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Depression Flashcards

1
Q

What is first line for depression in Parkinson’s?

A

SSRIs

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2
Q

What is the prevalence of depression in Parkinson’s?

A

20%

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3
Q

In what % of cases do depressive symptoms precede motor symptoms?

A

30%

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4
Q

Why should TCAs be avoided in depression in Parkinson’s?

A

They can cause confusion and cognitive impairment

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5
Q

Why antidepressant should be avoided in depression in Parkinson’s as it can worsen sleep quality?

A

Mirtazapine

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6
Q

which factors are likely to cause depression in patients suffering from Parkinson’s?

A
  • left sided brain injury
  • family hx of depression
  • low dopamine levels in the limbic system
  • cognitive impairment
  • loss of functional independence
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7
Q

Which antidepressants have lower risk of sexual dysfunction side effects?

A
  • Bupropion

- Mirtazapine

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8
Q

Which antidepressants should be avoided in Parkinson’s?

A

TCAs

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9
Q

Which symptom is least likely to be different between young and old people suffering from depressive disorder?

A

Sleep disturbance

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10
Q

Which symptoms are to be different between young and old people suffering from depressive disorder?

A
  • Behavioural disturbances
  • Complaints of loneliness
  • Poor concentration and memory
  • Paranoid and delusional ideation
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11
Q

Antidepressants in the elderly

A
  • Newer antidepressants such as SSRI SNRIs are better tolerated as they have lesser side effects
  • those who show resistance to first-line treatment tend to do well with lithium augmentation
  • EECT is the most effective treatment for life-threatening depressive disorder.
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12
Q

What is a good prognostic factor for depression in the elderly?

A

Female gender

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13
Q

What are poor prognostic factor for depression in the elderly?

A
  • male gender
  • history of dysthymia
  • atypical features
  • active medical illness or poor physical health
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14
Q

Stress and depression often increase the risk of coronary artery disease by which biological markers?

A
  • Interleukin 6
  • Fibrinogen
  • natural killer cells
  • von Willebrand factor
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15
Q

What combination of medication has been found to be effective in treatment resistant depression?

A

“Californian rocket fuel” is a medical slang term for the combined administration of mirtazapine (a NaSSA) and venlafaxine (an SNRI). This combination is usually used in the treatment of treatment-resistant depression.

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16
Q

Which symptom is less likely to occur in adolescent onset depression vs adult onset?

A

Psychomotor retardation

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17
Q

What is the one year prevalence of depression?

A

5.3%

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18
Q

What is the life time prevalence of depression?

A

13%

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19
Q

What is the mean age of onset of depression?

A

30

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20
Q

What is the mean number of episodes in patients with MDD?

A

5 episodes

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21
Q

What is the most common comorbidity in patients with MDD?

A

Alcohol abuse

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22
Q

What percentage of patients with MDD attempt suicide?

A

9%

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23
Q

What proportion of patients diagnosed with depression by their GP go on to have an episode of mania within 10 years?

A

1 in 10

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24
Q

How long does an untreated episode of depression last?

A

6 to 13 months (compared to 3 months if treated)

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25
Q

What are the 5Rs (Kupfer curve?) of the treatment of depression

A

Response: 50% improvement of symptoms (<50% = partial response)
Remission: depression not detectable on any clinical scales
Recovery: remission continues for >6 months (untreated episode duration)
Relapse: further episode within 6 months
Recurrence: further episode after 6 months

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26
Q

What are the positive prognostic indicators of MDD?

A

Mild episodes
Absence of psychotic symptoms
Short admission
Hx of solid friendships during adolescence
Stable family functioning
Good social functioning during 5 years preceeding illness
Absence of co-morbid psychiatric disorders
No more than one previous admission for MDD

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27
Q

What the relapse indicators for MDD?

A

Persistent dysthymia
Co-morbid physical/psychiatric conditions
Female sex
Longer episodes of illness before seeking treatment
Greater number and duration of prior episodes
Never marrying
Severity of episodes i.e. suicidality, psychotic features

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28
Q

What are the NICE guidelines for management of mild depression?

A

Mild - Moderate:

  • CBT based self help programme
  • Computer cognitive based programme
  • Physical activity programme
  • Watchful waiting is acceptable but must review in 2/52
  • Avoid antidepressants if possible (poor risk:benefit ratio)
  • Other psychological therapies i.e. CBT, IPT

Moderate - Severe:

  • Antidepressants (1st line = SSRIs)
  • Psychological therapies
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29
Q

How long should antidepressants be continued after remission?

A

6 months

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30
Q

How long should patients with >2 episodes in the recent past or with residual symptoms continue antidepressants?

A

2 years

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31
Q

When is ECT indicated?

A

If other treatments have proven ineffective and/or condition is considered to be potentially life-threatening

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32
Q

What is the NNT for antidepressants in adults (response)?

A

4-5

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33
Q

What is the NNT for antidepressants in adults (remission)?

A

6-7

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34
Q

What are the differences between male and female patients in terms of suicidal ideation and attempts?

A

Men have more suicidal ideation
Women have more suicidal attempts
Men 2-4x more likely to be successful

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35
Q

What is the management of treatment resistant depression?

A
  1. Confirm true resistance by ruling out ‘5As’ - Alcoholism, inAdequate dosing, poor Adherence, Axis 2 Disorders (PD), Alternate diagnoses
  2. Switch to another drug (same or different class)
  3. Augment with lithium, antipsychotic, psychotherapy or another antidepressant
  4. If no response after 2-3 adequate trials, consider ECT/TMS/novel agent i.e. ketamine
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36
Q

What combination of antidepressants is high risk for serotonin syndrome?

A

SSRI + MAOI

37
Q

Why is a combination of an SSRI and a TCA thought to be effective for treatment resistant depression?

A

Pharmacological (two different) and Kinetic mechanisms - SSRIs block metabolism of TCAs

38
Q

What is Agomelatine?

A

A novel antidepressant - 5HT2C antagonist

39
Q

What are the strategies for improving sexual dysfunction as a SE of antidepressants?

A
  1. Consider switching to an antidepressant with a better SE profile depending on overall improvement in depression with current medication
  2. Add sildenafil/tadafinil
  3. Add bupropion
40
Q

How does St John’s Wort interact with SSRIs?

A

Increases effects

41
Q

What is the MOA of ketamine as an antidepressant?

A

NMDA receptor antagonist

42
Q

Proportion of patients that don’t respond to first trial of antidepressant?

A

1/3

43
Q

Prevalence of clinical depression after stroke?

A

30-40%

44
Q

SMR for patients with dysthymia is higher than the general population by a factor of?

A

12

45
Q

SMR for patients with depression is higher than the general population by a factor of?

A

20

46
Q

Which SSRI is contraindicated with Tamoxifen?

A

Fluoxetine
duloxetine
bupropion
paroxetine

47
Q

Proportion of patients with MDD that show elevation in cortisol levels?

A

50%

48
Q

SMR for major depression?

A

20%

49
Q

What can be said about the trend in point prevalence of depression?

A

It’s increasing

50
Q

Prevalence of depression in patients with coronary heart disease?

A

21%

2-3x that of general population

51
Q

Which substance is implicated in epilepsy related depression in patients treated with certain anticonvulsants?

A

Folate

52
Q

Prevalence of dysthymia

A

4%

53
Q

Depression rating scale most sensitive to change

A

MADRS

54
Q

Best antidepressant for use following MI?

A

Sertraline

55
Q

SSRI with least placental exposure?

A

Sertraline

56
Q

Most common side effect of SSRIs

A

Sexual dysfunction (nearly 60%)

57
Q

Rating scale that covers larlgely somatic symtoms and fewer cognitive symptoms

A

Hamilton depression rating scale

58
Q

Kubler Ross’s five stages of greif

A 
Denial
Anger
Bargaining
Depression
Acceptance
59
Q

According to ECA study what is the increased risk for depression in separated/divorces subjects vs continually married?

A

3x

60
Q

Which antidepressants are contraindicated in children?

A

Venlafaxine

Paroxetine

61
Q

Risk increase of giving birth to a child with septal defects on Citalopram?

A

2x

62
Q

A 28-year-old lady has been caught for shoplifting. She does not have any previous history of shoplifting. The police are surprised that she did not make any efforts to remain undetected. What type of stealing is this?

A

Depressed stealing

63
Q

Star*D trial overview

A

pragmatic (real world) trail which aimed to assess the effectiveness of treatments in patients diagnosed with major depressive disorder.

It consisted of four different levels of treatment

Level 1 - This consisted of citalopram (given for 14 weeks)

Level 2 - This consisted of either swapping to sertraline, Bupropion, or venlafaxine, or augmenting with Bupropion, or buspirone. Cognitive psychotherapy was also included as a switch or add on at this level.

Level 3 - This consisted of swapping to mirtazapine or nortriptyline or adding on lithium or triiodothyronine (T3).

Level 4 - This consisted of swapping to either tranylcypromine (MAOI) or a combination of venlafaxine and mirtazapine.

Outcome measure used was remission (becoming symptom free).

64
Q

Main conclusions of star*d trial

A

In level 1 1/3 of participants achieved remission. A further 10-15% responded but not to the point of remission.

If treatment with an initial SSRI fails then 1 in 4 who choose to switch to another medication will enter remission regardless of whether the second medication is an SSRI or a medication of a different class. If patients choose instead to add a medication on 1 in 3 will get better

65
Q

Most common cause of serotonin syndrome

A

The most frequent cause of severe reaction is the co-administration of an MAOI with an SSRI.

66
Q

Which combinations of antidepressants should be avoided?

A

Phenelzine and sertraline (MAOI + SSRI)

The combination leads to a high risk of serotonin syndrome.

67
Q

According to the NICE Guidelines, which medication is associated with a higher incidence of discontinuation symptoms?

A

Paroxetine

68
Q

Which SSRI is most associated with causing diarrhoea?

A

Sertraline

69
Q

Features of atypical depression

A

Low mood with mood reactivity (mood varies greatly in response to specific events)
reversal of the features normally seen in depression:
They have hypersomnia (sleep a lot), hyperphagia (eat a lot), weight gain, and libidinal increases

70
Q

Best treatment option for atypical depression

A

People with atypical depression tend to respond best to MAOIs

71
Q

Which antidepressants have the lowest risk of sexual dysfunction?

A

Agomelatine and Bupropion have probably the lowest risk of sexual dysfunction.

72
Q

Which opthalmic problem may be caused by St John’s Wort?

A

Early macular degeneration

73
Q

Which sexual dysfunction can Paroxetine cause?

A

Vaginismus

74
Q

Lifetime prevalence of dysthymia

A

4%

75
Q

Which SSRIs has an active metabolites?

A

Fluoxetine

Sertraline

76
Q

What suggests life-threatening symptom of serotonergic syndrome?

A

High fever

Other Signs and symptoms include seizures, irregular heartbeat or unconsciousness

77
Q

Which SSRI has been shown to be effective when administered sublingually?

A

Fluoxetine

78
Q

Which SSRIs would be most likely to raise the levels of theophylline?

A

Fluvoxamine

79
Q

Beck’s depression inventory

A

SELF RATED
Has 21 questions (max score of 63)
Each question scored from 0-3
Assesses severity of depression
Covers period of two weeks before the evaluation
14-19 mild depression, 20-28 moderate, and 29-63 severe depression.

80
Q

HAMD (Hamilton depression rating scale)

A

CLINICIAN RATED
Multiple choice questionnaire used to rate the severity of depression
17 or 21 items
Each item is scored out of between 3 and 5 points
For the 17 item version (the most commonly used) scores range between 0 and 54
Scores over 24 indicate a severe depression.

81
Q

MADRS (Montgomery-Asberg depression rating scale)

A

CLINICIAN RATED
10 diagnostic questionnaire used to measure the severity of depressive episodes
More sensitive to the changes brought on by antidepressants and other forms of treatment

82
Q

Whihc antidepressants are recommended in liver failure?

A

Imipramine
Paroxetine
Citalopram

83
Q

Which effect of SSRIs is presumed to be the cause of the associated sexual dysfunction?

A

5HT2 agonism

84
Q

Which antidepressantss should be avoided in epilepsy?

A

Amitriptyline
Dosulepin
Clomipramine
Buproprion

85
Q

What % of those who’ve had a first episode of depression will go on to have another?

A

50%

86
Q

What 0% of those with a history of two episodes of depression will have another recurrence?

A

80%

87
Q

What scales is used to measure effect of a treatment in depression?

A

MADRS

88
Q

Drugs used in MS that are associated with developing depression

A

Dantrolene, baclofen, steroids and interferon beta are all associated with the development of depression.

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