Depression Flashcards
Where does depression rank in terms of worldwide disability?
4th
How often and how long do symptoms need to be present to diagnose depression?
Symptoms need to be present every, or nearly every day, without significant changes throughout the day for more than 2 weeks.
What cannot be part of the cause?
Alcohol, drugs, medical problems or bereavement.
What are the diagnostic criteria for symptoms?
2 or more core symptoms AND 2 or more typical symptoms
Give 3 core symptoms and 7 typical symptoms. How are these split into biological and psychological?
Core: Low mood, anhedonia, fatigue. Typical: 1) Poor appetite (with weight loss without dieting, but can increase!), 2) Disrupted sleep (initially insomnia or early waking), 3) Psychomotor retardation or restlessness, 4) lowered libido, 5) lowered concentration, 6) feelings of worthlessness or inappropriate guilt (can be delusions), 7) recurrent thoughts of death or suicide.
1-5 of typical are the biological symptoms. The rest are psychological.
How is mild, moderate, and severe depression classified?
Mild: 2 core, 2 typical. Moderate: 2 core, 3+ typical. Severe: 3 core, 4+ typical
What can severe depression be split into?
Non-psychotic and psychotic. Psychotic has mood congruent delusions or hallucinations.
Give 2 biological aetiological factors.
Genetics (hereditary 37% of the time), lowered monoamines.
Give one psychological factor of depression
Negative childhood events
Give 5 differential diagnoses of depression
Bipolar schizophrenia anorexia anxiety hypothyroid cancer medicine side effect Parkinson’s
What are 4 things that worsen depression?
Inactivity, alcohol, drugs, isolation
Broadly, how is depression managed?
Therapy and medicine
Give 4 lifestyle measures.
Exercise, productivity, socialising, yoga, improving sleep, reading
Give 2 social factors for depression
Life events (in 60%) i.e. job, illness, finance. Poor social environment and isolation
How is mild depression managed?
With low intensity psychological intervention: sleep hygiene, mindfulness, problem solving techniques, self-help (books, headspace), computerised CBT, structured group based physical activities.
When should antidepressants not be used?
If there is less than an 8 week history, or not a previous history of depression. If there is then you can use antidepressants
How is moderate depression managed?
Antidepressants + CBT/ interpersonal therapy. IAPT should be utilised
How is severe depression managed?
(incl. psychotic depression, risk of suicide, or atypical depression). Urgent referral for Mental health assessment, with consideration of ECT. Antidepressants also.
How many people with one episode of depression relapse? How should a depression relapse be treated?
50-90% will relapse. They can have maintenance treatment, and there should be quick intervention with antidepressants (reduces relapses by 65%). CBT can be offered to reduce residual symptoms.
What is the comparison between CBT and antidepressants in mild-moderate depression?
CBT is as effective as medicine but obviously no side effects. Both together are better than either alone.
When and why should patients be initially reviewed and why after starting antidepressants?
After 4 weeks due to increased risk of suicide/ worsening of symptoms (esp. in under 30s).
How long does antidepressant treatment need to be continued for?
At least 6 months after complete recovery, with no reduction in dose. Otherwise more than 50% more relapse.
When should you switch drugs?
If there is no response after 4 weeks. If there is a slight improvement then increase dose. Switching drug is better than augmenting with other drugs!
What is first line antidepressant? How long may it take to work? What antidepressant has the longest half life?
Any SSRI. Fluoxetine (only choice in U18s) citalopram, or sertraline (best in IHD) are all good to start. May take up to 6 weeks to work but usually starts to work in about a week. Fluoxetine has a 5 week half life after stopping the drug for reactions (so withdrawal may not be awful)
Give 2 bloods you need to monitor and why for depression drugs
FBC (anaemia due to gastric bleeding), U+E (hyponatraemia)
What is 2nd line antidepressant?
Try another SSRI (cross taper doses)
What is 3rd line rx?
Mirtazapine (good for sedation) or venlafaxine (good for mixed anxiety/depression).
What is 4th line rx?
Keep switching, Can combine. Can use TCAs or MAOIs but rare. Lithium can be used, ECT if urgent
When can ECT be considered as rx?
In severe episodes with rapid increase of symptoms/other treatment ineffective/potentially life-threatening depression.
How is ECT thought to work?
Interrupting hyperconnectivity between areas of the brain maintaining depression
What should be carried on after ECT?
Antidepressant treatment
What x increased risk is there for patients with a physical condition to get depression?
2-3x
Give the 2 NICE questions to ask for screening for depression.
During the last month have you felt down, depressed, or hopeless? During the last month, have you been bothered by having little interest in things?
Give the 3 others if one of the answers to the NICE screening questions is yes.
During the last month have you been bothered with 1) worthlessness? 2) poor concentration? 3) thoughts of death/suicide?
After bereavement, what is assumed? Give the 5 stages.
A period of depression. Denial, anger, bargaining, depression, acceptance. These are mobile.
When would depression be hinted at after bereavement
Mood problems deepen and effect appetite, energy and sleep.
