Depression Flashcards

1
Q

What are the symptoms fo depression?

A
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
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2
Q

What is the somatic syndrome?

A

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

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3
Q

What are psychotic symptoms that can occur with depression?

A

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)

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4
Q

What is a mild depressive episode?

A

At least two of the three core symptoms
Plus additional symptoms, giving a total of at least four
With or without the somatic syndrome

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5
Q

What is a moderate depressive episode?

A

At least two of the three core symptoms
Plus additional symptoms, giving a total of at least six
With or without the somatic syndrome

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6
Q

What is a severe depressive episode?

A

All three core symptoms

Plus additional symptoms, giving a total of at least eight

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7
Q

What is a severe depressive episode with psychotic symptoms?

A

All three core symptoms
Plus additional symptoms, giving a total of at least eight
Plus delusions, hallucinations or depressive stupor

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8
Q

What are organic differentials for depression?

A

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

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9
Q

What is the epidemiology of depression?

A

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

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10
Q

What is the aetiology of depression?

A
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
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11
Q

What is the prognosis for depression?

A

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

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12
Q

What is the management for mild/moderate depression?

A

Low-intensity psychological interventions

Medication - First line treatment would usually be an SSRI, such as citalopram, sertraline, fluoxetine or paroxetine

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13
Q

What is the management for moderate/severe depression?

A

Medication
High-intensity psychological interventions
Consider secondary care referral

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14
Q

What is the management for severe complex depression?

A
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
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15
Q

How long should treatment be continued to prevent relapse?

A

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

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16
Q

What are the indications for antidepressants?

A
Depressive illness (more effective in moderate and severe depression)
Anxiety disorders
Neuropathic pain
Insomnia
Bulimia nervosa
Impulsivity
Migraines
Chronic fatigue syndrome
Irritable bowel syndrome
Narcolepsy
17
Q

What are commonly used SSRIs?

A
Fluoxetine
Paroxetine
Citalopram
Sertraline
Fluvoxamine
Escitalopram
18
Q

What are the side effects of SSRIs?

A
Nausea
Insomnia
Apathy and fatigue
Diarrhoea
Dizziness
Sweating
Restlessness (akathesia)
Sexual dysfunction
Cardiac defects with 1st trimester exposure (Paroxetine)
19
Q

What are the side effects of SNRIs?

A

Venlafaxine
Duloxetine
Comparable to SSRIs but patients may notice more sedation and greater discontinuation symptoms when stopped.

20
Q

What are commonly used TCAs?

A
Amitriptyline
Imipramine
Clomipramine
Dosulepin
Lofepramine
21
Q

What are the side effects of TCAs?

A
Antimuscarinic:
Dry mouth
Blurred vision
Constipation
Urinary retention
Others:
Sedation
Weight gain
Dizziness
Hypotension
Delirium
22
Q

What are commonly used MAOIs?

A

Phenelzine
Tranylcypromine
Isocarboxazid
Moclobemide (reversible MAOI)

23
Q

What are the side effects of MAOIs?

A
Dry mouth
Nausea, diarrhea or constipation
Headache
Sleep disturbance
Postural Hypotension
 significant interaction with certain food (tyramine containing food - cheese reaction)
24
Q

What are the side effects of NaSSA?

A
Mirtazapine 
Sedation 
Weight gain and increased appetite
Drowsiness
Dizziness
Headache
25
What is St Johns wort?
unlicensed herbal remedy for the treatment of depression Induces cytochrome P450 leading to loss of therapeutic effect of: Oral contraceptive Digoxin Warfarin HIV protease inhibitor Anticonvulsants (e.g phenytoin, carbamazepine)
26
What are withdrawal symptoms associated with antidepressants?
dizziness, numbness, tingling, nausea, vomiting, headache, sweating, anxiety, sleep disturbance, strange dreams, shaking and electric-shock like sensations. More common with paroxetine and venlafaxine Taper dose gradually over a period of least 4 weeks
27
In which order are antidepressants most likely to cause weight gain?
NaSSA (most) TCA SSRI/SNRI (no effect)
28
In which order are antidepressant most likely to cause sexual dysfunction?
SSRI (most) SNRI and TCA NaSSA