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Depression Flashcards

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1
Q

What system in the brain is involved in depression?

A

Aversive system
-it promotes survival in event of stress

loss event- depression
threat event- anxiety

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2
Q

what mediates the aversive system?

A

serotonin

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3
Q

what system in the brian is involved in mania?

A

Appetitive system
-promotes seeking behaviours

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4
Q

what mediates the appetitive system?

A

dopamine

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5
Q

what structure in brain is reduced in depression?

A

hippocampal volume reduced

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6
Q

how is depression diagnosed?

A

Depressive episodes should last at least 2 weeks (with no hypomanic or manic symptoms)

At least 2 of the following must be present:
-Depressed mood (to a degree that is abnormal for the individual, present for most of day and almost every day, uninfluenced by circumstances, and for at least 2 weeks)
-Loss of interest or pleasure in activities that are normally pleasurable
-Decreased energy or increased fatigue

PLUS at least 4 of:
-loss of confidence or self esteem
-unreasonable guilt
-suicidal behaviours
-complaints of diminished ability to concentrate
-agitation or retardation
-sleep disturbance of any type
-change in appetite

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7
Q

classifications used for depression?

A

ICD10/11
DSM5

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8
Q

what can be used to assess severity of depression?

A

-HRSD
-MADRS

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9
Q

Subtypes of depression?

A

-psychotic depression
-Cotard’s syndrome
-Somatic syndrome
-Atypical depression
-Late onset depression

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10
Q

‘I cant eat because my bowels have turned to durst’
-what subtype

A

Cotard’s

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11
Q

-weight loss, lack of appetite
-depression worse in morning
-waking in morning 2 hours before usual time
-loss of libido
-loss of interest of pleasure in activities that normally enjoy
-lack of emotional reaction to things they would normally react to

what subtype?

A

Somatic syndrome

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12
Q
  • Mood reactivity (that is, mood brightens in response to actual or potential positive events)
    • Significant weight gain or increase in appetite
    • Hypersomnia
    • Leaden paralysis (heavy, leaden feelings in arms or legs)
    • Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment

what subtype?

A

Atypical depression

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13
Q

Depression occuring for first time in later life
-what subtype?

A

late onset depression

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14
Q

Occasionally paranoid, typically ‘mood-congrent’ or hypochondiacal
what subtype?

A

Psychotic depression

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15
Q

what is considered mild depression?

A

2 key symptoms and
4 symptoms

Key symptoms= low mood, fatigue + anhedonia

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16
Q

what is considered moderate depression?

A

2 key symptoms
5-6 symptoms

key symptoms= low mood, fatigue + anhedoni

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17
Q

what is considered severe depression?

A

3 key symptoms (fatigue, low mood + anhedonia)
>7 symptoms

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18
Q

spontaneously resolving brief depressive episode following childbirth (50% of women)
-what subtype

A

post partum depression

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19
Q

recurrent depression in winter months
-what is this + what is treatment?

A

seasonal depression
-treat with bright light therapy

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20
Q

what is the monoamine hypothesis?

A

Depression is thought to be related to monoamine deficiency
-so medications which increase monoamine activity reduce depressive symptoms

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21
Q

what are examples of monoamines?

A

-Serotonin (5-HT)
-Dopamine
-Noradrenaline

22
Q

what role does stress play in depression?

A

Stress releases cortisol
-Chronic stress can cause cortisol dysregulation

Excess cortisol may cause depression through:
-neuronal damage (low hippocampal volume)
-release of proinflammatory cytokines

23
Q

what are the mofa of antidepressants?

A

Increase monoamine activity by two main mechanisms:
Reuptake inhibition- Keep monoamine in synaptic cleft

Monoamine oxidase inhibitors- Prevent removal of monoamine from presynaptic neuron

24
Q

examples of tricyclic antidepressants?

A

-amitriptyline
-Imipramine

25
Q

MofA tricyclic antidepressants?

A

inhibit the reuptake of serotonin + noradrenaline (keeping monoamines in synaptic cleft)

Monoamines= serotonin, dopamine and noradrenaline

26
Q

SE of tricyclic antidepressants?

A

-QT prolongations
-seizures
-anticholinergic

27
Q

examples of SSRIs?

A

-sertraline
-citalopram

28
Q

mechanism of action SSRIs?

A

Inhibit reuptake of serotonin in the monoamine synaptic cleft

examples of monoamines= serotonin, dopamine and noradrenaline

29
Q

SE of SSRIs?

A

-Self harm risk
-sexual dysfunction
-nausea/ tremor/ headache

30
Q

examples of SNRIs?

A

-venlafaxine
-Duloxetine

31
Q

mechanism of action of SNRI?

A

Seretoning and noradrenaline reuptake inhibitors (keeping monoamines in synaptic cleft)

Monoamine= noradrenaline, serotonin and dopamine

32
Q

mofa- monoamine oxidase inhibitors?

A

Prevent removal of monoamine from presynaptic neurone

+ also break down tyramine

33
Q

examples of reversible + irreversible monoamine oxidase inhibitors?

A

irreversible= phenylzine

reversible= moblecamide

34
Q

why can people on monoamine oxidase inhibitors not eat cheese, beer or wine?

A

-because monoamine oxidase inhibitors break down tyramine

cheese, wine + beer contain tyramine

If someone on monoamine oxidase inhibitor eats something with tyrosine in it they can have a hypertensive crisis

35
Q

more likely to have a hypertensive crisis with phenylzine or moblecamide?

A

more likely with phenylzine because it is irreversible

Moblecamide= reversible monoamine oxidase inhibitor

36
Q

example of atypical antidepressant?

A

Mirtazapine

37
Q

mofa atypical antidepressants (mirtazapine)?

A

Mixed receptor effects:
Alpha-2
5-HT2
AND
5-HT3

38
Q

when would an atypical antidepressant be used?

A

after a trial of SSRIs

-especially useful if patient has had trouble sleeping

39
Q

what is the diagnosis?

A

serotonin syndrome

40
Q

what causes serotonin syndrome?

A

Caused by excess of serotonin in synaptic cleft

Most often caused by combination of SSRI and MAOI
-St Johns wort and SSRI may cause this

41
Q

How does serotonin syndrome present?

A

Neuromuscular excitation- hyperreflexia, clonus, myoclonus

Altered mental status- delirium, agitation, insomnia

Autonomic dysregulation- tachycardia, high temperature, shivering, sweating and diarrhoea

42
Q

what can a prolonged fever for serotonin syndrome lead to?

A

-rhabdomyolysis
-metabolic acidosis
-renal failure
-DIC

43
Q

treatment of serotonin syndrome?

A

-benzodiazepines for agitation
-if severe ventilation and sedation

May use cyproheptadine (seretonin receptor antagonist) however little evidence

44
Q

treatment mild depression?

A

no treatment, watchful waiting and assessing again in 2 weeks

2 key symptoms (fatigue, low mood + anhedonia)
4 other symptoms

45
Q

treatment of moderate/ severe depression?

A

CBT

1st= SSRI (if no benefit in 6 weeks change) e.g. sertraline, escitalopram, fluoxetine
2nd= switch SSRI
3rd= consider another class of antidepressant e.g. SNRI venlafazine, tricyclic antidepressant (amytriptyline) or an MAOI (phenyzine/ meblocamide)

Moderate= 2 key symptoms (fatigue, low mood + anhedonia) + 5/6 other symptoms

Severe= 3 key symptoms + >7 symptoms

46
Q

is sertraline or fluoxetine preferred in children/ young people?

A

fluoxetine

47
Q

treatment is psychotic depression?

A

+ antipsychotic

48
Q

treatment if life threatening or rapid response needed?

A

ECT

49
Q

what antidepressant when used with an NSAID risks GI bleed?

A

SSRI + NSAID risk GI bleed
-and so warrant a PPI

50
Q

how should SSRIs be stopped?

A

-gradually over 4 weeks

51
Q

what type of antidepressant can cause hyponotraemia?

A

SSRI

52
Q

can you take triptans and SSRIs together?

A

No- avoid triptans when on SSRI as they can lead to serotonin syndrome

psych (18 decks)

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