Depression Flashcards
What type of disorder is depression
Affective
Aetiology Depression
F>M
FH
Excess adverse life events
Stress due to life events (births, job loss, divorce, illness)
Stress associated with poor social environment and social isolation
Low self esteem
What criteria needs to be met for mild depression
2 core and 2 typical
At leat 4 total
What criteria needs to be met for moderate depression
2 core and 4 typical
At least 6 total
What criteria needs to be met for severe depression
All 3 core + 5 typical At least 8 total
What does depression + psychosis give a Dx of
Severe depression
What are the core symptoms of depression
- Low mood (most of the day, everyday)
- Anhedonia
- Fatigue (low energy)
What are typical symptoms of depression
Loss of confidence/low self esteem Unreasonable feelings of guilt or self reproach or excessive guilt Recurrent thoughts of death by suicide or any suicidal behaviour Decreased concentration Agitation or retardation Sleep disturbance of any sort Change in appetite
1st line Rx for depression
SSRI
Name 3 common SSRIs
Sertraline
Fluoxetine
Citalopram
What is 2nd line for depression
Try another SSRI
Or switch to
SNRI
Classes of anti-depressants
SSRIs
SNRIs
TCAs
Monoamine Oxidase inhibitors
When to NICE recommend ECT
Rapid improvement of severe symptoms after other methods have proven ineffective
And/or when the condition is life threatening
Psychological therapies for depression
CBR
IPT
Individual dynamic psychotherapy
Family therapy
CI to ECT
Mainly patients with CI to general anaesthetic
Not really any CI to eCT itself
What is the prophylaxis for 1 episode of depression
Continue anti-depressants for 6/12
What is the prophylaxis for 2nd episode of depression
Continue anti-depressant for 2 years
What is the prophylaxis for 3rd episode of depression
Discuss life long treatment
Does depression reccurr frequently
Yes
what is the main issue with TCAs
They are lethal in overdose
How many women experience the baby blues
About 75%
Risk factors for post-natal depression
Hx of post-partum depression Unplanned pregnancy Lack of support Marital problems Social circumstances Sleep deprivation Hormonal changes
When are women at greatest risk of post-natal depression
30 days following childbirth
Which Scale is used to assess for post-natal depression
Edinburgh Post-Natal depresison Scale
Why should you observe babies with mothers who are taking anti-depressants
If the mother is breast feeding it may pass onto baby and cause SE
Rx for post-natal depression
SSRIs
CBT
Rx for severe post-natal depression
ECT considered
Psychological therapy for post-natal depression
CBT
IPT
What should any suspicion of post-partum psychosis trigger
Emergency referral to specialist team
What is the peak onset of post-partum psychosis
2 weeks post partum
Risk factors for post-partum psychosis
Previous post-partum psychosis
Single parenthood
Reduced social support
Previous mental illness
What happens at discharge of post-partum psychosis
Referral to local mental health
Health visitors will be needed
Clinical features of post-partum psychosis
Psychotic symptoms (delusions, hallucinations) Affective symptoms (depression or mania) Mood instability Insomnia Disorientation Paranoia
How to treat post-partum psychosis:
For affective symptoms:
Mood stabilisers
Antidepressants
ECT
For psychotic symptoms:
Second generation anti-psychotic
Psychological therapy
