Depression Tutorial

Question 1

What are the 3 core symptoms of depression?

Answer 1

Low mood
Anhedonia
Low energy/high fatigue

Question 2

What are the associated symptoms of depression?

Answer 2

• Loss of appetite
• Loss of libido
• Sleep disturbance
• Loss of confidence/self-esteem
• Unreasonable guilt/self reproach
• Loss of conc
• Suicidal thoughts
• Psychomotor agitation/retardation

Question 3

What’s required for a diagnosis of MDD?

Answer 3

• > 2wks
• No manic episodes in history
• No organic disorder or substance cause
• Excluded psychotic disorders

Question 4

So how do we diagnose MDD?

Answer 4

Atleast 2 of the core symptoms
+ more from the associated up to total of 4 for Mild MDD

Moderate = total of 6 Sx
Severe = total of 8 Sx

Question 5

What symptoms jump you straight to severe depression?

Answer 5

Psychotic symptoms e.g. hallucinations or delusions

Question 6

What tests might you want to do on a “depressed” patient to rule out organic problems?

Answer 6

TSH for hypothyroid
FBC for anaemia & chronic infection
CT head if neuro signs or trauma history

Question 7

What other tests would you want to do when determining treatment for depressoin?

Answer 7

Baseline:
- LFTs
- U&Es + creatinine
- ECG

Potentialy also a fasting blood glucose & fasting lipid profile if using anti-psychotics

Question 8

In what order would we use treatments for depression?

Answer 8

1) SSRI
2) Switch SSRI
3) Switch to SNRI or augment with novel e.g. mirtazepine
4) Augment with mood stabilizer or try a TCA

After stage 2 you’re really picking what you do based on the side effect profile, past treatment and the specific target symptoms

Question 9

When would you use ECT in MDD?

Answer 9

If severely treatment resistant
OR if they need swift resolution of severe symptoms (particularly if they’re psychotic)

As it’s far faster acting than therapy or drugs

Question 10

What order of drugs would you employ for mania?

Answer 10

1st is mood stabilizer e.g. lithium

Might need a short term sedative e.g. a benzo
Might need an anti-psychotic in severe cases that need short term resolution

Question 11

What drugs do we use in BPD?

Answer 11

Mood stabilizers/

Don’t give them anti-Ds unless you really have to in a severe resistant depressive episode. There’s too much risk of an extreme manic switch