Depression Flashcards
Epidemiology of major depressive disorder?
- 5% in general population
- 10-20% in chronically ill patients
- Major cause of disability and suicide
- Diminshes adherence to medical treatment
Pathogenesis depression?
- Genetic predisposition
- Small effec from large numbers of genes
- Adversity and emotional deprivation predispose to depression
- Cab be triggered by stressful life events
Name some associated biological factors for depression?
- Hypofunction of monoamine neurotransmitter systems
- Abnormalities of the HPA axis
- Elevated cortisol levels that do not suppress with dexamethasone
Psychological symptoms of depression?
- Reduced mood
- Reduced self-esteem
- Loss of interest and enjoyment
- Suicidal thinking
Somatic symptoms of depression?
- Fatigue
- Reduced appetite
- Disturbed sleep
- Loss of libido
Questions for screening a patient with low mood?
- 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
Describe the investigations into depression?
- Not usually required unless suspicion of:
- Cushings disease
- Hypothyroidism
Treatments for depression?
- Medications
- Best one depends on specific patient symptoms, background and the side effects of the drugs
- Psychological treatment
- CBT
- Interpersonal therapy
Categories of antidepressive drugs?
- Tricyclic antidepressants
- Selective serotonin re-uptake inhibitors (SSRIs)
- Monoamine oxidase inhibitors
- Noradrenaline re-uptake inhibitors + SSRIs
- Noradrenaline specific serotonergic inhibitor
Examples of Tricyclic antidepressants?
- Amitriptyline
- Clomipramine
How do Tricyclic antidpressants work?
- Inhibit re-uptake of noradrenaline and 5-HT at synaptic clefts
- Effects seen after 1-2 weeks
SEs of tricyclic antidepressants?
- Sedation
- Anti-cholinergic effects
- Postural hypotension
- Can cause an overdose
Examples of SSRIs?
- Citalopram
- Fluoxetine
- Sertraline
Side effects of SSRIs??
- QTc prolongation
- Headache
- Sexual dysfunction
- Serotonin syndrome
Describe serotonin syndrome?
- SSRIs react with other drugs to increase serotonin (5-HT)
- Causes:
- Hyperactivity
- Delirium
- Hyperthermia
Examples of Monoamine oxidase inhibitors?
- Phenelzine
- Moclobemide
MOA of monoamine oxidase inhibitors?
- Increase navailability of neurotransmitters at synaptic clefts
- By inhibiting noradrenaline and 5-HT metabolism
In the elderly, what is the treatment for mild or subthreshold symptoms?
- Increasing social contact
- Physical exercise
What is the first line medical therapy for depression in the elderly and name some specific SEs?
- SSRIs
- Hyponatraemia
- Postural hypotension
- Increased risk of GI bleeding
What type of antidepressant should be avoided in the elderly?
- Tricyclics
- Due to their anticholinergic effects
ICD-10 criteria for depressive disease?
- Depressed mood
- Loss of interest in things you would normally enjoy
- Reduced energy levels
Describe a mild depressive episode?
- 2 of the main symptoms of depression
- 2 of the other symptoms
- Minimum duration is 2 weeks
Describe a moderate depressive disease?
- 2 of the main symptoms of depression
- 3 of the other symptoms
- Minimum duration is 2 weeks
- Difficulty continuing normal work and social functioning
What questions should be used to screen for depression?
- 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
Name some tools to assess the degree of depression in patients?
- Hospital Anxiety Depression (HAD) scale
- Patient Health Questionnaire (PHQ-9)
What does NICE use to grade depression?
DSM-4
