wamss notes depressive mood disorders

Question 1

major depressive disorder (MDD)

Answer 1

Condition in which at least 2 weeks of low mood predominates resulting in significant distress or impairment in functioning

Question 2

male to female ratio of major depressive disorder

Answer 2

M:F 1:2

Question 3

classification of major depressive disorder (MDD)

Answer 3

A) 5 or more of the symptoms present in the same 2 week period, at least one symptom must be symptom 1 or 2
B). The Sx cause significant distress or impairment of functioning
C) Is not attributable to another medical condition
D) Not better explained by another psychiatric disorder
E) No episodes of mania or hypomania

Question 4

what is the acronym used to remember the symptoms of major depressive disorder

Answer 4

SIGECAPS

Question 5

what are the symptoms of major depressive disorder

Answer 5

1. Depressed mood most of the day nearly every day
2. Sleep Disorder
3. Interest Deficit
4. Guilt, worthlessness, hopelessness
5. Energy deficit
6. Concentration deficit
7. Appetite disorder (↑↓)
8. Psychomotor retardation/agitation
9. Suicidality or recurrent thoughts of death

Question 6

what might FBC show that would indicate a cause other than major depressive disorder

Answer 6

anaemia or infection

Question 7

what might U&Es show that would indicate a cause other than major depressive disorder

Answer 7

electrolyte imbalances, hyponatraemia

Question 8

what might LFTs show that would indicate a cause other than major depressive disorder

Answer 8

liver damage, ETOH, hepatic encephalopathy

Question 9

severity of major depressive disorder

Answer 9

Mild: 2 symptoms
Moderate: 3 symptoms
Moderate-Severe: 4-5 symptoms
Severe: 2-5 Symptoms + psychomotor agitation

Question 10

Ddx of major depressive disorder

Answer 10

Other psychiatric disorders: dysthymia, bipolar, stress related disorders adjustment/bereavement disorders, PTSD, anxiety disorders…
non psychiatric disorders

Question 11

non-psychiatric Ddx of major depressive disorder

Answer 11

Neurological Disorders (dementia, Parkinson, MS, CVA, tumour)
Endocrine- (Addison’s, Cushing’s, hypothyroidism, menopausal, hypopituitarism)
Metabolic Disorder (hypoglycaemia, hypocalcaemia)
Substance misuse & medication related

Question 12

treatment for mild major depressive disorder

Answer 12

psychological therapies are generally more effective

Question 13

treatment of severe major depressive disorder

Answer 13

antidepressants and generally more effective although concurrent psychological therapies may be helpful If the pt engages

Question 14

treatment of moderate major depressive disorder

Answer 14

psychological therapies and pharmacological are equally effective

Question 15

non pharmacological intervention for major depressive disorder

Answer 15

Psychoeducation
Psychotherapy:
- CBT
- Interpersonal Psychotherapy (IPT)
Group therapy
Social work
Diet, exercise, lifestyle…
Psychologist

Question 16

first line medication for major depressive disorder

Answer 16

SSRI, SNRI, NaSSA

Question 17

SSRI options

Answer 17

Sertraline (zoloft)
Citalopram (celexa)
Escitalopram (Lexapro)
Paroxetine (paxil)
Fluoxetine (Prozac)

Question 18

SNRI options

Answer 18

Venlafaxine (Effexor)
Desvenlafaxine
(Pristique)
Duloxetine

Question 19

NaSSA options

Answer 19

Mirtazapine

Question 20

how long might it take for medication to take effect in major depressive disorder

Answer 20

It may take 2-6 weeks to see a clinical response
If there is no initial or only a partial response then consider ↑ the dose: note relatively flat dose
response curve with SSRIs
If there is still no or partial response consider switching to a different first line medication

Question 21

second line choices for major depressive disorder

Answer 21

RIMA eg. Moclobemide
NRI eg. reboxetine
NDRI eg. bupropion

Question 22

third line choices for major depressive disorder

Answer 22

MAOI or TCA

Question 23

MAOI options

Answer 23

Selegiline Zelpar
Phenelzine Nardil
Tranylcypromine Parnate

Question 24

TCA options

Answer 24

Amitriptyline (endep)
Nortriptyline (allegron, noritren)
Imipramine (tofranil)
Clomipramine (anafrandil)

Question 25

mood stabilisation augmentation for major depressive disorder

Answer 25

Lithium, Sodium Valproate, Lamotrigine + SSRI + TCA

Question 26

if there is comorbid psychosis in major depressive disorder

Answer 26

antipsychotics should be added to Tx

Question 26

if there is comorbid psychosis in major depressive disorder

Answer 26

antipsychotics should be added to Tx

Question 27

prognosis for major depressive disorder

Answer 27

80% relapse at least once 15% chronic reoccurrence Tx reduces chance of reoccurrence by 70%

Question 28

Tx for major depressive disorder reduces chance of reoccurrence by

Answer 28

70%

Question 29

life expectancy of major depressive disorder

Answer 29

shorter life expectancy (suicide and other)

Question 30

persistant depressive disorder (dysthymia)

Answer 30

Symptoms of depression lasting at least 2 years, less severe than MDD.

Question 31

criteria of persistent depressive disorder (PDD)

Answer 31

A. Depressed mood for most of the day, more days than not for >2 years B. Presence, while depressed of 2 or more of the following: - Appetite disorder - Concentration deficit - Hopelessness - Energy Deficit - Worthlessness ↓ self esteem - Sleep Disorder (↑↓) C. During the 2 years pt has net been without symptoms in criteria A&B for more than 2 months at a time

Question 32

while depressed, an individual with persistent depressive disorder may also experience

Answer 32

- Appetite disorder - Concentration deficit - Hopelessness - Energy Deficit - Worthlessness ↓ self esteem - Sleep Disorder (↑↓)

Question 33

if a person meets the criteria of MDD during PDD

Answer 33

If full criteria for a major depressive episode have been met at some point during the current episode of illness then they should be given a Dx of major depressive disorder at that time as a specifier within the Dx of dysthymia

Question 34

melancholic depression

Answer 34

A subtype of MDD characterised by persistent & severe depression

Question 35

criteria of melancholic depression

Answer 35

One of the following is present during the most severe period of the current episode: - Loss of pleasure in all or almost all activities - Lack of reactivity to usual pleasurable stimuli (doesn’t feel good even temporarily when something good happens) 3 or more of the following - Distinct quantity of depressed moon characterised by profound despondency, despair - Depression regularly worse in the morning - Early-morning awakening - Marked psychomotor agitation - Significant anorexia or weight loss - Excessive or inappropriate guilt

Question 36

atypical depression

Answer 36

Shares the criteria of MDD or dysthymia but is characterised by improvement in mood in response to positive events

Question 37

epidemiology of atypical depression

Answer 37

M:F 1:3 Tends to be more chronic

Question 38

adjustment disorder

Answer 38

Also called reactive or situational depression occurs when a pt is unable to cope with a particular stress or major life event

Question 39

criteria of adjustment disorder

Answer 39

Development of emotional or behavioural Sx to an identifiable stressor occurring within 3 months Sx cause significant functional impairment or distress that is out of proportion to the severity of the stressor Does not meet the criteria of other mental disorders & is not an exacerbation Once the stressor has ended the Sx do not persist for >6months

Question 40

once the stressor causing adjustment disorder has ended

Answer 40

the Sx do not persist for >6months

Question 41

after the identifiable stressor, adjustment disorder occurs within

Answer 41

3 months

Question 42

substance/medication induced depressive disorder

Answer 42

Prominent & persisted disturbance in mood characterised by depressed mood or markedly diminished interest or pleasure in almost all activities Evidence that that the symptoms developed soon after substance intoxication or withdrawal The substance is capable of producing the symptoms Is not better explained by a mood disorder

Question 43

depressive disorder due to another medical condition

Answer 43

Prominent & persisted disturbance in mood characterised by depressed mood or markedly diminished interest or pleasure in almost all activities There is evidence that the Sx are a direct consequence of a medical condition Disturbance is not better explained by another mental condition

Question 44

recurrent brief depression

Answer 44

Depressed mood & 4 other Sx of depression for 2-13 days at least once per month for at least a year, but does not meet the criteria for MDD or other MD

Question 45

short-duration depression

Answer 45

Depressed mood & 4 other Sx of depression with clinically significant distress for 4-13 days, in a pt who does not meet criteria for MDD or other MD

Question 46

depressive episode with insufficient Sx

Answer 46

Depressed affect with at least 1 Sx of depression associated with clinically significant distress or impairment for at least 2 weeks in a pt who does not meet the criteria for MDD or other MD

Question 47

unspecified depressive disorder

Answer 47

Sx characteristic of a depressive disorder that cause significant distress or impairment but do not meet the full criteria for any of the disorders. Often used when there is insufficient information to make a more specific diagnosis eg ; ED