Depressive Disorder Flashcards
What is a depressive episode
An ongoing or periodic episode of low mood, lack of energy and anhedonia.
10-15% of women suffer from post-natal depression within 1-2 months post-partum
10-20% lifetime prevalence for all people. Ratio is M:F of 1:2.
What is dysthymia?
Dysthymia = chronic low mood not fulfilling the criteria of depression lasting 2 years either due to severity or due to length of depressive periods.
What are the risk factors for depression?
Family History of depressive illness Major Life changes Chronic health problems Substance misuse Childhood abuse There are certain genetic associations with Depression.
What are the core symptoms of depression and how many must be present?
2 Core symptoms must be present:
Core Symptoms: Continuous low mood for at least 2 weeks, lack of energy and anhedonia.
What are the somatic symptoms of depression?
Somatic Symptoms: Sleep changes (specifically early morning waking), appetite and weight loss or gain, diurnal variation in mood (mornings are worse), psychomotor retardation/agitation and loss of libido.
What are the cognitive symptoms of depression?
Cognitive Symptoms: Low self-esteem, guilt and self-blame, hopelessness, hypochondrial thoughts, poor attention/concentration, and suicidal thoughts – always ask.
Rumination is a key aspect involved in depression
Always ask about suicide and self-harm
What sort of symptoms do you get in psychotic depression?
Psychosis – hallucinations which are often auditory and delusions such as hypochondriacal/guilt/nihilistic and persecutory. In Post-natal depression usually, this involves worries about the baby’s health, their capability as a mother and if they can cope.
What questions should be asked in a detailed risk assessment of someone who has had a suicide attempt or thoughts?
If they have revealed suicide attempts or plans you must get a very detailed history.
Start with the day it happened, why did they feel that way, what was different to the day before, had it been planned, how were they going to do it, what did they think would happened and how do they feel about it now?
What are the 4 classifications of depression?
Mild – 2 core and 2 others
Moderate – 2 core and 3/4 others
Severe – 3 core and at least 4 others
Severe with Psychotic symptoms
What differentials should be considered in a patient you think has deperssion?
Psychiatric disorders – schizophrenia, bi-polar disorder, anorexia nervosa, anxiety Substance abuse Dementia Sleep disorders Physical illness Medication SE e.g. beta blockers
What questionnaire can be used by GPs to screen for depression?
Patient health questionnaire-9 (PHQ-9) is used by GP's as a tool to characterise severity of depression: • 0-4 no depression identified • 5-9 mild depression • 10-14 moderate depression • 15-19 moderately severe depression • 20-27 severe depression
What general advice can be given to help manage/prevent depressive symptoms?
Self-help – exercising, eating healthy, engaging in productive activities, socialising, improving sleep relaxation and self-soothing (being kind to yourself)
Avoid – inactivity, drugs, alcohol, daytime TV and isolation.
How are mild, moderate and severe depression managed?
Mild depression – focus on holistic interventions such as low intensity psychological interventions on sleep hygiene, anxiety management (mindfulness), guided self help and computerised CBT. If symptoms persist beyond 8 weeks then can trial antidepressants.
Moderate depression – Combination of antidepressant and high intensity psychological intervention such as 8-12 sessions of CBT or interpersonal therapy
Severe depression including psychotic depression and high risk of suicide – rapid intervention with a specialist mental health assessment and consideration of inpatient treatment and ECT. If psychotic then anti-psychotics.
Which team should be contacted if a patient is at high risk of suicide?
If suicidal start with the crisis team but the patient must be willing to engage otherwise mental health act assessment would be appropriate.
How is recurrent depression managed?
Recurrent depression – very likely after one episode of depression to develop further episodes so maintenance therapy should be started. If a drug worked before use this as maintenance. CBT and psychoeducation can also help.
First line – Fluoxetine, sertraline, or citalopram
Second line – alternative SSRI
Third line – TeCAs, SNRI’s
Fourth line – TCA and lithium can sometimes be helpful as an adjunct
What is the psychotherapy of choice for depression in <18s?
Psychoanalysis (treatment of choice in <18s)
What information should be offered to patient before starting antidepressants?
Warn that symptoms may get worse in the first few weeks and important to monitor closely for suicidal ideation. Assess formerly after 4 weeks and if effective continue for at least 6 months. Can titrate dose up if only minor response. Discuss discontinuation problems and advice not to stop without consulting a doctor.
What are SSRIs?
Inhibit the reuptake of serotonin at the synapse
Fluoxetine
Paroxetine
Sertraline
Citalopram + Escitalopram
What are the side effects of SSRIs?
Nausea and diarrhoea, restlessness, agitation, headache, (all of which usually go after a few weeks)
Long term - sexual dysfunction, weight changes (usually loss), bleeding and suicidal ideation (especially young men).
Can precipitate mania in Bi-polar
Associated with hyponatraemia especially in the elderly
1st trimester: congenital heart defects
3rd trimester: pulmonary HTN of new-born
Which specific side effect must you be careful of in citalopram and what precautions should you take as a result?
Citalopram lengthens QT interval and can cause torsade’s de pointes so check ECG before.
