depression_management_flashcards

Question 1

What should be considered when assessing the severity of depression?

Answer 1

Number of symptoms, degree of functional impairment and/or disability, and duration of the episode.

Question 2

What aspects of a patient’s history should be explored?

Answer 2

Previous episodes of depression and mood elevation (BPAD), comorbid physical illnesses, responses to previous treatments, and the quality of interpersonal relationships.

Question 3

What important question should always be asked to assess suicide risk?

Answer 3

“Have you had thoughts of harming yourself or ending your life?” - if significant risk to self, refer to specialist MH services urgently.

Question 4

What interventions are included in Step 1 of the Stepped Care Model?

Answer 4

Assessment, support, psychoeducation, active monitoring, and referral for further assessment and interventions.

Question 5

What interventions are included in Step 2 of the Stepped Care Model?

Answer 5

Low-intensity psychological interventions, psychological interventions, medication, referral for further assessment and interventions.

Question 6

What interventions are included in Step 3 of the Stepped Care Model?

Answer 6

Medication, high-intensity psychological interventions, combined treatments, collaborative care, and referral for further assessment and interventions.

Question 7

What interventions are included in Step 4 of the Stepped Care Model?

Answer 7

Medication, high-intensity psychological interventions, ECT, crisis service, combined treatments, multi-professional, and inpatient care.

Question 8

What advice should be given to patients when starting treatment?

Answer 8

Symptoms may get worse soon after starting treatment; provide clear advice on how to seek help, e.g., local crisis lines, Samaritans, A&E.

Question 9

What should be the management for mild to moderate depression?

Answer 9

Sleep hygiene advice, further assessment within 2 weeks, low-intensity psychosocial interventions such as individual-guided self-help based on the principles of CBT, computerised CBT, and structured group physical activity programmes.

Question 10

When should medication be considered for mild to moderate depression?

Answer 10

Past history of moderate or severe depression, symptoms present for a long time (>2 years), symptoms persist after other interventions.

Question 11

What is the first-line medication for moderate to severe depression?

Answer 11

SSRI (e.g., sertraline).

Question 12

What are the risks associated with SSRIs?

Answer 12

Bleeding, especially in the elderly, gastric ulcers, hyponatremia, and potential drug interactions.

Drug Interaction: fluoxetine, fluvoxamine, paroxetine
 Discontinuation Symptoms: paroxetine
 Death from Overdose: venlafaxine
 Overdose: TCAs (except lofepramine)
 Stopping due to side effects: venlafaxine, duloxetine, TCAs
 Blood Pressure Monitoring Needed: venlafaxine
 Worsening Hypertension: venlafaxine, duloxetine
 Postural Hypotension and Arrhythmia: TCA

Question 13

What should be included in the review after starting antidepressant medication?

Answer 13

Review after 2 weeks (if low suicide risk), then every 2-4 weeks thereafter for 3 months.

Question 14

What should be done for patients 18-25 years old or at increased risk of suicide?

Answer 14

Follow-up after 1 week.

Question 15

What high-intensity psychological interventions are recommended for moderate to severe depression?

Answer 15

Individual CBT and Interpersonal Therapy, consisting of 16-20 sessions over 3-4 months.

Question 16

What should be considered for severe and complex depression?

Answer 16

Use crisis resolution and home treatment teams, develop a crisis plan, consider inpatient treatment, and consider ECT if necessary.

Question 17

What are the caution points when switching antidepressants?

Answer 17

Be cautious when switching from fluoxetine to other antidepressants, from fluoxetine or paroxetine to a TCA, to a new serotoninergic antidepressant or MAOI, and from non-reversible MAOI.

Question 18

What is the management for persistent subthreshold depressive symptoms or mild to moderate depression?

Answer 18

Consider psychological intervention, avoid routine use of antidepressants unless certain conditions apply.

Question 19

What is the management for moderate or severe depression?

Answer 19

Offer an antidepressant and a high-intensity psychological intervention.

Question 20

What should be considered for the first episode of depression?

Answer 20

Consider an SSRI (e.g., citalopram, sertraline).

Question 21

What should be considered for a recurrent episode of depression?

Answer 21

Consider an antidepressant that the patient has previously had a good response to, avoid antidepressants that have previously failed.

Question 22

What should be done if the patient has a co-existing chronic physical health problem?

Answer 22

Sertraline is preferred due to a lower risk of drug interactions.

Question 23

What should be done if the patient develops psychosis?

Answer 23

Add the antipsychotic earlier on (whenever the psychosis comes on).

Question 24

What is the process for stopping antidepressants?

Answer 24

The dose should be tapered down over a period of 2-4 weeks.

Question 25

What should be explained to patients about depression?

Answer 25

Explain that depression is a condition with persistently low mood that impacts day-to-day functioning, it is common, and involves treatment options such as psychological therapy and medication.