Depression and Anxiety Flashcards
What is Depression/ Anxiety - symptoms?
Depression
* Low mood, lack of interest in life,
* insomnia/too much sleep,
* flattening/loss of reactivity
* restlessness/psychomotor agitation,
* fatigue/loss of energy,
* tearfulness, diminished ability to concentrate/indecisiveness,
* suicidal ideation
Anxiety
* Excessive Fear and anxiety, phobias, avoidance of tasks/situations/scenarios.
* Also compulsive or obsessive behaviours (may be considered a disorder in its own right)
* Physical symptoms – palpitations, digestive
symptoms, sweating.
* Cognition may be intact. Mood & memory may not be affected. Patients are typically co-operative/looking for treatment
What are the conventional ways to diagnose and treat Depression?
Depression diagnosis
* Based on presenting clinical picture.
* Taking into account the patient’s experience – questionnaires
* Hamilton scale (practitioner defined)
* Reactive depression – a diagnostic term suggesting a response to a recent event - although a long term grief response is now associated with physiology such as vitamin D deficiency or hormones similar to post-natal depression
Treatment of depression
* ‘Watchful waiting’
* Talking therapy
* Medication: Anti-depressants - Selective serotonin reuptake inhibitors (SSRIs), Serotonin/norepinephrine reuptake inhibitors (SNRIs): Monoamine oxidase inhibitors (MAOIs); Tricyclic antidepressants (TCAs)
* ECT – electro-convulsive -therapy
Aim of treatment
* Medications tend to be aimed at increasing the availability of some neurotransmitters
* Correcting a ‘chemical Imbalance’ narrative has recently been strongly challenged. Evidence base for efficacy is poor but works for some patients.
* Nice guidelines - Foster an ‘atmosphere of optimism and hope , recovery is possible’ With appropriate treatment, 70–80% of individuals with major depressive disorder can achieve a significant reduction in symptoms
What are the conventional ways to diagnose and treat Anxiety?
Anxiety diagnosis
* Based on Clinical picture – Patient’s experience and Practitioner clinical evaluation usually GP
* Diagnosis of exclusion (hyper-thyroid, nutritional deficiency etc)
Anxiety treatment
* Talking therapies – CBT
* Benzodiazepines – Valium etc ( short term – with consideration of the potential to addiction)
* SSRIs preferred . Other classes of anti-depressants .
* Beta-blockers
* NICE guidelines – stepped interventions – so step 1 – if this doesn’t work consider step 2 etc –
Expectation of treatment
Depending on degree and co-morbidity – will be expected to be resolved or managed
Anti-depressant withdrawal can be frightening and debilitating. Bear this in mid when prescribing cause by
herbal medicines
