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Year 3 > Depression (PSY) > Flashcards

Depression (PSY) Flashcards

1
Q

Define major depressive disorder.

A

Episodic mood disorder primarily characterised by depressed mood and anhedonia, lasting for at least 2 weeks

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2
Q

Which demographics does major depressive disorder affect? (4)

A
  • 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
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3
Q

What causes major depressive disorder?

A

Lack of monoamines (serotonin, noradrenaline, dopamine)

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4
Q

What are some risk factors for major depressive disorder? (7)

A
  • female
  • recent childbirth (postnatal status)
  • stress
  • trauma
  • co-existing medical conditions e.g. dementia
  • medications: corticosteroids, propranolol, OCP
  • personal/Fx depression
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5
Q

What is persistent depressive disorder?

A

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

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6
Q

What are the two major criteria for depression?

A
  • depressed mood - most of the day, nearly every day, for 2 weeks
  • anhedonia - markedly diminished interest/pleasure in all activities for 2 weeks
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7
Q

What are the ‘minor’ criteria for depression? (7)

A
  • sleep disturbance (insomnia/hypersomnia)
  • guilt/worthlessness
  • fatigue
  • diminished concentration/cognition
  • weight change (due to appetite change)
  • agitation (change in activity)
  • suicidal ideation
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8
Q

What is the diagnostic criteria for major depressive disorder according to DSM-V?

A

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)

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9
Q

How do we diagnose major depressive disorder?

A

Clinical diagnosis (DSM-V or ICD-11 criteria)

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10
Q

What investigations can we do to exclude organic causes of major depressive disorder? (3)

A
  • FBC - anaemia
  • TFTs - hypothyroidism
  • metabolic panel
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11
Q

What questionnaire can we give in depression?

A

Patient Health Questionnaire 9 (PHQ-9)

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12
Q

What scale can we put patients with depression on?

A

Hospital Anxiety and Depression (HAD) scale

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13
Q

What two diagnostic criteria are used to diagnose major depressive disorder?

A
  • 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)
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14
Q

What are the first-line medications for depression? (4)

A
  • SSRIs - sertraline, citalopram, fluoxetine
  • SNRIs - venlafaxine, duloxetine
  • MAO inhibitors - isocarboxazid
  • TCAs - amitriptyline
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15
Q

What are some issues of SSRIs? (5)

A
  • GI side effects
  • GI bleed risk if used with NSAIDs (co-prescribe PPI)
  • erectile dysfunction
  • hyponatraemia (SIADH)
  • citalopram –> prolongs QT interval
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16
Q

What is a side effect of citalopram (SSRI)?

A

Prolongs QT interval

17
Q

Who do we give fluoxetine (SSRI) to?

A

SSRI of choice in children and adolescents

18
Q

Who do we give sertraline (SSRI) to?

A

SSRI of choice in post-MI

19
Q

How long should we give antidepressants for?

A
  • 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
20
Q

What psychotherapy is there for major depressive disorder?

A

CBT

21
Q

What lifestyle changes are there for major depressive disorder? (5)

A
  • exercise
  • nutrition
  • sleep hygiene
  • social support
  • stress reduction
22
Q

What are the NICE guidelines for depression?

A
  • 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
23
Q

What antidepressants do you avoid if patient at risk of suicide?

A

Avoid TCAs (e.g. amitriptyline) and venlafaxine (SNRI) - risk of death from OD

24
Q

What do you need to do after prescribing antidepressants for depression?

A

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)

25
Q

What are some complications of major depressive disorder? (3)

A
  • self harm / suicide
  • weight gain from antidepressants
  • sexual adverse effects of SSRIs
26
Q

Describe the prognosis of major depressive disorder.

A

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

Year 3 (95 decks)

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