Depression

Question 1

Epidemiology of major depressive disorder?

Answer 1

• 5% in general population
• 10-20% in chronically ill patients
• Major cause of disability and suicide
• Diminshes adherence to medical treatment

Question 2

Pathogenesis depression?

Answer 2

• Genetic predisposition
  
  • Small effec from large numbers of genes
• Adversity and emotional deprivation predispose to depression
• Cab be triggered by stressful life events

Question 3

Name some associated biological factors for depression?

Answer 3

• Hypofunction of monoamine neurotransmitter systems
• Abnormalities of the HPA axis
  
  • Elevated cortisol levels that do not suppress with dexamethasone

Question 4

Psychological symptoms of depression?

Answer 4

• Reduced mood
• Reduced self-esteem
• Loss of interest and enjoyment
• Suicidal thinking

Question 5

Somatic symptoms of depression?

Answer 5

• Fatigue
• Reduced appetite
• Disturbed sleep
• Loss of libido

Question 6

Questions for screening a patient with low mood?

Answer 6

• In the past month have you….
  
  • Felt depressed or hopeless?
  • Found that you no longer enjoy the little pleasures in life?
  • Been feeling overly tired?
• Assess for symptoms:
  
  • Sleep cycle, Mood, Appetite, Libido
  • Concentration, Perception of self/future
• Rule out differential psychiatric diagnoses
  
  • Mania episodes, evidence of psychosis
• Assess suicide risk

Question 7

Describe the investigations into depression?

Answer 7

• Not usually required unless suspicion of:
  
  • Cushings disease
  • Hypothyroidism

Question 8

Treatments for depression?

Answer 8

• Medications
  
  • Best one depends on specific patient symptoms, background and the side effects of the drugs
• Psychological treatment
  
  • CBT
  • Interpersonal therapy

Question 9

Categories of antidepressive drugs?

Answer 9

• Tricyclic antidepressants
• Selective serotonin re-uptake inhibitors (SSRIs)
• Monoamine oxidase inhibitors
• Noradrenaline re-uptake inhibitors + SSRIs
• Noradrenaline specific serotonergic inhibitor

Question 10

Examples of Tricyclic antidepressants?

Answer 10

• Amitriptyline
• Clomipramine

Question 11

How do Tricyclic antidpressants work?

Answer 11

• Inhibit re-uptake of noradrenaline and 5-HT at synaptic clefts
• Effects seen after 1-2 weeks

Question 12

SEs of tricyclic antidepressants?

Answer 12

• Sedation
• Anti-cholinergic effects
• Postural hypotension
• Can cause an overdose

Question 13

Examples of SSRIs?

Answer 13

• Citalopram
• Fluoxetine
• Sertraline

Question 14

Side effects of SSRIs??

Answer 14

• QTc prolongation
• Headache
• Sexual dysfunction
• Serotonin syndrome

Question 15

Describe serotonin syndrome?

Answer 15

• SSRIs react with other drugs to increase serotonin (5-HT)
• Causes:
  
  • Hyperactivity
  • Delirium
  • Hyperthermia

Question 16

Examples of Monoamine oxidase inhibitors?

Answer 16

• Phenelzine
• Moclobemide

Question 17

MOA of monoamine oxidase inhibitors?

Answer 17

• Increase navailability of neurotransmitters at synaptic clefts
• By inhibiting noradrenaline and 5-HT metabolism

Question 18

In the elderly, what is the treatment for mild or subthreshold symptoms?

Answer 18

• Increasing social contact
• Physical exercise

Question 19

What is the first line medical therapy for depression in the elderly and name some specific SEs?

Answer 19

• SSRIs
  
  • Hyponatraemia
  • Postural hypotension
  • Increased risk of GI bleeding

Question 20

What type of antidepressant should be avoided in the elderly?

Answer 20

• Tricyclics
  
  • Due to their anticholinergic effects

Question 21

ICD-10 criteria for depressive disease?

Answer 21

• Depressed mood
• Loss of interest in things you would normally enjoy
• Reduced energy levels

Question 22

Describe a mild depressive episode?

Answer 22

• 2 of the main symptoms of depression
  
  • • 2 of the other symptoms
• Minimum duration is 2 weeks

Question 23

Describe a moderate depressive disease?

Answer 23

• 2 of the main symptoms of depression
  
  • • 3 of the other symptoms
• Minimum duration is 2 weeks
• Difficulty continuing normal work and social functioning

Question 24

What questions should be used to screen for depression?

Answer 24

• During the last month:
  
  • Have you often felt down, depressed or hopeless?
  • Have you often felt bothered by having little interest of pleasure in doing things?
• If yes to either, more comprehensive assessment should occur

Question 25

Name some tools to assess the degree of depression in patients?

Answer 25

• Hospital Anxiety Depression (HAD) scale
• Patient Health Questionnaire (PHQ-9)

Question 26

What does NICE use to grade depression?

Answer 26

DSM-4