Depression + Anxiety clinical Flashcards
Is depression higher in men or women?
Women
What are the risk factors of depression?
- Genetics
- Anxiety
- Gender
- Lack of parental care or childhood sexual abuse
- Social adversity, stress and the persons reaction to it
- Physical illness (kidney disease and diabetes give a 5 times higher risk)
- Poor sleep and chronic insomnia
- Vitamin D deficiency
- Quitting smoking
- Drugs
- Mother having postnatal depression
What are the risks to the individual for untreated depression?
- Increase in risky behaviour such as drug or alcohol abuse
- Cognitive impairment, including poor interactions with friends, family, colleagues etc…
- Poor work
- Poor sleep and it’s consequences
- Suicidal ideation or suicidal acts
What are the risk factors for recurrent depression?
- History of frequent and/or multiple episodes
- Onset after the age of 60
- Long duration of individual episodes
- Family history of affective disorder
- Poor symptom control during continuation therapy
- Co-morbid anxiety disorder or substance abuse
What drugs/substances can induce depression?
- Alcohol
- Steroids (e.g. dexamethasone)
- Benzodiazepines (e.g. diazepam, lorazepam)
- Antipsychotics
- Anticonvulsants (e.g. carbamazepine, pregabalin)
- NSAIDs
- Cardiovascular drugs (e.g. beta-blockers, CCBs)
- Caffeine/caffeine withdrawal
What are the emotional symptoms of depression?
- Sadness
- Anxiety
- Irritability
- Lack of enjoyment
- Suicidal ideation
- Hopelessness
- Inappropriate guilt
What are the physical symptoms of depression?
- Fatigue
- Eating/weight changes
- Joint, abdominal and other pains
- Insomnia/hypersomnia
- Sexual dysfunction
- Headaches
- Psychomotor agitation
What are the cognitive symptoms of depression?
Difficulties with:
- Attention and concentration
- Short and long term memory
- Decision making
- Planning and organisation
- Mental sharpness
- Word-finding
- Thinking speed
- Judgement
What is sub-threshold depression?
Where the person has a few symptoms and feels low, but can still function.
What is mild depression?
Where the person has enough symptoms for a diagnosis but can function reasonably well.
What is moderate depression?
Where the person has a range of symptoms and is not coping well.
What is severe depression?
Where the person has a full set of symptoms, can’t function and may even suffer psychotic symptoms too.
What is complex depression?
Where symptoms have failed to improve with treatment and may have psychosis and/or other symptoms and problems.
What are possible differential diagnosis for depression?
- Bipolar depression
- GAD
- Drug- induced depression
- Schizophrenia
- ADHD
- Substance misuse
- Personality disorders
- Normal bereavement
- Physical illness
- Dementia
- Panic disorder
- Seasonal affective disorder
What are the 7 more common depression co-morbidities?
- GAD
- Psychosis
- Insomnia
- OCD
- PTSD
- Panic disorder
- Dementia
What are the low intensity non-pharmacological treatments for depression?
- Guided self-help
- Being active
- Computer based CBT
What are the high intensity non-pharmacological treatments for mild, moderate and severe depression?
- Psychological therapies e.g. CBT, interpersonal therapies etc…
- General support and advice e.g. on financial matters to reduce stress
What are the high intensity non-pharmacological treatments for severe and complex depression?
- ECT (electroconvulsive therapy)
- TMS (transcranial magnetic stimulation)
What are the three standard first line anti-depressants?
Citalopram, fluoxetine, sertraline
What time of the day should SSRIs be taken?
In the morning.
What time of day should mirtazapine be taken?
At night.
Roughly how long can it take for anti-depressants to work?
2-6 weeks
When switching from an ineffective SSRI, what should be tried?
Another SSRI or a better tolerated newer- generation anti-depressant.
What are the symptoms of serotonin syndrome?
- Restlessness
- Myoclonus
- Tremor and rigidity
- Hyperreflexia
- Shivering/elevated temperature
- Arrhythmias
