Depression Flashcards
What are the general diagnostic features of depression?
Depressed mood
Energy decreased
Anhedonia
What are the additional diagnostic features of depression?
Death (suicidal) thoughts Sleep disturbance- early wakening, insomnia, hypersomnia Worthlessness or guilt Appetite change Mentation decreased Psychomotor retardation
What are the possible signs of psychomotor retardation in depression?
Slowing of motor responses including speech
Catatonia
Stupor- state of extreme retardation in which consciousness is intact but patient stops moving, speaking, eating, drinking
What are some “other” features of depression
Loss of libido Constipation Physical pain irritability, agitation PSychosis
What are the features of psychosis?
Hallucinations- mainly auditory, olfactory strongly associated
Delusions
What are the features of hallucinations?
Have full force and clarity of true perception
Not willed or controlled
Located in external space
What is a delusion?
Unshakable idea or belief which is out of keeping with the person’s social or cultural background, it is held with extraordinary conviction
What are the types of delusions?
Paranoid
Grandiose
Self referential
Hypochondrial
What are the criteria for diagnosis of depression?
At least 2 weeks
No manic or hypomanic episodes in life
Not attributable to organic disorder or psychoactive substance use
Features
What is the criteria for mild depression?
At least 2 general featues
Additional to give at least 4
What are the features of moderate depression?
At least 2 general features
Additional to give 6
What are the features of severe depression?
All 3 general and additional to give at least 8
OR psychotic symptoms
What are the management options for subtheshild to mild depression?
Active monitoring
Sleep hygiene
Low intensity psych and psychosocial interventions
Antidepressant therapy in certain circumstances
What are the indications for antidepressant therapy in sub threshold to mild depression?
PMH moderate to severe depression
>2 years sub threshold symptoms
Not responding to other interventions
What is the management of moderate to severe depression?
Antidepressant therapy
High intensity psychological intervention- CBT, IPT, behavioural actovation
Couples/family therapy
What is the anti depressant therapy pathway?
- SSRI
- Increase dose/try another SSRI
- SNRI, MAOI or TCA- usually SNRI
- Augmentation and combination in consultation with psychiatry
What are some psychological interventions?
CBT IPT Family therapy Couples therapy Individual psychodynamic therapy
What are some physical treatments of depression?
ECT
Psychosurgery
Deep brain stimulation
Vagus nerve stimulation
What are some SSRIs?
Sertraline
Fluoxetine
Citalopram
Paroxetine
What are the most common side effects of SSRIs?
GI upset= most common
Sexual dysfunction
Discontinuation syndrome
What is the presentation of discontinuation syndrome?
Agitation
Nausea
Dysequilibrium
What are some SNRIs?
Venlafaxine
Duloxetine
What are some side effects of SNRIs?
Sedation, insomnia Hypomania Dry mouth, sweats Sexual dysfunction- not as much as SSRIs Loss of appetite Discontinuation syndrome
What are the types of TCAs?
tertiary- amitriptyline, imipramine
Secondary- nortitriptyline, clomipramine
Why are TCAs nt widely used for depression?
Side effect profile
Toxicity in overdose
In what TCAs are side effects less common?
Secondary TCAs- e.g. noritriptyline
What are some side effects of TCAs?
Sedation Dry mouth Blurred vision Weight gain Constipation Sexual dysfunction
Why are MAOIs generally avoided?
Side effects common and severe
What are the side effects of MAOIs?
Orthostatic hypotension Weight gain Dry mouth Sedation Sexual dysfunction Serotonin syndrome
What is done to avoid serotonin syndrome with MAOIs?
Wait 2 weeks before switching from SSRI/SNRI to MAOI
What type of delusions are seen in depression?
Generally mood congruent, catastrophic, nihilistic
What is th management of catatonic stupor?
ECT
BZDs
