Depression - SAD Flashcards
Depression
-etiology
-predisposing factors
Majority of cases secondary to environmental factors
Young females
Past psych history
-past episodes and how were they managed
Past medical history
-chronic/terminal illness
- DM
- hypothyroidism
- CVD (MI, stroke)
Family history
-depression/bipolar affective disorder
Social history
- relationship status, no of children
- employment, finances
- social/familial support
- accommodation
Substance use
-alcohol, illicit substances => exacerbates symptoms, reduces treatment efficacy
Depression
-screening for core features and timeframe
-associated features
Either core symptom for most days in 2wks
- persistent low mood
- anhedonia
PHQ-9
Disturbed sleep
Appetite, weight change
Anergia
Psychomotor activity
Poor concentration, indecisive
Worthless, guilt
Suicidal thought/acts
Psychosis
Severity of depression classification
Less severe
-PHQ9 U16
More severe
-PHQ9 16+
Differentiating between dementia and depression
Depression more likely if
-short, rapid onset
-physical symptoms
-global memory loss (dementia affects short term memory)
Depression management of
-less severe
-more severe
Both involve shared decision making
Less severe
Antidepressants not offered 1st unless patient’s preference
Options in order of preference
-self guided help
-group CBT => BA
-solo CBT => BA
-SSRI
More severe
Options in order of preference
-CBT + antidepressant
-solo CBT => BA
-SSRI => SNRI => other if indicated based on past Hx
Antidepressant choice (SSRI)
-contraindications
-key interactions
-side effects
1st line - citalopram, fluoxetine
Post MI - sertraline
Children - fluoxetine
Avoid citalopram/escitalopram with meds/conditions that prolong QT
NSAIDs/aspirin - avoid SSRI but if given, add PPI
Warfarin/heparin - mirtazapine instead of SSRI
Triptan/MAOIs - risk of seretonin syndrome if SSRI given
GI symptoms
Increased GI bleed risk
SIADH => hypo Na
SSRI
-monitoring
-reducing dose
-discontinuation symptoms
After starting SSRI, review in
-1wk if U25/increased suicide risk
-2wks for everyone else
Good response => continue for min 6 months after remission to reduce relapse risk
Gradually reduce dose over 4wks
Discontinuation symptoms - within 5 days of stopping, last 1-2wks
-increased mood change
-restlessness
-difficulty sleeping
-unsteady
-sweating
-GI symptoms (pain, cramps, diarrhoea, vomiting)
-paraesthesia
-electric shock-like feelings in head
Seasonal affective disorder
-how to identify it
-management
Depression occuring in winter
1st line - psychological therapy
Follow up in 2wks
-add SSRI if needed
ECT
-indications
-contraindications
Severe depression
-refractory to meds
-psychosis
CI in raised ICP
Short term SE
-headache
-nausea
-short term memory impairment
-memory loss prior to ECT
-cardiac arrythmia
Long term SE
-impaired memory