Depression Flashcards
What is depression?
A mood disorder causing a persistent feeling of sadness and loss of interest
How is depression divided?
Mild - core symptoms + 2/3 other symptoms
Moderate - core symptoms + 4 other symptoms
Severe - suicidal, marked loss of functioning
Severe divided into with/without psychotic symptoms
What is dysthymia?
Mild/moderate depressive illness lasting intermittently for 2 years or more
Mood relapses and remits with several weeks of feeling well and then followed by longer periods of being unwell
What is seasonal affective disorder?
Recurrent episodes of depressive illness occurring in winter months in northern hemisphere
What are puerperal affective disorders?
Depression related to pregnancy
Name 4 risk factors for developing depression
Family history of depression
Death or loss in your life
Conflict - personal disputes or disputes with family/friends
Abuse - physical, sexual, or emotional
Other illnesses - sleep problems, chronic pain, anxiety, ADD
Medications
Substance abuse
Social isolation due to illness or separation from family or social groups
Emotional or perfectionist personality
How common is depression?
1/3 of population will feel unhappy at any one time
Middle-aged people feel the least happy
5% prevalence in the community
More common in women
No difference in ethnic group or socioeconomic class
Similar prevalence in married and non-married people
Divorced people have 2-3x the prevalence
Becoming more common
Associated with increased mortality in those with physical illness
What are the psychiatric differential diagnoses for depression?
Alcohol misuse Amphetamine misuse and withdrawal EUPD Dementia Delirium Schizophrenia Normal and pathological grief Bipolar disorder!!! Seasonal affective disorder!!!
What are the organic differential diagnoses for depression?
Cushing's syndrome Hypothyroidism!!! Hyperparathyroidism Corticosteroid treatment Brain tumour MS Vit B12 deficiency Addison's disease
What are the biological symptoms of depression?
Lack of sleep Lack of appetite Anergia Lack of motivation Change in libido and erectile dysfunction Impoverished, slow, monotonous speech - psychomotor retardation Weight loss Constipation Bodily pains Psychomotor agitation Menstrual cycle changes
What are the psychological symptoms of depression?
Anhedonia Diurnal mood variation Depressed, miserable, or irritable Thoughts of hopelessness Guilt Suicidal thoughts Persistent low mood Feelings of unworthiness
What are the cognitive symptoms of depression?
Struggling with concentration Memory difficulties Agitation Loss of confidence Indecisive Difficulty problem solving
What is the criteria for depression diagnossi?
Symptoms every day, most of the day for 2 weeks or more
What is the monoamine deficiency theory?
Unbalance of monoamines eg serotonin, dopamine, noradrenaline is what causes depression
What is the hypothalamo-pituitary-adrenal axis theory?
Steroids cause depression
Administration of exogenous steroids and Cushing’s disease cause the onset of depression
What changes occur in the brain that seems to be related to depression?
Non-specific changes involving regions that are associated with emotional and cognitive abnormalities, increased brain ventricle volume and orbito-frontal, dorsolateral frontal and anterior cingulate cortex altered activation implicated
What could cause depression and why?
Stress
Triggers brain changes in stress hormones and neurotransmitters
What investigations should you do in a depressed patient to rule out differentials?
FBC, U&E, serum creatinine, eGFR Liver biochemistry Serum calcium ESR/CRP TSH Serum cortisol ANA CXR EEG/brain scan
What is the physical management of depression?
Cessation of depressing drugs Regular exercise Antidepressants Adjunctive drugs eg lithium if no response to 2 different antidepressants ECT
What is the psychological management of depression?
Education and regular follow-up by same professional
CBT
Other indicated psychotherapies (couple, family, interpersonal)
What is the social management of depression?
Financial - eligible benefits, debt counselling
Employment - acquiring or changing a job or career
Housing - adequate, secure tenancy, safe social neighbours
Young children - childcare support
What is the prognosis of depression?
With treatment, episodes last 3-6 months
Likelihood of recurrence is high
Less favourable outcome the lower the age of onset
Prognosis worse with psychotic features, prominent anxiety, personality disorders, and severe symptoms
Persistent symptoms in around 10%
What are the common co-morbidities of depression?
Anxiety!! OCD Drug dependence!! Alcohol dependence!! PTSD Personality disorder
What antidepressants might you prescribe?
MAO
SSRIs
SNRIs
TCAs
