Mood disorders Flashcards

1
Q

What are the risk factors of depression?

A
  • Age
  • Personal or family history
  • Postnatal status
  • Medication
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2
Q

What medications are known to potentially cause depression?

A
  • Corticosteroids
  • Propranalol
  • Interferon
  • Oral contraceptive
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3
Q

What are the 2 screening questions asked when diagnosing depression?

A
  1. During the last month, have you felt down, depressed or hopeless?
  2. During the last month, have you felt bothered by having little interest or pleasure in doing things?
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4
Q

What are the 2 main grading scales used to assess depression?

A

=> HAD Scale
0-7 normal
8-10 borderline
11 + case

=> PHQ-9 Scale
0-4 normal
5-9 mild
10-14 moderate 
15-19 moderately severe
20-24 severe
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5
Q

What is the DSM-IV criteria?

A

Symptoms must be present everyday or nearly everyday with no significant changes throughout the day, for over 2 weeks and represent a change in normal personality without alcohol/drugs, medical disorders or bereavement

=> At least 2 core symptoms:

  • Depressed mood for most of the day
  • Anhedonia
  • Fatigue

=> At least 2 typical symptoms:

  • Poor appetite with marked weight loss
  • Disrupted sleep
  • Psychomotor retardation
  • Decreased libido
  • Evidence of reduced ability to concentrate
  • Feelings of worthlessness
  • Recurrent thoughts of death, suicide ideation or suicide attempts
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6
Q

What is the pathophysiology of Depression?

A

=> Monoamine Deficiency Theory:

- Decrease in levels of Serotonin, NA, and Dopamine

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7
Q

What is the management of Depression?

A
  • Psychotherapy
  • Antidepressants
  • ECT (Electroconvulsive Therapy)

=> Antidepressants only considered when:

  • Past history of moderate or severe depression
  • Initial presentation of sub -threshold depressive symptoms for a long period of time
  • Sub-threshold depressive symptoms or mild depression that persists with intervention
  • Chronic physical health problems + complication caused by mild depression

=> Antidepressants protocol:

  • SSRIs first line, and usually second line too
  • TCAs if SSRIs not working
  • If SSRIs not working in MAJOR depression, give Venlaxafine or Metrazapine
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8
Q

SSRIs - Examples, MOA, adverse affects and when to use?

A
  • Citalopram, Fluoxetine, Sertraline, Escitalopram
  • Considered first line for moderate to severe depression, and in mild depression if psychological treatment fall
  • MOA is inhibition of seratonin reuptake transporters on pre-synaptic cleft
  • Adverse affects include GI upset, weight disturbance and possible suicidal thoughts
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9
Q

TCAs - Examples, MOA, adverse affects and when to use?

A
  • Amitriptyline, Lofeperamine
  • Second line treatment for mediate to severe depression if SSRIs ineffective
  • MOA is inhibitor of Serotonin and NA reuptake
  • Many adverse affects as TCAs target wide range of receptors
  • Dry mouth, blurred vision, constipation, urinary retention
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10
Q

When are Venlafaxiine and Mirtazapine used?

A
  • Option for MAJOR depression when SSRIs not effective
  • MOA of Venlafaxine - Seratonin and NA reuptake inhibitor
  • MOA of Mirtazapine - Antagonist of inhibitory pre-synaptic a receptors

=> Adverse affects include GI upset and suicidal thoughts

They are Seratonin Noradrenaline Reuptake Inhibitors (SNRIs)

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11
Q

What are the protocols when switching antidepressants?

A

=> When switching from one SSRI to another:
- 1st SSRI should be withdrawn before next one started

=> Fluxotine to another SSRI:
- Withdraw and leave a 4-7 day gap

=> Switching to Venlafaxine:
- Cross taper

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12
Q

What are the categories of depression?

A

=> Mild depression:

  • 2 core symptoms
  • 2 typical symptoms

=> Moderate depression:

  • 2 core symptoms
  • 3+ typical symptoms

=> Severe depression:

  • 3 core symptoms
  • 4+ typical symptoms
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