Week 1 - Depression and suicide risk Flashcards
What are the ICD-10 criteria for depressive disorder ?
For 2weeks+, must have 2 of:
1. persistent low mood
2. loss of interest or pleasure
3. fatigue or low energy
If any of above, then other criteria:
4. disturbed sleep
5. poor concentration or indecisiveness
6. low self confidence
7. poor or increased appetite
8. suicidal thoughts or acts
9. agitation or slowing of movements
10. guilt or self blame
What are the DSM-5 criteria for major depressive disorder ?
Over 2weeks+, must have five or more of:
- depressed mood *
- diminished pleasure or interest in all activities *
- poor or increased appetite
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or inappropriate guilt
- diminished ability to think or concentrate
- recurrent thoughts of death or suicide
(* = must have one of)
What ICD-10 score is classed as mild depression ?
4 symptoms from the list
What ICD-10 score is classed as moderate depression ?
5-6 symptoms from the list
What ICD-10 score is classed as severe depression ?
7+ symptoms from the list +- psychotic symptoms
If a diagnosis of depression is suspected based on the ICD/DSM criteria, what else would you want to ask/know in order to confirm the diagnosis ?
- historical episodes of mania/hypomania ? (bipolar disorder, currently in depressive state)
- recent bereavement/loss ? (normal response to a life circumstance)
- any other medical conditions ?(chronic pain, hypothyroidism etc can cause depressive symptoms)
- what meds are u on ? (meds like COCP, steroids, beta blockers and statins can increase risk of depression)
Give some examples of physical health problems that can increase the risk of mood disorders ?
- hypothyroidism
- addisons disease
- diabetes
- dementia
- MS
- CVD
- hepatic impairment
- renal impairment
- haematological problems
- chronic pain
- substance abuse
Give some examples of medications that can increase risk of depression ?
- corticosteroids
- beta blockers
- statins
- oral contraceptives (mainly progestogens)
- isotretinoin
What are some of the common initial side effects of sertraline ?
- GI upset
- mild nausea
- dry mouth
- drowsiness
- decreased sex drive, impotence, difficulty having orgasm
Which conditions use antidepressants ?
- depression
- anxiety (GAD, PTSD, OCD…)
- schizoaffective disorder
- organic mood disorders
- premenstrual dysphoric disorder
How long does it take for symptoms to improve when using an antidepressant ?
3-6 weeks
Once a patient hits remission, when can they stop taking antidepressants ?
6months after remission is achieved, in order to avoid relapse
After how long of no symptom improvement cna you change antidepressants/add another agent ?
after 2 months of no improvement you can change meds or add other agents
what are the different types of antidepressants?
- SSRIs
- SNRIs
- TCAs
- MAOIs
What are the treatment options for mild depression ?
- watchful waiting (wait 2-4 weeks to see if it self improves)
- guided self help (online courses with therapist)
- exercise
- talking therapies (CBT and counselling)
