Depression + suicide Flashcards
depression triad
low mood
anhedonia
low energy
diagnostic criteria for depression (DSM-4)
1) low mood or anhedonia for 2+ weeks (mood is change from baseline)
2) plus 5 specific symptoms nearly every day
3) impaired function
4) not due to other cause
biological symptoms of depression
Concentration reduced, indecisive Appetite + weight changes Psychomotor retardation/agitation Early waking, sleep changes, morning mood worse Sex drive reduced
CAPES
symptoms of depression - non-bio and bio
Low mood/irritable - most of day, nearly every day Low energy Anhedonia - most activities, most of day Guilt/worthlessness Suicidality
Concentration reduced, indecisive Appetite + weight changes Psychomotor retardation/agitation Early waking, sleep changes, morning mood worse Sex drive reduced
Other causes for depression to rule out
bipolar - ask mania
negative schizophrenia sx - ask hx psychosis
bereavement - ask re stressful life events
medication or substances
medical illness
CBT - how does it work? what is the typical course?
understand thoughts, behaviours + how they affect you
modify them
identify + challenge negative ones
8 sessions over 3 months
antidepressants - when to review?
1 week if under 30/at increased suicide risk
otherwise 2 weeks
stopping antidepressants - when + how?
continue at least 6mo after remission
reduce dose over 4 weeks
beware discontinuation max 2wk
SEs of SSRIs
tummy upset + nausea headaches anxiety sexual problems agitation dry mouth
THA-SAD life
discontinuation symptoms of antidepressants
psych - mood change, anxiety energy - restless, sweating sleep - problems + vivid dreams CNS - electric shock sensations, dizziness ill - upset stomach, flu like
those PESCI meds! (top down)
last max 2 weeks
alternatives to SSRIs
SNRI
mirtazapine or tricyclics
ECT
lithium
