Depression

Question 1

What are the core symptoms of depression?

Answer 1

Persistent low mood for two weeks
Anhedonia
Lack of energy

Question 2

Give some somatic symptoms of depression

Answer 2

Early morning wakening 
Reduced appetite 
Weight loss
Psychomotor retardation 
Loss of libido

Question 3

Give some examples of depressive cognitions

Answer 3

Low self esteem 
Guilt and self blame 
Hypochondrial thoughts
Poor concentration or attention
Suicidal thoughts

Question 4

How is depression diagnosed?

Answer 4

Mild = 2 core + 2 other symptoms
Moderate = 2 core + 3/4 other symptoms
Severe = 3 core + at least 4 other symptoms
All have to be present for at least 2 weeks

Question 5

What are some risk factors for depression?

Answer 5

Female
Past history of mental illness
Concurrent chronic illness/pain 
Ethnicity
Genetic

Question 6

What are some predisposing factors for depression?

Answer 6

Stressful life events

Prolonged adversity e.g. marriage difficulties, problems at work

Question 7

What investigations would you do for someone presenting with depression?

Answer 7

FBC, TFTs, U&Es, CRP, LFTs

CT/MRI if indicated to rule out an organic cause

Question 8

What is the management for someone with depression?

Answer 8

1st line = non-pharmacological. 6-8 session intervention such as CBT
2nd line = medication

Question 9

What are the medication options for someone with depression?

Answer 9

1 = SSRIs 
2 = SNRIs 
3 = TCSs 
4 = MAOIs

Question 10

What would be the indication to start medication in someone with depression?

Answer 10

Moderate to severe depression

Question 11

Give some SSRI side effects

Answer 11

Nausea and vomiting
Loss of appetite
Abdominal pain 
Insomnia 
Sweating
Fatigue

Question 12

How do SSRIs work?

Answer 12

Block re-uptake of 5-HT, therefore increasing serotonin levels in the synaptic space to bind to postsynaptic receptors

Question 13

Give some examples of SSRIs

Answer 13

Sertraline
Citalopram
Paroxetine
Fluoxetine

Question 14

How do SNRIs work?

Answer 14

Prevent the re-uptake of noradrenaline and serotonin

Question 15

Give some examples of SNRIs

Answer 15

Venlafaxine

Duloxetine

Question 16

Give some side effects of SNRIs

Answer 16

Nausea
Dry mouth 
Headache 
Dizziness
Sexual dysfunction

Question 17

How do TCAs work?

Answer 17

Inhibit the re-uptake of noradrenaline and serotonin in the synaptic cleft

Question 18

Give some side effects of TCAs

Answer 18

Anticholinergic side effects 
Drowsiness
Tachycardia 
Hypotension
Prolong the QT and PR interval 
Weight gain 
Rashes

Question 19

Give some anticholinergic side effects

Answer 19

Dry mouth 
Urinary retention
Constipation 
Blurred vision and dilated pupils
Increased body temperature

Question 20

Give some examples of TCAs

Answer 20

Amitriptyline
Dosulepin
Clomipramine
Lofepramine

Question 21

How do NASSAs work?

Answer 21

Noradrenergic and specific serotenergic antidepressants act to prevent the reuptake of noradrenaline, as well as being an alpha1 and alpha2 blocker

Question 22

Give some side effects of NASSAs

Answer 22

Weight gain
Increased appetite
Sedation
Dry mouth

Question 23

Give an example of a NASSA

Answer 23

Mirtazapine

Question 24

How do MAOIs work?

Answer 24

Act to inhibit the action of monoamine oxidase enzymes which prevents the breakdown of monoamine neurotransmitters

Question 25

When would you use ECT to treat depression?

Answer 25

Depression which refuses to respond to medication. It seems to be particularly useful in treating patients who have the following factors.

• Psychomotor retardation
• Early-morning wakening
• Psychotic features
• Weight loss