Depression Flashcards
Depression is…
both negative affect and/or absence of positive affect
negative affect - low mood (in that moment)
absence of positive affect - loss of interest and pleasure in most activities
Core Symptoms for diagnosis of depression
Persistent sadness or low mood nearly every day.
Loss of interests or pleasure in most activities. (anhedonia)
loss of energy (anergia) (/ fatigue)
2/3 Needed, to be present persistently for two weeks and cause distress/impairment
Other symptoms of depression - more = worse
BIOLOGICAL weight loss/gain insomnia or hypersomnia change of appetite change in libido
COGNITIVE psychomotor agitation/impairment poor confidence feelings of worthlessness/guilt bad concentration thoughts/actions of suicide diurnal variation of mood
Risk factors for depression
Female PMHx of depression Chronic illness causing pain/morbidity Other mental health problems (dementia etc) African, Asian, refugee populations
Screening tool for depression
PHQ-9
Investigations can be used to exclude organic causes
What is Dysthymia
a chronic depressive state of more than two years in duration, which does not meet full criteria for major depression and is not the consequence of a partially resolved major depression
Treatment for depression
1) low intensity psychosocial intervention/CBT
2) Anti depressant ( SSRI first, then TCA)
3) high intensity psychosocial intervention (if they have a chronic condition and depression is mod-severe try with out drugs first)
Low intensity psychosocial interventions
Computerised CBT Relaxation therapy Brief psychological interventions - problem-solving therapy, - brief CBT - counselling.
Anti-depressants - first line
Selective serotonin reuptake inhibitors (better than TCAs because side effects arent so bad, and less toxic in overdose)
inhibit serotonin reuptake
take for 6 months
eg, citalopram, fluoxetine, paroxetine, or sertraline
citalopram
SSRI
less drug interactions - good for co-morbidities
can prolong QT interval (arrhythmias) (dose related - ECG)
fluoxetine
SSRI
used in younger people
top 3 neurotransmitters in psychiatric conditions
serotonin - obsessions and compulsions
noradrenaline - anxiety and attention
dopamine - attention, motivation, pleasure
SSRI - side effects
GI upset appetite/weight changes, up or down suicidal thoughts serotonin syndrome bleeding risk lower seizure threshold
what is serotonin syndrome
Symptoms
=serotonin toxicity, from serotonergic agents(SSRI, SNRI, TCA, MAOI, lithium)
The syndrome is the consequence of excessive stimulation of the central nervous system and peripheral serotonin receptors.
autonomic hyperactivity (fever) altered mental state (agitation) neuromuscular excitation (tremor, hyperreflexia, clonus)
leads to rhabdomyolysis - coma - death
name a tricyclic drug for depression (2nd line)
lofepramine
(inhibits serotonin AND noradrenaline reuptake at synaptic cleft)
also block muscarinic, H1, a1, a2 D2 receptors
