Depression Flashcards
_______ is the
leading cause of disability for all conditions among
both sexes, both in Australia and worldwide
depression
Depression is a chronic relapsing organic brain
disease. Its mean onset is at _____years of age. However,
40% of sufferers present by _____ years of age
27
20
Stress will also lead to a decrease in the protective
_______ which
can result in neuronal death—also referred to as
‘glional dropout
brain-derived neurotrophin factor (BDNF),
the reason why there is a slow response to antidepressants
poorly understood
biochemical cascade that occurs ‘beyond the receptor’
is the reason for the slow response to antidepressants
The DSM-5 classification divides depressive
disorders into
1. major depressive disorder (MDD), 2, disruptive mood dysregulation disorder, 3. persistent depressive disorder (PDD) 4 premenstrual dysphoric disorder
_________refers to
long-standing (2 years or more) depression of
mild severity.
Persistent depressive disorder (PDD)
_________ is a
less severe form of depression without sufficient
criteria for major depression
Adjustment disorder with depressed mood
Adjustment disorder duration
Its duration is usually no longer than 6 months
The two key criteria for major depressive disorder
(MDD) in the DSM-5 are a _____ and _______ persisting for at least 2 weeks
pervasive depressed mood
and marked loss of interest or pleasure (otherwise
referred to as anhedonia)
2 important questions in screening depression:
• In the past month, have you been bothered by the
fact that you feel down, depressed or hopeless?
• In the past month, have you often been bothered
by the fact that you have little interest or
pleasure in doing things
DSM-5 diagnostic criteria for major
depressive disorder
At least five of the following symptoms nearly every
day for 2 weeks (criterion 1 or 2 essential):
1 depressed mood (subjective or objective)
2 loss of interest or pleasure
3 change in weight (5% change over 1 month) or
appetite
4 insomnia or hypersomnia
5 psychomotor agitation or retardation
6 loss of energy or fatigue
7 worthlessness or guilt
8 impaired concentration or indecisiveness
9 recurrent thoughts of death or suicide ideation or
any suicide attempt
Depression scales
Scales commonly used include ___ and ____
K10 (a distress score) and DASS 21 or 42 (for depression and anxiety symptoms).
The rate of antidepressant prescribing for Australians
over ______ of age is higher than for any other age
group.
80 years
________ is the most frequent
type of depression in the aged. Features may include
histrionic behaviour, delusions and disordered thinking
Agitated depression
Sadness is common in children, but depression, although
not as common, does occur and is characterised by
feelings of ______, _______, ______
helplessness, worthlessness and despair
What differentiates depression in children?
In children, irritability may be more
prominent than sadness.
In children, Although suicidal thoughts are
common, suicide is rare before______
adolescence
This term refers to depression occurring either in the
antenatal period or in the 12 months after delivery
Perinatal depression
depression scale use of perinatal depression
Edinburgh Postnatal Depression Scale (EPNDS
If perinatal depression is identified, the GP should
take into account the individual woman’s context, her
family and cultural setting, and use a______
family-centred
approach.
Questions to ask about suicide
- plan
- lethality
- means
- past history
- suicide of family member or peer
What is low risk of suicide
fleeting thoughts of self-harm
or suicide but no current plan or means
Mx of low risk of suicide
• Discuss availability of support and treatment
options.
• Arrange follow-up consultation (timing of this
will be based on clinical judgment).
• Identify relevant community resources and
provide contact details.
What risk of suicide?
suicidal thoughts and intent
but no current plan or immediate means
Medium
Mx of medium risk of suicide
• Discuss availability of support and treatment
options.
• Organise reassessment within 1 week.
• Have contingency plan in place for rapid
reassessment if distress or symptoms escalate.
• Develop a safety plan (a prioritised written list of
coping strategies and sources of support to use
when experiencing suicidal thinking).
What is HR of suicide?
continual/specific suicidal
thoughts, intent, plan and means
Mx for HR of suicide
• Ensure that the person is in an appropriately safe
and secure environment.
• Organise reassessment within 24 hours and
monitoring for this period.
• Follow-up outcome of assessment
The basic treatments are outlined by the acronym
_____
PACE (which purposefully places priority on the
psychological treatments—
_______involves teaching patients new ways of positive
thinking, which have to be relevant and achievable
for the patient
CBT
________is
useful in moderate to severe depression
, or when depression has an anxiety
disorder codiagnosis.
antidepressant medication
Antidepressant therapy
should be avoided if ______ is suspected,
and screening should be actively conducted for
symptoms of past or previous mania
bipolar disorder
______ are considered to have the most
favourable balance of benefit to harm in
moderate to severe depression
selective serotonin reuptake inhibitors
SSRIs
SE of SSRI
Sexual
dysfunction and gastrointestinal side effects
are common.
Other first line antidep
reboxetine and mirtazepine
common side effects include
hypersomnia, fatigue and nausea
reboxetine
can cause weight gain
and drowsiness)
mirtazepine
T or F
SSRIs have a relatively flat
dose response curve, but dose increase within
the recommended range is reasonable if there
is a partial response at a lower dose and no
troublesome side effects
T
____________ appear to be more effective in treating severe depression symptoms
(and may be a suitable first-line option here)
but otherwise adverse effects may limit
them to second-line treatment
Seretonin and noradrenaline reuptake
inhibitors (SNRIs)
____ and _______ are considered
second-line because of their side effect
profiles.
Tricyclic
antidepressants (TCAs) and monoamine
oxidase inhibitors (MAOIs)
The benefit of medication in moderate depression
is equivalent to psychological therapies such as CBT/
IPT and both of them are around _____ more likely to
achieve remission than placebo
20%
________ is defined
as having minimal or no symptoms of depression, 7 and
a good way of asking patients about this is to ask ‘Do
you think you are back to your normal self?’.
Remission
When using antidepressants, if a response is not
evident in the first ____ weeks or there is an inadequate
response in___ weeks, then it is unlikely that this
medication will work for this patient, and a treatment
change is recommended
2
6
______ is a relatively
safe and effective therapy for severe or resistant
depression
ECT (electroconvulsive therapy)
Cx of ECT
There is some risk of transient
short-term cognitive impairment and long-term
memory impairment, and this therapy is reserved
for severe depression when pharmacotherapy has
faile
_______ where
no anaesthetic is required, is a procedure being
explored as a less invasive alternative to ECT.
Transcranial magnetic stimulation,
Mild depression: _____
- Moderate depression: _______
- Severe depression:__________
psychological therapy
psychological therapy and/
or antidepressants
antidepressants, and consider
addition of psychological therapy to maintain
remission
One of the more commonly used and extensively
researched alternative therapies for depression is ____________which has had mixed results
in the research on its effectiveness. One review of the
literature suggests it is effective in mild to moderate
depression, 20 though two others suggest it is not
St John’s wort
( Hypericum perforatum ),
Interactions with St Johns Wort
HIV
medicines, warfarin, digoxin, anticonvulsants, oral
contraceptives and triptans.
Symptoms must coincide with the introduction
or dose increase of a serotonergic agent
Serotonin syndrome
3 impt symptoms of Serotonin syndrome
— mental status/behaviour changes (e.g.
agitation, confusion, hypomania, seizures)
— altered muscle tone (e.g. tremor, shivering,
myoclonus, hyper-reflexia)
— autonomic instability (e.g. hypertension or
hypotension, tachycardia, fever, diarrhoea
If antidepressant medication is used and remission
achieved, it is recommended that it be continued for a
minimum of ______ for an initial episode, and for
____ in subsequent episodes or in those at high
risk of relapse
12 months
2–3 years
What are the RF for relapse in depression?
• residual depressive symptoms
• 2 or more prior episodes in the past 5 years
• 3 or more prior episodes
• history of severe or prolonged depression
(especially with psychosis or attempted suicide)
• comorbid medical problems
• life stressors
