Depression Flashcards
How is a diagnosis of depression made?
2 core symptoms + 2 typical symptoms
What are the core symptoms of depression?
- Depressed mood for most of the day, every day.
- Anhedonia: loss of interest/pleasure
- Fatigue
What are the other symptoms of depression?
- Poor appetite with weight loss >5% of body weight
- Disrupted sleep
- Psychomotor retardation or agitation
- Decreased libido
- Reduced ability to concentrate
- Feelings of worthlessness, gilt or self-reproach
7 Thoughts of death, suicide ideation, suicide attempts
What is the criteria for mild depression?
2 core, 2 other
What is the criteria for moderate depression?
2 core, 3+ other
What is the criteria for severe depression?
3 core, 4+ other
What is the management of mild depression?
Low intensity psychological interventions:
- sleep hygiene, mindfulness, problem solving techniques
- self help, computerised CBT, group based programmes
What is the management of moderate depression?
Antidepressant + high intensity psychological intervention:
- 8-12 session CBT or interpersonal therapy
What is the management of severe depression?
Rapid specialist mental health assessment + consider inpatient admission or ECT
Which anti-depressant is recommended for first episode of depression?
SSRI
What lifestyle changes should be suggested to patients with depression?
Exercise (in wild nature) Tai chi Yoga Social interaction Psychotherapy Reading clubs Meditation Poetry
What are the risk factors for suicide? *
Low mood/anhedonia for >2 weeks and >4 of: Suicide plan/ideas of self harm Unexplained guilt/worthlessness Inabilty to function Concentration impaired Impaired appetite Decreased sleep/early waking Energy low
How should you counsel someone starting an SSRI?
- Full effect may take 6 weeks
- Effective dose will be continued >6m after recovery
- Monitor FBC (GI bleed) and U&Es (hyponatraemia)
- ECG (citalopram causes prolongation of QT interval)
- Risks of discontinuation/ withdrawal Sx
What are three examples of SSRIs?
Citalopram
Sertraline
Fluoxitine
What are some examples of Tricyclic antidepressants?
Amitryptiline
Nortriptyline
