Depression Flashcards
What are the main symptoms of depression?
Persistent sadness or low mood and a marked loss of interests to pleasure
Disturbed sleep Altered appetite Fatigue Agitation Poor concentration Inappropriate guilt Suicidal thoughts - red flag
Outline the neurobiological basis and relevant theories of depression
Depletion of 5-HT, NA, DA
Monoamine theory - 5-HT depletion in raphe nuclei and NA depletion in LC
Neurohormonal - HPA axis activity increased
Autoimmune - pro inflammatory cytokines/glucocorticoids released from stressful situations activate microglia leading to cell death
Circadian
What are the pharmacological and interventional approaches used in the treatment of depression?
SSRIs
TCAs - 5-HT and NA reuptake blockers but a1, M1, H1 antagonists
MAOIs - inhibit enzyme breakdown of NA/5-HT
Atypical antidepressants (NRIs and SNRIs)
CBT
TMS - transcranial magnetic stimulation directed at PFC and limbic system (good for severe depression and non-responsive to treatment)
ECT - electroconvulsive therapy but side effect of memory loss, muscle aches and stigma but gold standard treatment for severe depression
Lithium mood stabiliser in bipolar disorder
What are the side effects of common antidepressants?
SSRIs - nausea, sleep disorders, sexual dysfunction, increased bleeding (negative symptoms increase before they work)
Atypical antidepressants - ANS side effects because of NA reuptake inhibition
TCAs - original antidepressants - sedation, postural hypotension, confusion, visual problems, cardiac dysthymia, mania, drug interactions (because of antagonism on M1, a1, H1)
MAOIs - ‘cheese reaction’ - dry mouth, nausea, headache, drowsiness (medical emergency caused by vasoconstriction and hypertension)x
Define depressive illness, acute stress reactions and PTSD - what are the relevant clinical presentations?
Depressive illness = persistent feeling of sadness/low mood
Acute stress reaction = transient disorder that develops without an apparent mental disorder in response to exceptional physical and mental stress that usually subsides within hours
PTSD = arises as a delayed response to a stressful event of an exceptionally threatening or catastrophic nature, likely to cause pervasive distress in anyone
Distinguish between normal grief, abnormal grief reaction and depression
Bereavement is normal but grief reactions can differ
Normal: intense sorrow, emotional pain, feelings of disbelief
Abnormal: idealisation of the dead person, denial of death, self-neglect, intense bereavement reactions
Difference between grief and depression: grief includes prominent yearning and longing, symptoms focused on deceased person, grieving people tend to want to be with others whereas depressed isolate themselves and are incapable of social function
What are benefits for CBT over medication for depression?
Completed in a shorter time scale
Long term effects as can change behaviour to adapt lifestyle
Provided in different formats to suit individual
No side effects
What are some disadvantages to CBT?
Not suitable for complex mental health needs or learning difficulties
Involves confronting emotions which can be challenging
Patient has to be ready to commit and pursue change
Requires work outside of sessions
Outline the steps of CBT
Problem identification Goal selection Other options Consideration of consequences Plan of action Implementation Evaluation
What are the two patterns of depressive states?
Unipolar = low level mood affecting quality of life
Bipolar = recurrent episodes of mania and depression
How is depression graded and diagnosed?
Graded: mild, moderate, severe
Mild - symptoms result in minor impairment, few symptoms in excess of 4/5 required for diagnosis
Moderate: symptoms of functional impairment between mild and severe
Severe: most symptoms and they markedly interfere with daily functioning
What’s the DSMV and ICD-10 differences in diagnosis of depression?
ICD-10 requires at least 4/10 depressive symptoms
DSM-V requires at least 5/9 for at least 2 weeks
Both require low mood +/- reduced pleasure
How long do symptoms need to persist for chronic depression?
ICD-10 >2 years
What circuitry is involved in depression?
Decreased activity in PFC and hippocampus
Increased activity in hypothalamus and amygdala
Where is 5-HT produced and what’s it involved in?
Raphe nuclei of brainstem (and enteric nervous system in gut)
Mood, agitation, appetite, nausea, sexual function, GI function, anxiety
