Week 5.1: Treating mood disorder in primary care Flashcards
What is the difference between primary care and secondary care?
Primary Care: First point of contact for patients (e.g., General Practitioners (GPs)). They handle a wide range of health issues.
Secondary Care: Specialized medical services (e.g., psychiatrists, hospitals)
What are some of the challenges in primary care?
High patient volume: GPs in the UK see 30-50 patients a day.
Patients often present with physical symptoms that may mask underlying mental health issues.
Includes anxiety and depression, but not severe conditions like psychosis or bipolar disorder.
Common Mental Disorders (CMD)
What are the challenges in diagnosing under primary care?
Unhappiness vs. Depression: Being unhappy doesn’t always mean clinical depression.
Stress vs. Anxiety Disorder: Feeling stressed doesn’t necessarily mean having an anxiety disorder.
Measuring Mental Health: Unlike physical conditions like high blood pressure, mental health is harder to measure.
GPs often see patients with mild or early symptoms of various illnesses. Many conditions improve over time without severe intervention.
Over-diagnosis and Over-treatment: Concerns about whether too many people are diagnosed with depression and prescribed antidepressants.
A condition where individuals experience symptoms similar to coeliac disease (e.g., fatigue, mood changes, IBS) without having coeliac disease
Non-Coeliac Gluten Sensitivity (NCGS)
Short-chain carbohydrates that are poorly absorbed in the small intestine, leading to symptoms in IBS patients.
Foods like garlic, onions, and certain fruits that can cause bloating and discomfort in people with IBS
FODMAPs
What is the connection between diet and mood disorders?
Research shows that diet quality can influence mental health. A healthy diet rich in fruits, vegetables, and whole grains can improve mood and reduce symptoms of depression.
Diets high in glycemic index (e.g., biscuits, chocolate, cake, bread) may increase the risk of depression.
A group focused on the link between nutrition and mental health
ISNPR (International Society of Nutritional Psychiatric Research)
A cytokine found to be significantly raised in patients with depression
IL-6 (Interleukin-6)
What is the connection between neuronal dysfunction and depression?
Factors like inflammation, oxidative stress, and mitochondrial dysfunction can affect mood
Proteins that play a role in the immune system. Elevated levels of certain cytokines, like IL-6, are associated with depression.
Cytokines
Imagine eating a lot of sugary snacks and feeling a quick energy boost followed by a crash, which can affect your mood.
High GI (Glycemic Index) Diets on Mood
A diet rich in fruits, vegetables, nuts, and olive oil, which has been shown to reduce the risk of cardiovascular disease.
Can reduce inflammation, which may benefit people with depression even without diabetes
Mediterranean Diet
Found in fish, these are crucial for brain function and may reduce the risk of depression.
High fish consumption and lower levels of depression
Omega-3 Essential Fatty Acids
Tool that is used to assess the severity of depression
PHQ-9 (Patient Health Questionnaire-9)
Mild symptoms that don’t meet the full criteria for depression but still affect functioning
Sub-threshold Depression
A tool to assess the severity of anxiety based on seven questions
GAD-7 Questionnaire
Characterized by severe mood swings, including manic episodes that can lead to hospitalization
Bipolar Disorder I
Involves hypomanic episodes (less severe than mania) and depressive episodes
Bipolar Disorder II
A milder form of bipolar disorder with less severe mood swings
Cyclothymia
What are the indicators of Bipolar Disorder?
Family History: A family history of bipolar disorder increases the likelihood.
Atypical Depression: Symptoms like increased appetite and feeling very heavy may indicate bipolar disorder.
Response to Antidepressants: If a patient becomes hypomanic or manic after taking antidepressants, it may indicate bipolar disorder
What are the risk and protective factors of suicide?
Risk Factors: Severe depression, feelings of hopelessness, poor support systems, and access to means of self-harm (e.g., antidepressants, firearms) increase the risk of suicide.
Protective Factors: Having a family, especially young children, good social support, and religious beliefs can reduce the risk of suicide
Is there any risk to asking about suicidal thoughts?
Directly asking patients about suicidal thoughts and plans is essential and does not increase the risk of self-harm.
A condition of feeling very irritable or restless, which can sometimes lead to suicidal thoughts.
Akathisia
What is the relationship between Antidepressants and Severity of Depression?
Mild Depression: Not recommended
Moderate to Severe Depression: Can be lifesaving and recommended
Sub-threshold Depression: May be considered for persistent depression (less than five symptoms) that hasn’t improved with lifestyle changes or therapy
Is a statistical measure used to evaluate the effectiveness of a healthcare intervention.
It represents the average number of patients who need to be treated to prevent one additional bad outcome (e.g., death, stroke, heart attack).
NNT (Number Needed to Treat)
Why does NNT matter?
Lower NNT: A lower NNT is better because it means the treatment is more effective. For example, if the NNT is 2, it means you only need to treat 2 people for 1 person to benefit.
Higher NNT: A higher NNT means the treatment is less effective. For example, if the NNT is 20, you need to treat 20 people for 1 person to benefit.
What is the NNT for antidepressants?
The NNT for antidepressants is about 5-7, meaning that for every 5-7 patients treated, one will benefit
Currently considered the best option for treating depression
SSRIs (Selective Serotonin Reuptake Inhibitors)
Where are TCAs used?
Depression: Effective for major depressive disorder.
Chronic Pain: Used in low doses to treat chronic pain conditions.
Migraine Prevention: Helps prevent migraines.
Anxiety Disorders: Sometimes used for generalized anxiety disorder and panic attacks
Are a class of medications primarily used to treat depression.
They were among the first antidepressants developed and are named for their chemical structure, which includes three rings of atoms
Tricyclic Antidepressants? (TCAs)
How long does it usually take to wean off antidepressants?
Antidepressants should be gradually reduced over about four weeks to avoid discontinuation effects, such as anxiety and panic.
Unpleasant symptoms that can occur if you stop taking antidepressants too quickly.
Ex. anxiety, panic
Discontinuation Effects
