Depression + Anxiety Flashcards
Monoamine hypothesis
Depression results from the depletion of monoamines noradrenaline, serotonin and dopamine. Antidepressants increase the amount of these
Organic causes of depression (neuro, endocrine, metabolic, infective, drugs)
Neuro: stroke, Alzheimers, Parkinsons, Huntingtons, MS, tumours Endocrine: cushings, addisons, hypothyroidism, hyperparathyroidism Metabolic: iron deficiency, hypercalcaemia, hypomagnesaemia Infective: infectious mono, hepatitis, HIV Drugs: levodopa, steroids, beta blockers, digoxin, alcohol
Beck’s triad
Negative view of yourself, the present and the future
S+S depression
Core: low mood, low energy, anhedonia Biological: sleep, appetite, loss of libido, restlessness Psychological: poor self esteem, guilt, self harm/ suicide thoughts, concentration
ICD 10 Criteria for depression
Mild: 2 core + 2 other Moderate: 2 core + 4 other Severe: 3 core + 3 other (+ psychosis)
Management of depression
Mild: watch + wait, self help, sleep hygiene, counselling Moderate + severe: CBT + SSRI Use SSRI, then try another SSRI, then try an SNRI or Mirtazapine. Can combine mirtazapine with an SSRI or SNRI. Failing that use lithium, sodium valproate or antipsychotic. For severe: can use ECT
SSRIs (action, SE, complications, SSRI discontinuation syndrome)
Selectively inhibit reuptake from the presynaptic cleft. SE: nausea, vomiting, diarrhoea, dizziness, sedation, sexual dysfunction, akathisia Can cause GI bleeds - do not take NSAIDs, aspirin or warfarin Can cause hyponatraemia SSRI discontinuation syndrome: headache, dizziness, shock like sensations, paraesthesia, GI symptoms, lethargy
Serotonin syndrome (causes, S+S)
Caused by SSRIs, TCA, lithium, tramadol Agitation, confusion, nystagmus, tremor, seizures, hyperthermia, autonomic instability
Citalopram + sertraline uses, key SE
Citalopram = least drug interactions, good for the elderly, prolongs QT Sertraline = best for CV patients
Fluoxetine + paroxetine uses, key SE
Fluoxetine = best for younger patients, longest HL, good for bulimia Paroxetine = shortest HL, can get discontinuation syndrome
SNRIs action, SE + contraindications
Venlafaxine, duloxetine Same SE as TCAs (anticholinergic) + sexual dysfunction Don’t give in uncontrolled HTN - do ECG + BP before starting
NASSAs - SE
Mirtazapine - sedative + weight gain More sedative at a lower dose Less sexual dysfunction than others
TCAs - names, action, SE, OD, contraindications
Amitryptylline, clomipramine, imipramine Inhibit reuptake of noradrenaline + serotonin SE: anticholinergic (dry mouth, dry eyes, constipation, urinary retention), antihistaminergic (sedation, weight gain) CV (postural hypotension, arrhythmias), neuro (delirium, seizures) Lethal in OD Contraindications: CV disease, liver disease, glaucoma, prostatic hypertrophy
MAOi - names, action, cautions, SE, interactions
Phenelzine, isocarboxacid, tranylcypromine Inhibit degradation of monoamines presynaptically Must adhere to strict no tyramine diet (no cheese, game, yeast etc) Can cause HTN crisis SE: anticholinergic, weight gain, insomnia, postural hypotension Interact with insulin
ECT - uses, SE
Used for severe depression, catatonia, psychosis SE: headaches, muscle aches, nausea, confusion, temporary memory loss
Risk factors for suicide
Male aged 25-44 Single/ widowed/ divorced Unemployed High level occupation (doctor, vet, pharmacist) SES IV, V Physical illness = cancer, AIDS, epilepsy, MS
S+S anxiety
Pyschological - fear, feeling of doom, night terrors, poor concentration Physical: CV, GI, resp, genitourinary
Neurological cause of anxiety
Noradrenergic neurones in locus coeruleus (pons) + serotinergic neurones in raphe nuclei = act on limbic system to increase anxiety Also can be caused by imbalance in GABA
Management of GAD
CBT, SSRI Benzos for short term use only
Agoraphobia
Fear of places that are difficult or embarrassing to escape from - may respond to CBT
Panic disorder management
SSRI, then TCA
OCD - S+S, diagnosis
Obsessional thoughts (recurrent ideas, perceived as senseless, resulting in anxiety) Commonly: doubt, contamination, orderliness, safety Compulsive acts (recurrent behaviour, reduces anxiety, seen as senseless) Commonly: washing, cleaning, arranging, ritualistic behaviours Diagnosis - more than 2 weeks
OCD management
CBT such as ERP - exposure + response prevention 1st) SSRI 2nd) Clomipramine 3) + gabapentin, lamotrigine, olanzapine + risperidone
PTSD - S+S, management
Hyperarousal, involuntary + intense flashbacks + avoidance Around 6 months post event EMDR - eye movement desensitisation reprocessing Avoid meds but if needed: paroxetine or mirtazapine
