Depressive Disorder Flashcards
What is depressive disorder?
Disorder where symptoms of unhappiness become qualitatively different and pervasive or interfere with normal functioning
Who gets depressive disorder?
- More than 50% of cases before age 30
- Onset usually late 20s-30s
Criteria for depressive disorder?
- Depressive episode should last at least 2 weeks
- No hypomanic or manic episodes in individual’s life
- At least 2 of the following symptoms:
- Depressed mood
- Loss of interest or pleasure
- Decreased energy
+
Additional symptom or symptoms to make at least 4 (eg guilt, poor concentration etc)
Acronym to help assess depressive episode?
MEE
- Mood
- Energy
- Enjoyment
Additional symptom list in depressive episodes?
- Loss of confidence
- Guilt
- Suicidal ideas or behaviours
- Poor concentration
- Agitation/retardation
- Sleep in disturbance
- Changes in appetite
What is dysthymia?
Mild or moderate depressive illness that lasts intermittently for 2 years or more
What is psychotic depression?
Occurs in those with severe depression where thinking becomes psychotic
What usually occurs in psychotic depression?
Hallucinations within the theme of depression
-Voices telling them that they are a failure
What syndrome can occur in psychotic depression?
Cotard syndrome
-Nihilistic delusions can occur where it is believed by the patient that a part of them us dead or decomposed or annihilated or they don’t exist entirely as a human being
Mental state exam in depressive disorder?
Appearance: Slouching, tired, unkempt, dishevelled
Behaviour: Upset or teary
Speech: Slowed down speech, monotonal, low volume, poverty of speech
Mood: low
Affect: Blunted, flattened, not responding much
Thoughts: Suicidal thoughts/self harm, guilt, shame, thought blocking
Perception: Probably normal unless psychotic
Cognition: Poor concentration and memory, but most likely orientated
Insight: Generally aware of how they are feeling
Initial screening for depressive disorder?
2 screening questions: If answer to one or both is yes then person should be assessed for depressive illness
What are the 2 initial screening questions?
- During the last month have they been feeling down, depressed or helpless
- During the last month, have you been bothered by having little interest or pleasure in doing things
Other screening tools for depressive disorders?
- PHQ-9 (patient health questionnaire)
- Hospital anxiety and depression scale
Possible physical causes of depression?
- Thyroid disease
- Cushing’s
- Hyperparathyroidism
- Corticosteroid treatment
- Brain tumours
Management of depression patients who are actively suicidal?
Admission to hospital
Treatment for mild to moderate depression?
Talking therapies mainly CBT
Treatment for moderate and severe episodes of depression?
Medication
1st line= SSRI
What is a first line antidepressant and examples of it?
SSRI
- Citalopram
- Escitalopram
- Fluoxetine
- Paroxetine
- Sertraline
Which SSRI is best?
Little evidence to suggest one is best
- Escitalopram is probably best all round but
- Sertraline is also well established and has good cardiac safety
How long does it usually take anti-depressants to work?
2-4 weeks
Treatment for a first episode of depression?
-Antidepressant should be given for at least 6 months after full recovery without reducing the dose
Treatment for second episode or more of depression?
Antidepressants should be continued for 1-2 years after full recovery without reducing the dose
Treatment for life-threatening depressive illness particularly with psychotic symptoms?
Electroconvulsive therapy
