GP: Depression

Question 1

Apart from being female, give 3 risk factors for depression.

Answer 1

Afro-caribbean
Age 55-64
Unemployment
Benefits
Living alone
Women in large households
Chronic illnesses (parkinson's, RA, heart attack)
Postpartum depression
Low SE status

Question 2

Describe the diagnostic criteria for major depression.

Answer 2

1. Low mood every day
2. Loss of interest or pleasure in activities
3. At least one of: Fatigue, feeling worthlessness and guilt, recurrent thoughts of death or suicide, inability to concentrate and make decisions, psychomotor agitation, insomnia/hypersomnia, change in appetite (usually decreased).
   Symptoms persist 2 weeks with significant impairment.

Question 3

How is depression assessed?

Answer 3

The Patient Health Questionnaire-9 score. This asks if the patient has been affected by 9 problems over the last 2 weeks. The patient fills it out every time they see the GP.

Question 4

What chronic disease can depression cause?

Answer 4

Fibromyalgia

Question 5

How and when can chronic disease affect risk of depression?

Answer 5

1 chronic disease increases risk of depression by 1-2x the general population risk. For example, Parkinson’s disease has a 50% depression rate, due to the psychological effects of having the disease and the loss of dopaminergic receptors.

Question 6

Describe the non-pharmacological management of mild depression.

Answer 6

1. Exercise
2. watchful waiting (especially if acute ie after a breakup)
3. self-help (books etc)

Question 7

Describe the non-pharmacological management of severe depression.

Answer 7

Cognitive behavioural therapy.

Question 8

Give the class and 2 examples of a drug you would give to an adult for depression.

Answer 8

1. SSRI - citalopram, sertraline.

2. Tricyclic antidepressants - amitriptyline, protriptyline.

Question 9

Give the class and mechanism of action of citalopram and give 2 common side effects.

Answer 9

SSRI - cause serotonin to stay in the synaptic gap for longer, increasing the firing rate of nerves. Exact mechanism is unknown. (wikipedia)
There are serotonin receptors in the gut so there are abdo side effects such as nausea.
Sexual dysfunction
Interact with anticoagulants to cause GI bleeding.

Question 10

When should you take an SSRI and why?

Answer 10

Morning - Can give you bad dreams

Question 11

When should you take a TCA and why?

Answer 11

Evening - causes drowsiness.

Question 12

What would you give a 17-year-old for depression?

Answer 12

Fluoxetine.

Question 13

What drug can be given if SSRIs are contraindicated? Give the mechanism of action and 2 side-effects.

Answer 13

TCA eg amitriptyline, protriptyline
Block the serotonin and noradrenaline transporters, increasing synaptic concentrations of these neurotransmitters.
SEs: Drowsiness, dry mouth, constipation.

Question 14

Give one reason why tricyclic antidepressants are not advised as first-line treatment for depression and one contraindication.

Answer 14

They are more toxic so it is easier to die from overdose. Overdose causes dysrhythmia leading to death. Contraindicated in wolff-parkinson-white disease.

Question 15

How is anxiety assessed?

Answer 15

The Generalised Anxiety Disorder - 7 scoring system.