Depressive Disorders Flashcards
aetiology: depressive disorder
- 1 in 5 lifetime prevalence
- 4.5% in UK
- peak in elderly
- F:M 2:1
core symptoms: depression
- lowered moof
- anhedonia
- reduced energy levels
somatic symtpoms: depression
- anhedonia
- early morning wakening
- diurnal mood variation
- psychomotor retardation/agitation
- marked loss of libido
- appetite and weight loss
accessory symptoms: depression
- reduced concentration and attention
- reduced self-esteem and confidence
- ideas of guilt and inworthiness
- bleak and pessimistic views of futures
- ideas or acts of self-harm/suicide
- distrubed sleep
- diminished appetite and weight loss
def: mild depression
- 2 core symptoms
- 2 accessory symptoms
- with somatic symtpoms if 4+ present
- not present to intense degree
- minimum 2 weeks
- patient distressed, some impact on work and social activites but not ceasing to function
def: moderate depression
- 2 core symtpoms
- 3-4 accessory symtpoms
- several ssymptoms to marked degree
- minimum 2 weeks
- severe difficulty continuing with work/social/domestic activities
def: severe depression
- all 3 core symtpoms
- 4+ accessory symtpoms
- severe accesoty symtpoms
- minimum 2 weeks
- unlikely to be able to continue with work/social/domestic activities
def: severe depression with psychotic features
- severe depression with hallucinations/delusions/stupor
- delusions usually mood congruent (sin, poverty, self blame, guilt etc)
- hallunctinations usually derogatory voices/unpleasant smells
- severe motor retardation
- Cotard’s syndrome - delusional belief that he/she deos not exist/is dead/rotting inside
def: Cotard’s syndrome
delusional belief they do not exist/are dead/rotting inside
def: recurrent depressive disorder
- recurrent episodes depression with no mania
- remission between episodes
def: atypical depression
- low mood but responds to positive events
- increased appetite and weight gain
- yperinsomnia
- heavy sensation in limbs (Leaden paralysis)
- interpersonal rejection sensitivity - tendency for deep and anxiety and humiliation at slightest rebuff
- significant occupations and social impairment
- responds better to MAOI
ix: depression
- full hx and MSE inc drug/alcohol
- physical examination
- blood tests - FBC, U+E, LFT, TFT, bone profile, B12 and folate
- ECG
- CT brain/MRI if indicated
what electrolyte disturbance and organ dysfunction can cause depressive symptoms?
hypocalcaemia
thyroid
rx: mild depression
psychological: CBT
social: adress precipitating facots (debt/ work/housing etc
rx: mild-moderate depression
SSRI
high intensity CBT
rx: moderate-severe depression
SSRI
antipsychotic if also psychotic fx
psychological: CBT high intensity
rx: depressive stupor/catatonia
ECT and lorazepam as well as CBT and SSRI
rx: refractory depression
- change SSRI to alternative SSRI
- add lithium if that fails
- add antipsychotic
- combine mirtazepine with SSRI?SNRI
- ECT
SSRI: names
sertraline
fluoxetine
paroxetine
citalopram
escitalopram
SNRI: names
venlafaxine
duloxetine
interations: SSRI
dangerous with St John’s Wort
increases levels of antipsychotics and benzos
citalopram/escitalopram - QT prolongation
SE: SSRI
GI - nausea, vomiting, dyspepsia
headache
agitation/anxiety
sexual dysfunction
hypotnatramia
increased risk bleeding
+/- insomnia
no weight gain
citalopram/escitalopram - QT prolognation
SE: SNRI
- GI - N+V, dyspepsia
- headache
- anxiety/agitation
- hyponatramia
- sexual dysfunction
- sweating
- +/- insomnia
- elevation of BP at higher doses
- venlafaxine - QTc prolongation
TCA: names
amitriptyline
clomipramine
lofepraina
