Depression

Question 1

Major depressive disorder

- Features

Answer 1

Episode of Low mood, anhedonia

• That impairs one’s function
• For at least 2 weeks

Other features (3+)

• Weight/ appetite change
• Insomnia/ hypersomnia
• Psychomotor retardation/ agitation
• Low energy
• Poor concentration/ attention
• Guilt/ feelings of worthlessness
• Suicidal thoughts/ self harm

Question 2

Recurrent depressive order

Answer 2

Repeated episodes of depression, without evidence of mania.

May have hypomanic episode after depressive episode.

Question 3

Epidemiology

• Gender
• Peak onset
• Lifetime prevalence
• Suicide rates

Answer 3

Gender
- F>M

Peak onset
- 25-35

Lifetime prevalence
- 20%

Suicide rates
- 8-19%

Question 4

Risk factors for depression

Answer 4

Divorce (esp male)

Unemployment

Social isolation

Stress

Family history

Adverse childhood experience

Bereavement

Physical illness

Medication: steroids, beta-blockers, OCP.

Question 5

Drugs that can cause depression

Answer 5

Corticosteroids

Metyldopa

GnRH agonists

IFN gamma

Question 6

Depression investigations

Answer 6

Patient health questionnair

Geriatric depression scan
- >10= suggests depression

Edinburgh postnatal depression scale

FBC
- rule out anaemia

Question 7

Organic causes of depression

Answer 7

Hypothyroidism

Cushing’s

Anaemia

Dementia

Nutrition deficiency

• Vit D
• B12
• folate

OSA

Question 8

Management of mild depression

- With description of mild depression

Answer 8

Mild depression

• Partial impairment of function
• No psychosis/ suicidal ideation/ psychomotor retardation

Management

1. Supportive
   - Exercise, music, self-guided books
2. Psychotherapy
   - CBT

2 Antidepressant
- Only if previous treatment has failed

Question 9

Management of moderate depression

- With description of moderate depression

Answer 9

Moderate depression

• Significant impairment due to symptoms
• No psychosis/ suicidal ideation/ psychomotor agitation

Management

1. Psychotherapy
   - CBT
   - Interpersonal therapy
2. Antidepressant
   - SSRI
   - SNRI

Question 10

Management of severe depression

- With description of severe depression

Answer 10

Depression that includes

• Psychosis
• Suicidal ideation
• Psychomotor retardation
• Catatonia

Management
1. Hospitalisation/ Psych referral

1. Antidepressant
   - SSRI/ SNRI- titrate dose up

Psychosis/ catatonia

• Benzodiazepine
• Antipsychotic: risperidone

If psychotic/ suicidal and resistant to antidepressants
- ECT: 2-3 x a week, 6-12 times

Question 11

Neurophysiology of depression

Answer 11

Combination of environmental factors and neurophysiology alterations.

Monoamine hypothesis
- Low dopamine/ serotonin/ NA