Depression (PSY) Flashcards
Define major depressive disorder.
Episodic mood disorder primarily characterised by depressed mood and anhedonia, lasting for at least 2 weeks
Which demographics does major depressive disorder affect? (4)
- F>M
- 3rd decade of life
- affects 5-10% of patients in primary care setting
- 1/5 nursing home residents without dementia are diagnosed with depression
What causes major depressive disorder?
Lack of monoamines (serotonin, noradrenaline, dopamine)
What are some risk factors for major depressive disorder? (7)
- female
- recent childbirth (postnatal status)
- stress
- trauma
- co-existing medical conditions e.g. dementia
- medications: corticosteroids, propranolol, OCP
- personal/Fx depression
What is persistent depressive disorder?
Characterised by at least 2 years of a depressed mood for most of the day, for more days than not, for at least 2 years
What are the two major criteria for depression?
- depressed mood - most of the day, nearly every day, for 2 weeks
- anhedonia - markedly diminished interest/pleasure in all activities for 2 weeks
What are the ‘minor’ criteria for depression? (7)
- sleep disturbance (insomnia/hypersomnia)
- guilt/worthlessness
- fatigue
- diminished concentration/cognition
- weight change (due to appetite change)
- agitation (change in activity)
- suicidal ideation
What is the diagnostic criteria for major depressive disorder according to DSM-V?
Five or more of the symptoms (as above) during the same two-week period and represent a change from previous functioning
At least one is either depressed mood OR anhedonia + 4 others (mood, anhedonia, sleep, guilt, fatigue, concentration, weight, agitation, suicidal)
How do we diagnose major depressive disorder?
Clinical diagnosis (DSM-V or ICD-11 criteria)
What investigations can we do to exclude organic causes of major depressive disorder? (3)
- FBC - anaemia
- TFTs - hypothyroidism
- metabolic panel
What questionnaire can we give in depression?
Patient Health Questionnaire 9 (PHQ-9)
What scale can we put patients with depression on?
Hospital Anxiety and Depression (HAD) scale
What two diagnostic criteria are used to diagnose major depressive disorder?
- ICD-11 (mild, moderate and severe depression)
- DSM-V: major depressive disorder ( 5+ symptoms >2wk, including low mood or anhedonia) vs subthreshold/minor depression (not defined but refers to 2-4 symptoms >2wk, including low mood or anhedonia)
What are the first-line medications for depression? (4)
- SSRIs - sertraline, citalopram, fluoxetine
- SNRIs - venlafaxine, duloxetine
- MAO inhibitors - isocarboxazid
- TCAs - amitriptyline
What are some issues of SSRIs? (5)
- GI side effects
- GI bleed risk if used with NSAIDs (co-prescribe PPI)
- erectile dysfunction
- hyponatraemia (SIADH)
- citalopram –> prolongs QT interval
What is a side effect of citalopram (SSRI)?
Prolongs QT interval
Who do we give fluoxetine (SSRI) to?
SSRI of choice in children and adolescents
Who do we give sertraline (SSRI) to?
SSRI of choice in post-MI
How long should we give antidepressants for?
- should be continued for at least 6 months after remission of symptoms to decrease risk of relapse
- when stopping them, doses should be reduced gradually over 4 weeks
What psychotherapy is there for major depressive disorder?
CBT
What lifestyle changes are there for major depressive disorder? (5)
- exercise
- nutrition
- sleep hygiene
- social support
- stress reduction
What are the NICE guidelines for depression?
- provide advice on activities to improve sense of wellbeing
- urgent referral to specialist mental health services if patient has more severe depression or psychotic Sx
- discuss options for Rx - SSRIs, CBT, group exercise, counselling etc
What antidepressants do you avoid if patient at risk of suicide?
Avoid TCAs (e.g. amitriptyline) and venlafaxine (SNRI) - risk of death from OD
What do you need to do after prescribing antidepressants for depression?
Arrange follow up two weeks after starting - check response, concordance, adverse effects or suicidal ideas since it gets worse before improving
(1 week follow up if 18-25y or concern for suicide)
What are some complications of major depressive disorder? (3)
- self harm / suicide
- weight gain from antidepressants
- sexual adverse effects of SSRIs
Describe the prognosis of major depressive disorder.
For patients in their first episode of depression, treatment to remission may take several months and should be continued for 9-12 months after remission
