Mood disorders Flashcards
What are the risk factors of depression?
- Age
- Personal or family history
- Postnatal status
- Medication
What medications are known to potentially cause depression?
- Corticosteroids
- Propranalol
- Interferon
- Oral contraceptive
What are the 2 screening questions asked when diagnosing depression?
- During the last month, have you felt down, depressed or hopeless?
- During the last month, have you felt bothered by having little interest or pleasure in doing things?
What are the 2 main grading scales used to assess depression?
=> HAD Scale
0-7 normal
8-10 borderline
11 + case
=> PHQ-9 Scale 0-4 normal 5-9 mild 10-14 moderate 15-19 moderately severe 20-24 severe
What is the DSM-IV criteria?
Symptoms must be present everyday or nearly everyday with no significant changes throughout the day, for over 2 weeks and represent a change in normal personality without alcohol/drugs, medical disorders or bereavement
=> At least 2 core symptoms:
- Depressed mood for most of the day
- Anhedonia
- Fatigue
=> At least 2 typical symptoms:
- Poor appetite with marked weight loss
- Disrupted sleep
- Psychomotor retardation
- Decreased libido
- Evidence of reduced ability to concentrate
- Feelings of worthlessness
- Recurrent thoughts of death, suicide ideation or suicide attempts
What is the pathophysiology of Depression?
=> Monoamine Deficiency Theory:
- Decrease in levels of Serotonin, NA, and Dopamine
What is the management of Depression?
- Psychotherapy
- Antidepressants
- ECT (Electroconvulsive Therapy)
=> Antidepressants only considered when:
- Past history of moderate or severe depression
- Initial presentation of sub -threshold depressive symptoms for a long period of time
- Sub-threshold depressive symptoms or mild depression that persists with intervention
- Chronic physical health problems + complication caused by mild depression
=> Antidepressants protocol:
- SSRIs first line, and usually second line too
- TCAs if SSRIs not working
- If SSRIs not working in MAJOR depression, give Venlaxafine or Metrazapine
SSRIs - Examples, MOA, adverse affects and when to use?
- Citalopram, Fluoxetine, Sertraline, Escitalopram
- Considered first line for moderate to severe depression, and in mild depression if psychological treatment fall
- MOA is inhibition of seratonin reuptake transporters on pre-synaptic cleft
- Adverse affects include GI upset, weight disturbance and possible suicidal thoughts
TCAs - Examples, MOA, adverse affects and when to use?
- Amitriptyline, Lofeperamine
- Second line treatment for mediate to severe depression if SSRIs ineffective
- MOA is inhibitor of Serotonin and NA reuptake
- Many adverse affects as TCAs target wide range of receptors
- Dry mouth, blurred vision, constipation, urinary retention
When are Venlafaxiine and Mirtazapine used?
- Option for MAJOR depression when SSRIs not effective
- MOA of Venlafaxine - Seratonin and NA reuptake inhibitor
- MOA of Mirtazapine - Antagonist of inhibitory pre-synaptic a receptors
=> Adverse affects include GI upset and suicidal thoughts
They are Seratonin Noradrenaline Reuptake Inhibitors (SNRIs)
What are the protocols when switching antidepressants?
=> When switching from one SSRI to another:
- 1st SSRI should be withdrawn before next one started
=> Fluxotine to another SSRI:
- Withdraw and leave a 4-7 day gap
=> Switching to Venlafaxine:
- Cross taper
What are the categories of depression?
=> Mild depression:
- 2 core symptoms
- 2 typical symptoms
=> Moderate depression:
- 2 core symptoms
- 3+ typical symptoms
=> Severe depression:
- 3 core symptoms
- 4+ typical symptoms
