Depression Flashcards
What are the 3 core symptoms of depression?
- Depressed mood
- Anhedonia (loss of pleasure)
- Fatigue
What are the additional symptoms of depression?
- Poor appetite/ weight loss (vice versa increased)
- Disrupted sleep
- Low concentration
- Guilt
- Low self esteem
- Self harm/ suicide
How are the different depression severities classified?
- Mild = 2 core + 2
- Moderate = 2/3 core + 3
- Severe = 3 core + 4 (+/- psychosis)
Increasing disruption in function
How often should symptoms present?
- Symptoms must be present, every or nearly every day
- Present for over 2 weeks
- Represent a change from normal personality without alcohol/drugs, medical disorders, or bereavement.
What investigations should you do?
Investigations are used to exclude pathological causes for depression
- Blood tests - blood glucose, U&Es, LFTs, TFTs, Ca levels, FBC, inflammatory markers
- Other tests – Mg2+ levels, HIV/syphilis serology, drug screening
- Imaging - MRI/CT brain
What is the diagnostic test for depression?
- Assess using PHQ-9
- It classifies symptoms of a scale of 0-3 over the past 2 weeks (0= not at all, 1= several days, 2= over half days, 3= nearly very day)
What are the diagnostic test questions?
During the past two weeks, have you:
• Been bothered by feeling down, depressed or hopeless?
• Had little interest of pleasure in doing things?
Further evaluation should be triggered if the answer is yes to either question:
- Significant weight loss/gain when not dieting
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day
- Diminished ability to think or concentrate, or indecisiveness nearly every day
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
What are the psychological treatments?
- CBT
What are the biological treatments?
Antidepressants
o SSRI e.g. fluoxetine, citalopram (preferred), sertraline
o TCA (tricyclics) e.g. amitriptyline, nortriptyline, lofepramine
o NaSSA e.g. mirtazapine (best in older people, low s/e)
o SNRI e.g. venlafaxine, duloxetine
What is the treatment for severely depressed patient with active suicidal thoughts and significant psychomotor retardation?
- Hospitalisation
- Psychiatric referral
- Electroconvulsive therapy (ECT) – in catatonic depression
What are the complications of SSRI
- GI issues (not given with NSAIDS)
- Weight gain
- Increased suicide risk
- Congenital defects if used in pregnancy (3rd trimester) (esp paroxetine)
- Contraindicated with warfarin/ heparin
- Citalopram don’t use in QT syndrome
What can happen on discontinuation of antidepressant?
Flu-like symptoms
Insomnia Nausea Imbalance Sensory disturbances Hyperarousal
How should SSRI be withdrawn?
Gradually over a month
What are the suicide risk factors?
- Male sex
- Alcohol or drug misuse
- History of deliberate self-harm
- History of mental illness
depression - History of chronic disease
- Advancing age
- Unemployment or social isolation/living alone
- Being unmarried, divorced or widowed
What are suicide protective factors?
- Family support
- Having children
- Religious belief
What are the factors that increase the risk of completing suicide at later date?
- Avoid being discovered
- Wrote a note
- Planned suicide
- Final acts (sorting out finances)
- Violent method
Side effects of mirtazapine?
- Increase in appetite
- Drowsiness
Side effects of ECT?
- Headache
- Nausea
- short term memory impairment
contraindicated in raised intercranial pressure
Why are antidepressants used?
Its use is based on the chemical/biological theory of depression. That there is dysfunctional neurotransmission in depression of serotonin and noradrenaline.
Antidepressants increase the neurotransmitters
What is dysthymia?
This is a persistent depressive disorder. It includes the symptoms of depression but often milder and longer lasting - most days for 2+ years
