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year three exam 2 > unipolar depression clinical > Flashcards

unipolar depression clinical Flashcards

1
Q

what is unipolar depression

A

psychological and physical symptoms that continue for weeks/months and interferes with daily life

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2
Q

what are the psychological symptoms of unipolar depression

A

loss of pleasure
depressed mood
poor memory
sadness
anxiety
suicidal ideation

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3
Q

what are the physical symptoms of unipolar depression

A

poor sleep
low appetite
mood swings
fatigue
weight changes
joint pain
sexual dysfunction
headaches

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4
Q

epidemiology of unipolar depression

A

1 in 5
W>M

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5
Q

what are the risk factors of unipolar depression

A

female
anxiety
genetics
lack of parental care in childhood
social adversity
physical illness
chronic insomnia
vit D deficiency
quitting smoking
drug use

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6
Q

what are the risk factors for recurrent depression

A

history of episodes
onset after 60y/o
long duration episodes
family history of affective disorder
poor symptom control
co-morbid anxiety/substance abuse

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7
Q

what are the risks if unipolar depression is left untreated

A

alcohol abuse/dependence
cognitive impairment
poor work performance
poor sleep
suicidal ideation

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8
Q

which drugs can cause unipolar depression

A

alcohol
steroids
benzos
antipsychotics
anticonvulsants
NSAIDs
CVD drugs
caffeine

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9
Q

what are the cognitive symptoms of unipolar depression

A
  • Difficulty with
    ○ Attention and concentration
    ○ Memory
    ○ Decision making
    ○ Planning
    ○ Mental sharpness
    ○ Word-finding
    ○ Judgement
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10
Q

how is unipolar depression diagnosed

A

key symptoms
- persistent low mood
- marked loss of interest or pleasure
associated
- disturbed sleep
- weight/appetite changes
- poor concentration
- feelings of worthlessness
- suicidal thoughts/acts
DSMIV - one key symptom for at least 2 weeks - minimum 5 symptoms
ICD10 - two key symptoms for at least 2 weeks, minimum 4 symptoms

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11
Q

what are the NICE categories for unipolar depression

A

ub-threshold - person has a few symptoms and feels low, but can function
* Mild - enough symptoms for a diagnosis but still functions reasonably well
* Moderate - where the person has a range of symptoms and is not coping well
* Severe - where person has a full set of symptoms, cannot function and may suffer from some psychiatric symptoms too
* Complex - where symptoms have failed to improve with treatment and may have psychosis, other symptoms and problems

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12
Q

what are the differential diagnosis for unipolar depression

A

GAD
drug inducesd
schizophrenia
personality disorder
bereavement
physical illness
dementia
panic disorder
SAD
bipolar depression

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13
Q

what are the co-morbidities with unipolar depression

A

GAD
psychosis
insomnia
OCD
PTSD
panic disorder

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14
Q

how is mild to moderate unipolar depression treated

A
  • Low intensity psychological or psychosocial interventions
    - May suggest medication - not common
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15
Q

how is moderate to severe unipolar depression treated

A
  • Medication
    - High intensity or psychological interventions
    - Onward referral
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16
Q

how is severe and complex unipolar depression treated

A
  • Medication
    - High intensity or psychological interventions
    - Combined treatments and collaborative care
    - ECT
    - Crisis service
    - MDT/in-patient care
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17
Q

what is ECT

A

electroconvulsive therapy for acute severe depression (life threatening)
Floods the brain with

18
Q

what are the first line choices for antidepressants

A

SSRIs - citalopram, escitalopram, fluoxetine, sertraline
duloxetine, mirtazapine, venlafaxine
TCAs- lofepramine
adjunctive - quetiapine

19
Q

when should each antidepressant be taken

A
  • SSRI and SNRI in the morning - no sleep disturbances
    • Mirtazapine taken at night
20
Q

how do you switch from fluoxetine to other antidepressants

A
  • Fluoxetine to others - long half life
    - Fluoxetine to moclobemide - taper and stop fluoxetine and wait 5-6wks
    - From a non-reversible MAOI –> 2 week washout period is required
    • 2+ failed antidepressants of adequate dose and duration, suggests the need for review of diagnosis
21
Q

what is serotonin syndrome

A

rare cause of serious effects, can occur with combinations of serotonergic drugs

22
Q

what are the symptoms of serotonin syndrome

A

restlessness
tremor
myoclonus
rigidity
hyperreflexia
shivering
elevated temperature
arrythmia
cardiac collapse

23
Q

how are antidepressants stopped

A
  • For less than 8 weeks stop over 1-2 weeks
    • After 6-8 month treatment - taper over 6-8 weeks
      After long term maintenance decrease by 25% by every 4-6 weeks
24
Q

what are the withdrawal symptoms from SSRIs

A

dizziness
sleep disturbances
agitation
volatility
nausea
fatigue
headache

25
Q

what are the symptoms for withdrawal from SNRIs

A

same as SSRIs
restlessness
abdominal distension
congestion

26
Q

what are the central side effects of antidepressants

A

anxiety - low and slow, split doses
seizures
confusion - swap meds
dizziness - take at night
headache - paracetamol
insomnia - take in morning
nausea - take with food
sleepiness
suicidal ideation

27
Q

what are the anticholinergic side effects of antidepressants

A

blurred vision - usually wears off
constipation - fibre and fluid
dry mouth
urinary retention

28
Q

what are the other side effects associated with antidepressants

A

hyponatraemia
postural hypotension
palpitations
sexual dysfunction
sweating
weight gain

29
Q

which antidepressants interact with alcohol

A

Mirtazapine, trazodone, amitriptyline

30
Q

why do SSRIs interact with NSAIDs

A

SSRIs double GI bleed risk and is worsened by NSAIDs

31
Q

which antidepressants interact with warfarin

A

SSRIs raise INR - fluoxetine and paroxetine are the worst and sertraline/citalopram the best

32
Q

which antidepressant interacts with tamoxifen

A

paroxetine may increase breast cancer recurrence

33
Q

which antidepressant does smoking interact with

A

decreased duloxetine levels

34
Q

what does St Johns Wort interact with

A

Antiretrovirals, ciclosporin, oral contraceptives and digoxin

35
Q

which antidepressants interact with AEDs

A

Clozapine - increased by SSRIs
Carbamazepine and valproate - increases TCA levels

36
Q

which antidepressants are suitable for use in children and adolescents

A
  1. fluoxetine - only licenced one if 4-6 sessions of psychological therapies not worked
  2. citalopram/sertraline - unlicensed
37
Q

antidepressants and pregnancy

A
  • Depression risk higher than risk of antidepressant
  • Avoid paroxetine
  • Little/no evidence for any detrimental effect on postnatal development
38
Q

antidepressants and elderly

A
  • No ideal antidepressant
  • SSRIs better tolerated than TCAs but increased GI bleed risk
  • Increased hyponatraemia, postural hypotension, haemorrhagic stroke with SSRIs
  • Low and slow
39
Q

antidepressants and cardiac disease

A

SSRIs first choice - may be protective against MI
- sertraline
no benefit of CBT unless depression present prior to MI
- QTc interval prolongation - citalopram and escitalopram C/I in known prolongation

40
Q

antidepressants and renal impairment

A
  • The greater the renal impairment, the greater the potential for drug accumulation
  • ADRs such as confusion, postural hypotension and sedation may be more common
  • Low and slow
  • Care is needed with anticholinergic drugs which may cause urinary retention and interfere with U and E measurements
41
Q

antidepressants and hepatic impairment

A
  • Greater the degree of impairment, the greater the impairment of drug metabolism and the greater the risk of toxicity
  • More sensitivity to S/E
  • Low and slow - frequent LFTs
  • In severe liver disease, avoid drugs causing marked sedation and/or constipation
    ○ Paroxetine is used by some specialist liver units with few apparent problems

year three exam 2 (38 decks)

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