Depression Flashcards
How to diagnose depression
- Symptoms must be present every/nearly every day, with no changes throughout the day for >2wks
- Which is different from normal personality, without alcohol/drugs/illnesses/bereavement
- 2 core symptoms + 2 typical symptoms
3 core symptoms
- Depressed mood, every day, most of the day with little variation regardless of situation
- Anhedonia, loss of interest/pleasure in daily life/enjoyable activities
- Fatigue
5 typical symptoms
- Poor appetite, marked weight loss
- Disrupted sleep, insomnia/waking early
- Psychomotor retardation (limited spontaneous movement/sluggish thought processes)
- Decreased libido
- Recurrent thoughts of death/suicide/attempts (passive or active)
- Feelings of worthlessness or inappropriate guilt
DDx for depression
- Bipolar disorder
- Schizophrenia
- Anorexia nervosa
- Dementia
- Sleep disorders
- Medications (B-blockers)
When would a diagnosis of mild, moderate and severe depression be made
- Mild = 2 typical + 2 core symptoms
- Moderate = 2 + >/=3 core symptoms
- Severe = 3 typical + >/=4 core symptoms
Management of mild depression
Low-intensity psychological interventions:
- Sleep hygiene
- Anxiety management (mindfulness)
- Problem solving techniques
Can include self help books/websites/apps e.g. headspace
When should anti-depressants be used in mild depression
- Symptoms last >8wks
- Hx of depression
Management of moderate depression
- Combination of anti-depressants and high-intensity psychological intervention
- CBT/interpersonal therapy
- If 1st episode of depression use SSRIs
Management of severe depression
Includes psychotic depression, high risk of suicide and atypical depression
- Rapid mental health assessment
- May need inpatient admission (MHA may be necessary)
- ECT
Management of recurrent depression
- Intervene quickly + early
- If drug worked previously will probably work again
- CBT to manage residual symptoms
Benefit of continuing medication after “cure”
Reduces recurrence by 65%
Herbal remedy for depression and should it be used
- St John’s wart
- Similar efficacy + less side effects compared to traditional antidepressants
- NOT recommended, as upregulates cytochrome p450 (COCP less effective)(different preparations will have varied amounts of active ingredient)
Lifestyle changes to Rx depression
- Exercise
- Social interaction (book club)
- Psychotherapy
- Meditation
- Rest from work, plan a phased return
Indications for ECT
- To gain rapid improvement from severe symptoms, after trial of other Rx’s is ineffective
- If the condition is considered life threatening (severe, prolonged, manic episode, severe depression)
What’s important to remember about ECT
After ECT continue with anti-depressants, MAY prevent recurrence (not actually proven yet)
