123 - Depression Flashcards
What are the core symptoms of depression?
Low mood Loss of interest Reduced energy Tiredness - after minimal effort More than 2 weeks
What other symptoms does depression have/
Irritability Lack of concentration Loss of pleasure Trouble sleeping Feeling of hopelessness Reduced self-esteem Loss of appetite
What are the ‘somatic’ / biological symptoms of depression?
Early morning wakening Weight loss / loss of appetite Anhedonia Loss of libido Worse in morning Loss of emotional activity Psychomotor retardation
What is depression associated with/
Anxiety
Disorders of experience
OCD
Psychotic symptoms
What are the stages of managing depression?
Screening - primary care
Recognised depression - mild/moderate - CCBT?
Further investigations - + antidepressant
Complex + severe - Refer to mental health services
What is the basis of antidepressants?
The monoamine hypothesis - depression is due to a lack of transmitters of serotonin, noradernaline or dopamine.
- so antidepressants act to inhibit reuptake/breakdown of these neurotransmitters
What are the classes of antidepressants?
SSRI - Selective Serotonin Reuptake Inhibitor
MAOI - Monoamine oxidase inhibitors
TCAs - Tricyclic antidepressants
Others - receptor blockers, reuptake inhibitors
How do SSRIs work?
Inhibit serotonin reuptake
eg. Citalopram, Fluoxetine, Paroxetine, Sertraline
- Side effects: N+V, GI disterbences + bleeding (avoid NSAIDS), anorexia, insomnia, QT prolongation, Serotonin syndrome, Hyponatraemia.
How do MAOIs work?
Mono amine oxidase inhibitors - Inhibit the enzyme MOA which breaks down the compondents of the neurotransmitters, stopping them being made and released.
eg. Moclobemide (selective to MAO-A), Phenelzine, Isocarboxazid, Tranylcypromine.
Cheese reaction!
- Side effects: Postural hypotension, Atropine like effects, weight gain, CNS stimulation..
How do TCA’s work?
Transcyclic antidepressants
Inhibit reuptake by competitively binding to pre-synaptic neurone.
eg. Amitriptyline, Imipramine, Nortriptyline, Lofepramine.
Side effects: Sedation, confusion, motor uncoordination Weight gain Tachycardia - arrthymias Atropine-like effects
What are atropine like effects?
Anatgonist of muscarinic receptors - counters the parasympathetic NS so: Blurred vision/dilated pupils dry mouth - reduced secretions Urinary retention Increased HR
How do receptor blocker antidepressants work?
eg. Mirtazapine - enhances release of noradrenaline and serotonin.
eg. Trazodone - Blocks reuptake of serotonin, and blocks serotonin receptors
How do non-selective reuptake inhibitors work/
Eg. Venlafaxine - serotonin reuptake inhibitor
Duloxetine - Inhibits noradrenaline and serotonin.
What do benzodiazepines work?
Hypnotics - help with insomnia
Anxiolytics - Help anxiety
Agonist of GABAa - increases inhibitory neurotransmission - sedation + reduce anxiety
Examples of benzodiazapines?
Hypnotics:
Temazepam
Nitrazepam
Z-related
Anxiolytics: Diazepam Chlordiazepoxide Lorazepam Oxazepam
