flu-like symptoms and headaches)
- DVLA recommends not driving in first month due to sedating effects
