Depression - BB Flashcards
Core symptoms of depression
- Low mood
- Anhedonia
- Lack energy
Biological symptoms to consider in someone with depression
- Low energy
- Poor appetite/increased appetite
- Weight loss
- Loss libido
- Abnormal sleep - esp early morning waking
- Psychomotor retardation or agitation - more likely retardation
- Diurnal mood variation
- Blunted emotional reactivity
If antidepressant is not taking efefct quick enough and patient is deterorating physically as inpatient, what can you do?
Trial of electroconvulsive therapy
Indications for ECT
- Severe depression when need for rapid antidepressant effect
- Medication resistant
- Psychotic depression
- Severe treatment resistant mania
- Catatonia
Side effects of ECT
- Headaches - use simple analgesia
- Muscle aches - due to seizures, muscle relaxants are given through procedure
- Short term memory loss - resolves completelt in most cases, memory tests should be done throughout treatment to monitor for significant loss, can switch to unilateral ECT if concerned
- Nausea/vomitting
- Risk of GA - cardiac, discuss with anaesthetist
- Temporary confusion
Components for discharge for patient admitted with depression
- Referral to CPN
- Refer to outpatient psychiatry clinic
- Crisis team for initial support at discharge - esp while awaiting CPN allocation
- Psychological therapies - eg CBT
- Support groups
- Psychoeducation courses
- Benefits and occupational advice
- Advice re lifestyle measures, importance of sleep and routine, substance msuse
- Mindfulness
Section used of MHA if refusing ECT
- Section 62 of MHA
- Allows 2 sessions of emergency ECT
- Second opinion of approved doctor (SOAD) applied for at this time to provide legal framework for ongoing ECT
ICD-10 criteria for depression - mild vs moderate vs severe
Mild:
* Two or three of the symptoms are usually present.
* The patient is usually distressed by these but will probably be able to continue with most activities.
Moderate:
* Four or more of the symptoms
* Great difficulty in continuing with ordinary activities.
Severe (without psychotic symptoms):
* Several of the symptoms are marked and distressing, typically loss of self-esteem and ideas of worthlessness or guilt.
* Suicidal thoughts and acts are common and a number of “somatic” symptoms are usually present.
ICD-10 criteria depression and symptoms
- Lowering mood
- Reduced energy
- Decrease activity
- Capacity for enjoyment, interest and concentration is reduced
- Tiredness after minimal effort
- Sleep disturbance
- Appetite loss
- Self esteem and self confidence reduced
- Guilt or worthlessness
- Unresponsive to circumstances and varies little from day to day
Somatic:
* Loss of interest and pleasurable feelings
* Worst in morning
* Psychomotor retardation
* Agitation
* Loss of appetite
* Weight loss
* Loss libido
Why women higher rates of depression?
Biological:
* Hormonal - fluctuating oestrogen and progesterone
* Menopause
* Genetic sensitvity - serotonin processing
Psychological:
* Life stressors - children, caregiver role
* Abuse
* Societal expectations - compelled to take on many roles, express emotions openly –> emotional strain
* Rumination coping style - dwell on negative thoughts
Sociocultural:
* Gender inequality
Diagnosis:
* Help seeking behaviour - more women seek help than men
* Gender stigma for men reporting
Social influences that can increase risk of depression
- Lack social support/isolation
- Loss of relationships - eg death, divorce
- Stressful life event - abuse/trauma, financial difficulties
- Job insecurity
- Family - unstable/dysfunctional family environment, parental pressures
- Financial - poverty, unemployment
TCAs vs SSRIs
SSRI:
* Fewer side efefcts
* Safer in overdose
* Fewer sedative effects
* More selective - lower risk of SEs
* Can cause sexual dysfunction, weight changes, serotinin syndrome, delayed onset
TCAs:
* Highly effective
* Can be used for pain too
* Rapid onset in some - within 1 week
* Cheaper
* Sedative
* Toxic in overdose
* CV effects - orthostatic hypotension
* Higher risk drug interactions
