Depression Flashcards
What are the symptoms fo depression?
Duration of 2 weeks Reduced concentration Loss of interest and enjoyment (anhedonia) Reduced confidence and self-esteem Reduced energy (anergia) Ideas of guilt and unworthiness Pessimism about the future Ideas/acts of self-harm/suicide Disturbed sleep Changes in appetite Low mood
What is the somatic syndrome?
Markedly reduced appetite
Weight loss (>5% of normal body weight in 1 month)
Early morning wakening (at least 2 hours before usual time)
Diurnal variation in mood (depression worse in the morning, improving through the day)
Psychomotor retardation/agitation
Loss of libido
Marked anhedonia
Lack of emotional reactivity
What are psychotic symptoms that can occur with depression?
Delusions:
Tend to be mood congruent i.e. their content is in line with low mood. Worthlessness, guilt, ill health, poverty, imminent disaster. Nihilistic
Hallucinations:
2nd person auditory, olfactory (decomposing flesh)
What is a mild depressive episode?
At least two of the three core symptoms
Plus additional symptoms, giving a total of at least four
With or without the somatic syndrome
What is a moderate depressive episode?
At least two of the three core symptoms
Plus additional symptoms, giving a total of at least six
With or without the somatic syndrome
What is a severe depressive episode?
All three core symptoms
Plus additional symptoms, giving a total of at least eight
What is a severe depressive episode with psychotic symptoms?
All three core symptoms
Plus additional symptoms, giving a total of at least eight
Plus delusions, hallucinations or depressive stupor
What are organic differentials for depression?
Neurological: Multiple sclerosis, Parkinson’s disease, Huntington’s disease. spinal cord injury, CVA, head injury, cerebral tumours
Endocrine: Thyroid and parathyroid disorders (especially hypothyroidism), Cushing’s/Addison’s disease
Infections: HIV/AIDS, syphilis, typhoid, brucellosis, infectious mononucleosis, herpes simplex
Iatrogenic: Secondary to prescription of opiates, L-dopa, steroids
Others: Malignancies (especially pancreatic), SLE, rheumatoid arthritis, renal failure, porphyria
What is the epidemiology of depression?
M:F = 1:2
Lifetime prevalence of depressive symptoms 10 to 20%
Point prevalence of major depressive illness 5%. Of these:
10% are referred to a psychiatrist
0.1% admitted to hospital
What is the aetiology of depression?
Biological: genetics hormonal changes substance misuse serious illness Psychological: negative thoughts learned helplessness psychodynamic defence mechanisms Social: life events social isolation bereavement loss childhood abuse social adversity
What is the prognosis for depression?
50-60% will recover within a year
Chronic depression (more than 2 years) occurs in 10-25%
5-15% will die by suicide
Relapse:
After 1 year, 25% will have had a further episode
After 10 years, 75% will have had a further episode
What is the management for mild/moderate depression?
Low-intensity psychological interventions
Medication - First line treatment would usually be an SSRI, such as citalopram, sertraline, fluoxetine or paroxetine
What is the management for moderate/severe depression?
Medication
High-intensity psychological interventions
Consider secondary care referral
What is the management for severe complex depression?
Secondary care Medication: venlafaxine, an SNRI mirtazapine, a NASSA tricyclics, like imipramine MAOIs, like phenelzine adjunctive medications, such as antipsychotics or lithium High-intensity psychological interventions ECT Crisis Resolution and Home Treatment (CRHT) Multidisciplinary (MDT) approach Inpatient care
How long should treatment be continued to prevent relapse?
Following recovery from a single episode of depression, treatment should be continued for 6 months
Following recovery from recurrent depression, treatment should be continued for 2 years
