Mood Disorders Flashcards
Key Symptoms of Depression
- Persistently Low Mood
- Anhedonia
- Anergia
Associated Symptoms of Depression
- Concentration Reduced
- Self Esteem Reduced
- Guilt and Worthlessness
- Hopeless about future
- Appetite Diminished
- Suicidal Thoughts
- Sleep Disturbance
Classification of Depressive Disorders
Mild (≥2A + 2B),
Moderate (≥2A + 3B),
Severe (All 3A + ≥2B)
Most days, most of the time, for 2/52
Associated somatic symptoms of depression
Psychomotor Retardation, Agitation, Loss of Libido,
Constipation and Amenorrhoea
Dysthymia
– Longstanding mild depressive symptoms; Often associated with other psychiatric
illness or physical illness; Can co-occur with Depression ‘Double Depression’
Psychotic depression
Severe spectrum of disease; Delusional intense worry and perceived faults; May be associated with Cotard’s syndrome and Derogatory Auditory Hallucinations
o High Suicide Risk; Depressive Stupor might occur (Severe Psychomotor Retardation)
o Depressive Stupor risks fatality from dehydration; Treated with Em ECT
o Needs to be distinguished from other Psychotic Disorders; Distinguishing features
include Mood Congruity of Delusions and Hallucinations
Atypical Depression
Increased Sleep, Appetite and Phobic Anxiety; Responds better to MAOI
Mixed Anxiety and Depressive Disorder
Termed if symptoms of either to not meet criteria
for diagnosis of either mood or anxiety disorder
Organic Mood Disorder
Anaemia, Hypothyroidism, Addison’s, Cushing’s, Hypercal, DM, Pituitary, Ca and CNS tumour, Epilepsy, SLE, MS, Stroke, TBI, Vit D and B Deficiency
Epidemiology of Depression
Common; 2F>M; 15% Lifetime risk; Mean late 20yrs onset; Positive Family Hx; Moderate Heritability of about 40%; More so if early onset
o Predisposition of Depressive Disorder
and Anxiety Disorders but Bipolar Disorder predisposition is separate
Biological Aetiology of Depression
Genetics, Organic Mood Disorder,
Neurochemical Changes
o Hypofunction of Monoamine systems (5-HT, NA) and HPA axis
o Negative bias in Emotional Processing might involve failure of FP regulation of
processes in Amygdala
o Focal Lesions of Subcortical WM on MRI – Late onset depression and Poor prognosis;
Other structural changes include Glial reduction in PFC and Hippocampal Atrophy;
Unknown if Causal, Consequential or Coincidence
Psychological and Social Aetiology of Depression
Childhood, Abnormal Cognition, Learned Helplessness, Personality
o Cognitive Theory – Tendency to think negatively of self, future and the world
o Neuroticism – Personality attributes of Anxiety, Obsessions and Poor Stress Coping
o Adverse Experiences in Childhood, Recent Life Events and Lack of Social Support
Management of Mild Depression
Mild Depression without previous episodes – Often self-limiting; Antidepressants may not be
indicated; Information, Advice and Self Help to Problem Solving
o Sleep Hygiene (Timing, Activities prior, Environment, Physical Exercise)
o Drug treatment if previous episodes of ≥Mod depression that responds to treatment
• Consider: Ideas, Concerns, Expectations; Suicide Ideation, Psychotic Symptoms, disabling
symptoms, Past DH, Past History of Mania, Cardiac Disease (avoid TCA with recent MI);
Management of Moderate Depression
Drug Treatment is First-line for ≥Mod depression; >70% respond to Antidepressants, although
only 30% might respond to first-line drugs
o Monitor emergent Suicide Ideation which can occur with mood improvement;
Especially in younger people; No evidence for increased suicide
o After recovery, continue at same dose for at least 6-9/12; Dose is tapered off over
several weeks to Reduce Risk of Relapse (by >50%) and Withdrawal
Medication counselling, Psychosocial Support; Ensure Drug is at adequate dose, good adherence and sufficiently long duration
SSRIs
o SSRIs are safer and more tolerable than TCAs; 4 – 6 weeks before Improvement; 6 – 8 weeks therapeutic trial; First-line Antidepressants are Setraline and Citalopram
▪ SE: Nausea, Anxiety/Agitation, Drowsiness, Insomnia, Sexual Dysfunction;
Consider Gastroprotection if on NSAID in older peoples
Sedating Antidepressants
o Paroxetine and Fluvoxamine – Sedating Antidepressants; Useful if insomnia; NB:
Paroxetine is associated with weight gain; Fluoxetine – Strongly Activating;
Antidepressants with fewer sexual SE
o Bupropion and Mirtazapine have fewer sexual SE
Considerations with Antidepressants
Avoid Antidepressants in Pregnancy and Breastfeeding; Avoid ETOH when on TCA or MAOI;
Cannabis, Amphetamines, Cocaine, Heroin and Ketamine interact with TCA; Avoid driving and
heavy machinery if SE cause drowsiness and blurred vision
Examples of SSRIs
Setraline (=Zoloft)
Citalopram
Paroxetine
Fluoxetine (=Prozac)
Examples of TCAs
Amitriptyline
Desipramine
Imipramine
