Depression Flashcards
list some risk factors for developing depression
unemployment
chronic illnesses
post-natal period
substance misuse
what neurotransmitters are involved in depression
serotonin
noradrenaline
dopamine
what are the 3 core symptoms seen in depression
low mood
low energy levels
loss of interest (adhenonia)
think MEE - mood, energy and enjoyment
for a diagnosis of depression, how many core symptoms must be present
2 out of 3
list some of the associated symptoms of depression
lack of appetite/weight loss poor sleep poor concentration suicidal thoughts psychmotor retardation anxiety irritability
how do symptoms of depression fluctuate as the day goes on
shows diurnal variability, symptoms are worse first thing in the morning
what is Beck’s triad
hopelessness
worthlessness
excessive guilt
for a diagnosis of depression how long do symptoms have to be present for
at least 2 weeks
also no manic episodes
describe a diagnosis of mild depression
2 core symptoms + 2 additional symptoms
describe a diagnosis of moderate depression
2 core symptoms + 4 additional symptoms
describe a diagnosis of severe depression
2 core symptoms + at least 4 additional symptoms but also cannot carry out activities of daily living
what are the additional features present in psychotic depression
delusion and hallucination observed
delusions centred around guilt and failure
hallucinations are second person auditory
what is Cotards syndrome
extreme form of nihilistic delusion where individuals believe part of them has already died
what is dysthymia
continuous chronic form of depression that is present for at least 2 years and does not respond to most antidepressants
how does atypical depression present
biological symptoms are reversed such as increase in appetite, weight gain and excessive sleeping
presents with reactive mood changes
what other tests may be useful in ruling out an organic cause for dementia
FBC - anaemia
TFTs
LFTs
how is mild depression managed
no medication required
low intensity interventions such as sleep hygiene, mindfulness
arrange follow up in 2 weeks, if persistent consider CBT
how is moderate to severe depression managed
antidepressants and CBT
when is ECT indicated for depression
extreme/life threatening depression
when a rapid response is required
what is the first line antidepressant for depression
SSRIs
what is the mechanism of SSRIs
inhibit reuptake of serotonin from synapse into presynaptic cleft
list some examples of SSRIs
fluoextine
sertraline
citalopram
what are the other indications for SSRIs
generalised anxiety disorder
panic disorder
OCD
phobia
are SSRIs safe in overdose
yes however issues with withdrawal and have to slowly reduce dose
what are the main side effects of SSRIs
headache nausea anxiety insomnia agitation decreased sexual function
what is the main risk of prescribing SSRIs in young people
initially increases risk of suicidal ideation
what is the main risk of prescribing SSRIs in older people
increased risk of hyponatraemia and therefore falls
what is the mechanism of action of tricyclics
block the reuptake of serotonin and noradrenaline from the synapse
what are some examples of tricyclics
amitriptyline
imipramine
clomipramine
lofepramine
what are the indications for TCAs
usually second line for depression
chronic neurological pain
what are the side effects of TCAs
weight gain, sedation
anti-cholinergic s/e urinary retention, constipation, blurred vision, sexual dysfunction
what are the cardiac side effects associated with TCAs
QT prolongation
postural hypotension
what are some examples of SNRIs
duloxetine
venlafaxine
what are the side effects of SNRIs
GI upset
hypertension
palpitations
dizziness
what are the main indications for prescribing mirtazapine in depression
if someone has low weight and insomnia as side effects are weight gain and sedation
what type of drugs are monoamine oxidase inhibitors
moclobemide
phenlzine
what must be restricted with use of MAO inhibitors
certain foods such as red wine and cheese as can cause a hypertensive crisis/cheese reaction
how long should a trial of antidepressants last before a review of them
4-6 weeks
if initially starting on SSRI and symptoms do not improve within 6 weeks what is the next step
try an alternative SSRI if unsuccessful try another class of antidepressants
once a patient is in remission from their depression, how long must they continue on their antidepressant to prevent relapse
at least 1 year
outline the process of ECT
procedure under general anaesthetic that triggers a therapeutic seizure where electrodes are placed on patients anterior temporal areas
what are the side effects of ECT
confusion
headache
autobiographical memory loss
