Depression Flashcards
Definition depression
Pervasive low mood
- Typically considered a form of sadness, not just the absence of happiness
Epidemiology depression
Lifetime prevalence – 2.9-12/100,000
- For less severe manifestations – 20/100,000
Point prevalence – 3.7-7.7/100,000
F:M = 2:1
18-44
Cause of depression
Unknown
Combination of
- genetic
- biology
- environment
- psychology
Pathophysiology of depression
Deficiency in monoamines
- serotonin
- norepinephrine
- dopamine
Risk factors depression
First degree relatives
- MDD – x3
- BPD – x2
Onset associated with excess of adverse life events
Chronic pain
Endocrine illness
Personality e.g. cyclothymic, depressive
Psychological presentation depression
Change in mood – depression, anxiety, perplexity, anhedonia (loss of pleasure)
Change in thought context – guilt, worthlessness, ideas of reference, delusions, hallucinations
Physical presentation depression
Change in bodily function – fatigue, too much/little sleep, waking up, weight loss/gain, constipation
Change in psychomotor functioning – agitation, retardation, stupor (extreme retardation)
Social presentation depression
Loss of interests –
Irritability
Apathy
Withdrawal
Loss of concentration, registration & memory
Criteria for depression
Lasts for 2 weeks
No hypomanic or manic episodes in lifetime (would suggest bipolar)
Not attributable to psychoactive substance use or organic disorder
If psychotic symptoms of stupor then automatically severe depression with psychotic symptoms
- Need to exclude other psychotic illnesses
General criteria of depression
Depressed mood that is abnormal for most of the day almost every day for past 2 weeks, largely uninfluenced by circumstances
Loss of interest or pleasure – anhedonia
Decreased energy or increased fatiguability
Other criteria for depression
Loss of confidence or self-esteem
Unreasonable feelings of guilt or self-reproach or excessive guilt
Recurrent thought of death by suicide or any suicidal behaviour
Decreased concentration
Agitation or retardation
Sleep disturbance of any sort
Change in appetite
Grading of depression
Mild – 2 general + 2 more (total 4)
Moderate – 2 general + 4 more (total 6)
Severe – 2 general + 6 more (total 8)
Differential diagnosis of depression
Normal reaction to life events
SAD
Dysthymia – ‘mild depression’
- Often interspersed with depression (cyclothymia)
Bipolar disorder
Stroke, tumour, dementia (organic disorders)
Hypothyroidism, Addison’s Hyperparathyroidism
Infections – influenza, infectious mononucleosis, hepatitis, HIV/AIDS
Drugs
Management of depression
Antidepressants
- SSRIs
- TCAs
- Monoamine oxidase inhibitors
Psychological treatments
- CBT
- IPT
- Individual dynamic psychotherapy
- Family therapy
Physical treatments
- ECT
- Psychosurgery
- Deep brain stimulation (DBT)
- Vagus nerve stimulation (VNS)
exercise
Prognosis of major depression
Lasts 4-6 months, 54% recovered at 26 weeks
12% fail to recover
80+% have further episodes
15% die by suicide
