Depression Flashcards
F:M depression
2:1
Screening questions for depression
- Over last mo, have you been bothered by feeling down, depressed or hopeless?
- over the last mo, have you been bothered by having little interest or pleasure in doing things?
Core sx of depression
- persistent low mood
- loss of interest/pleasure
- fatigue
Other sx of depression
disturbed sleep poor concentration low self esteem change in appetite suicidal thoughts feeling of worthlessness/guilt
DSM IV use
assesses number of core and general sx of depression present
What is sub threshold depression
4 or fewer of DSM IV depression sx is sub threshold depression
What is Dysthymia
Sub threshold depression persisting for 2 yrs
aka chronic subthreshold depression
What is the questionnaire for depression
PHQ-9
Stepped care model of depression mx
Step 1: known or suspected presentations of depression
Step 2: persistent sub threshold or mild to moderate depression
Step 3: persistent sub threshold or mild to moderate depression with inadequate response to step 2 and Moderate to severe depression
Step 4: Severe and complex depression; severe self-neglect
Step 1 mx of depression
Support,
Psychoeducation
Active monitoring
Step 2
low intensity psychological interventions (eg Cognitive behavioural therapy, CBT or structured group physical activity programme)
Consider meds/referral if sx persist
Step 3
- Meds
- high intensity psychological interventions (one to one psychotherapy)
Step 4
- meds
- high intensity psychological interventions (one to one psychotherapy)
- electroconvulsive therapy
- crisis services
- in patient care
Problem solving therapy
step 2 mx
- write a list of problems,
- rank them in order of importance
- suggest solutions
Cognitive behavioural therapy (CBT)
- changing the way pt think/react
- may involve systemic desensitisation (behavioural method)
- or focussing on peoples thoughts and reasoning to challenge assumptions
Mindfullness based cognitive therapy
for people who are well currently but have a hx of 3 prvs depressions
How long do most antidepressants take to work
1-2 wks
How long for antidepressants to reach their peak effect
4-6 wks
When most SEs of antidepressants start to ease
2 wks post start
Main SEs of most antidepressants
GI problems:
- nause
- dry mouth
Increased anxiety
Monitoring after starting on antidepressants
Every 2 peaks until stable
Unless <30 or increased risk of suicide (every 1 wk)
How long should a course of antidepressants be
6 mo, but can be longer if they opt for it
- if 2 or more episodes of major depression, then 2 yrs
Discontinuation reaction to antidepressants
- if used more than 2mo, then suddenly stopped
- sx include headache, nausea, paraesthesia, dizziness, anxiety
How to avoid discontinuation reaction to antidepressants
weaning off over a period of about 1 mo
Meds used for depressin
SSRI SNRI TCA MAOi Mirtazapine
SSRI examples
citalopram,
fluoxetine,
paroxetine
sertraline (fewest interactions)
SNRI examples
Duloxetine or venlafaxine
TCA example
Lofepramine
MAOi example
phenelzine
Mirtazapine mech of action
presynaptic alpha2 antagonist
