Depressive disorders Flashcards
Prevalence of depression
17%. Most common Psychiatric disorder
Males vs female for depression
two fold increase in females
What is major depressive disorder
Must have depressed mood or loss of interest or pleasure in usual activities
All symptoms must be there nearly everyday except - suicide ideation or thoughts of death which only need to be recurrent.
Do excluded if symptoms cause by bereavement or psychotic symptoms are present in the absence of mood symptoms
Difference between depression and personality disorder
Depression is an episodic state that should return to based line with treatment where personality disorder it would always be the same.
DSM5 Criteria for depression
A) either depressed mood or loss of interest or pleasure over a 2 week period with at least 5 of the following
- depressed mood all day every day
- ↓Interest or pleasure in all everyday
- wt and appetite changes
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue
- Feeling of worthlessness or excessive or inappropriate guilt
- ↓concentration or indecisiveness
- Recurrent suicide ideation or thought of death.
B)impair function
c)not due to substance or medical condition
D) not better explain by other DDX
E)no manic or hypomanic
Mx of major depression Mild
care providers by GP
Moderated online or low intensity CBT or mild
Online - mindspot,
Low intensity CBT - know the principles
understanding feeling and thoughts and behaviours,
Monitoring for unhelpful or unrealistic thought
Changing thoughts to be more realistic by practice
Scheduling in fun activities
DBT - directive behaviour therapy
Mindfulness
Distress tolerance
emotional regulation
Interpersonal effectiveness
Mx of major depression Moderate
Psychotherapy - CBT/IPT, consider SSRI
Clinical practice guideline for adolescence and youth and then everyone else
CBT first
SSRI - evidence that they are significantly better especially fluoxetine- need to know for exam
tricyclic should bot be used
Mx for severe depression
Psychotherapy and SSRI
lifestyle changes for depression
Exercise Healthy eating control your work Sleep well - sleep hygiene Reduced alcohol and other drugs
Explain Fluoxetine to a patient
Availability: peak 4-6 hours
Half-life: 1-6 days (accumulation risk)
SE: headache, anxiety, insomnia, dizziness, rash, hypomania activation, GI upset, impotence, anorgasmia, wt loss, rare serious skin sensitivity in children
CI: MAOI within 5 wk, Pimozide
Interactions: other antidepressants, some antipsychotics, anti diabetic inc. insulin, drugs affecting platelet function, highly protein bound e.g. warfarin
Precaution; pre: screen for hypomania, post: for emergent suicidality.
Dose: Dep: initial 20mg, max 80mg, OCD 20/60mg
How to determine severity of depression
Mild - symptoms
Moderate symptoms but not suicidal
Severe - suicidal ? or greater impaired life.
What to rule out when thinking depression
Other psychological illness
Medical
- Neuro - parkinson, stroke, MS, space occupying lesion, alzheimer’s, Epilepsy, cereovascular disease and tumour.
- endo - Cushing, thyroid
- Auto - SLE
- Infection - HIV, Lyme disease, TB, sphysilis, mononucleosis
Medications
Steroids, NSAID, Beta blocker *methodopa, interferon gamma, sex hormones, alcohol, opioids, cannibus. cardiac drugs, antiHTN, sedative, hypnotics, antipsychotics, anti epileptics, antiparkinsonian drugs, analgesics, anti bacterials and antineoplastics
Ix to include in the work up for depression
FBC, TFT, LFT, U&E, UDS, ECG, CT brain
How to differentiate depression from grief
Varies from sad to neutral.
Epidemiology of depression
10-15% prevalence
F>M 2:1
Onset late 20-30
10% of severe depression goes on to complete suicide.
What is Dysthymia/persistent depressive disorder
I consistent state of depressed mood there whole life. Criteria A- depressed mood for most day for 2yrs B- Presence of 2 of the following - Poor appetite or overeating - Insomnia or hypersomnie - Low energy or fatigue - Low self esteem - Poor concentration or difficulty making decisions - Feeling hopelessness C- Symptoms free time of of
Criteria for premenstrual dysphoric disorder
A - at least 5 symptoms for majority of cycles that onset a 1week before menses and improves to after onset and asymptomatic postmenses
B - 1 or more of these
- labile affect
- Irritability or anger or conflict
- Depressed mood, hopelessness or self deprecating thoughts
- Anxiety, tension, or feeling on edge.
C- 1 or more of the following (B+C= 5in total)
- ↓Interest*not finished.
Tx of Persistent depressive disorder
Cognitive therapy - Negative thoughts and learned helplessness
Insight oriented psychotherapy - 1st line. Dresses pt understanding of how they try to gratify an excessive need for outside approval to counter low esteem and a harsh superego
Interpersonal therapy + antidepressant. Coping with stress and decrease depressive symptoms. Improve self-esteem.
Family and group therapies
Pharmacotherapy - SSRI and bupropion.
DDX Dysthmia
Major depressive disorder
Recurrent brief depressive disorder
Double depression - major depression and dysthymia
Alcohol and substance - cocaine, marijuana
Mx of depression
Rule out medical condition: TFT, FBC, B12, Folate, IS, EBV, Drug screen, U&E.
Determine severity - K10, Dass 21
Lifestyle: stop smoking, nutrient, stop alcohol, physical exercise, sleep, Sun, substance, socialise eg menshed, Headspace
Psychotherapy - CBT - challenge autonegativ thoughts, eCBT
Pharmacotherapy
